eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology
Dysfunctional Uterine Bleeding: Differential Diagnoses & Workup
Updated: Jun 9, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Advanced liver disease
Anabolic steroids
Cervical cancer
Cervicitis
Cervical polyps
Cirrhosis
Endometrial cancer
Leiomyoma
Leukemia
Postcoital bleeding
Salpingitis
Thrombocytopenia
Uterine cancer
Uterine leiomyomas
Vaginal lacerations
Von Willebrand disease
Workup
Laboratory Studies
- A detailed workup for DUB is beyond the scope of the ED, yet several studies are required to ensure hemodynamic stability in patients presenting with vaginal bleeding.
- In the patient with unstable vital signs, perform a CBC with platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), liver function tests (if other signs indicate liver disease), and type and cross-match.
- Pregnancy must be ruled out by urine and/or serum human chorionic gonadotropin, before consideration of any imaging studies or further referral or detailed examination.
- Consider thyroid function tests. FSH, TSH, DHEAS, and prolactin levels should be considered, although these results may not be available from the ED.
Imaging Studies
- Workup by the gynecologist should include pelvic ultrasonography to evaluate for fibroids or other structural lesions that may cause abnormal vaginal bleeding.
- Transvaginal ultrasonography (TVUS): Consider TVUS if the patient may be pregnant or may have anatomic problems or polycystic ovarian syndrome.
- Dilatation and curettage (D&C) can be both therapeutic and diagnostic. It may be the treatment of choice when bleeding is severe, and it allows more extensive sampling of the uterine cavity and also has a higher sensitivity than endometrial biopsy.
- Although mostly an office or intraoperative procedure, hysteroscopy can be used in place of D&C and allows direct visualization of the endometrial cavity with directed biopsy.
Procedures
- Pelvic examination
- Before instituting therapy, many consulting gynecologists perform an endometrial sampling or endometrial biopsy to diagnose intrauterine pathology and to exclude endometrial malignancy.
- Perform endometrial biopsy for the following patients:
- All patients older than 35 years
- Obese patients
- Patients with diabetes mellitus
- Patients with hypertension
- Patients with suspected polycystic ovarian disease
- D&C is indicated in the following situations:
- Consider D&C in patients at high risk for endometrial hyperplasia and carcinoma.
- Consider D&C rather than endometrial biopsy if suspected diagnosis is endometritis, atypical hyperplasia, or carcinoma.
- Perform in patients having heavy, uncontrolled bleeding.
- Perform if histologic examination is required but biopsy is contraindicated.
- Perform if medical curettage fails.
More on Dysfunctional Uterine Bleeding |
| Overview: Dysfunctional Uterine Bleeding |
 Differential Diagnoses & Workup: Dysfunctional Uterine Bleeding |
| Treatment & Medication: Dysfunctional Uterine Bleeding |
| Follow-up: Dysfunctional Uterine Bleeding |
| References |
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References
[Guideline] James AH, Kouides PA, Abdul-Kadir R, Edlund M, Federici AB, Halimeh S, et al. Von Willebrand disease and other bleeding disorders in women: Consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol. May 28 2009;[Medline]. [Full Text].
Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding. JAMA. Apr 14 1993;269(14):1823-8. [Medline].
Herbst A, Mishell D, Stenchever M. Abnormal uterine bleeding. In: Comprehensive Gynecology. 2nd ed. Mosby-Year Book; 1992:1083-1097.
Johnson CA. Making sense of dysfunctional uterine bleeding. Am Fam Physician. Jul 1991;44(1):149-57. [Medline].
Physician's Desk Reference. 50th ed. Medical Economics Books; 1996.
Pritchard JA, MacDonald PC, Gant NF. Complications of pregnancy. In: William's Obstetrics. 19th ed. McGraw-Hill Professional Publishing; 1993:819-820.
Rosenfeld JA. Treatment of menorrhagia due to dysfunctional uterine bleeding. Am Fam Physician. Jan 1996;53(1):165-72. [Medline].
Seamen C, Slovis C. Abnormal vaginal bleeding in the nonpregnant patient. Emerg Med Rep. 1996;17:219-226. [Medline].
Further Reading
Keywords
DUB, abnormal vaginal bleeding, menorrhagia, metrorrhagia, menometrorrhagia, ovulatory DUB, amenorrhea, oligomenorrhea, polycystic ovary disease, hyperandrogenism, hirsutism,obesity, enlarged ovaries, thrombocytopenia, hypothyroidism, hyperthyroidism, liver disease, hypertension, diabetes mellitus, adrenal disorders, vaginal carcinoma, cervical cancer, uterinecancer, ovarian cancer, functional ovarian cysts, cervicitis, endometritis, salpingitis, leiomyomas, vaginal infection, polyps, ectopic pregnancy, hydatidiform mole, blooddyscrasias, excessive weight gain, increased exerciseperformance
