Abnormal (Dysfunctional) Uterine Bleeding Differential Diagnoses

Updated: Mar 29, 2022
  • Author: Thomas Michael Price, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Diagnostic Considerations

Important considerations

Patients with chronic anovulation and recurrent bouts of abnormal uterine bleeding (AUB) are at increased risk for endometrial hyperplasia and malignancy. Failure to perform a proper evaluation of the endometrium in such patients can be disastrous. Endometrial sampling can be accomplished easily in the office, with minimal requirements for sedation.

Iatrogenically induced uterine injury from aggressive curettage might lead to intrauterine synechiae (Asherman syndrome). Affected patients might be rendered infertile or placed at high risk for spontaneous abortion in the future. For this reason, always consider medical management of AUB prior to surgical intervention.

Other conditions to be considered

Other conditions to be considered in patients with AUB include the following:

  • Adenomyosis

  • Endometrial polyps

  • Submucous leiomyomata (fibroids)

  • Surface lesions of the genital tract

  • Uterine sarcoma

Various coagulopathies to consider include the following:

  • Metabolic conditions associated with reduced estrogen metabolism

  • Chronic hepatic disease

  • Chronic renal failure

  • Congestive heart failure

Other pregnancy-related conditions to consider include the following:

  • Ectopic pregnancy

  • Iatrogenic causes

  • Adrenal steroids

  • Anticoagulants

  • Aspirin

  • Estrogen replacement therapy

  • Ginseng use

  • Intrauterine devices (IUDs)

  • Progestins

  • Psychotropic medications

  • Steroid contraceptives

  • Tranquilizers affecting neurotransmission

Differential Diagnoses