Dysfunctional Uterine Bleeding Differential Diagnoses

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Dysfunctional Uterine Bleeding Differential Diagnoses

Author: Millie A Behera, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG more...
Updated: Sep 29, 2014

Diagnostic Considerations
Important considerations

Patients with chronic anovulation and recurrent bouts of dysfunctional uterine

bleeding (DUB) 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 or 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 DUB prior to surgical intervention.
Other conditions to be considered

Other conditions to be considered in patients with DUB 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
Adnexal Tumors
Cervical Cancer
Cervicitis

Chlamydial Genitourinary Infections

Ectopic Pregnancy
Elective Abortion

Endometrial Carcinoma
Endometriosis
Endometritis

Gestational Trophoblastic Neoplasia

Hyperprolactinemia
Hyperthyroidism
Hypothyroidism

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Ovarian Polycystic Disease

Uterine Cancer
Vaginitis

Workup

Contributor Information and Disclosures

Author
Millie A Behera, MD Assistant Professor (Adjunct), Division of Reproductive Endocrinology and Fertility,
Department of Obstetrics and Gynecology, Duke University Medical Center; Medical Director, Bloom Reproductive
Institute
Millie A Behera, MD is a member of the following medical societies: American College of Obstetricians and
Gynecologists, American Society for Reproductive Medicine, AAGL
Disclosure: Nothing to disclose.

Coauthor(s)
Thomas Michael Price, MD Associate Professor, Division of Reproductive Endocrinology and Infertility,
Department of Obstetrics and Gynecology, Director of Reproductive Endocrinology and Infertility Fellowship
Program, Duke University Medical Center
Thomas Michael Price, MD is a member of the following medical societies: Alpha Omega Alpha, American
College of Obstetricians and Gynecologists, Phi Beta Kappa, Society for Reproductive Investigation, Society for
Reproductive Endocrinology and Infertility, American Society for Reproductive Medicine
Disclosure: Received research grant from: Insigtec Inc<br/>Received consulting fee from Clinical Advisors Group
for consulting; Received consulting fee from MEDA Corp Consulting for consulting; Received consulting fee from
Gerson Lehrman Group Advisor for consulting; Received honoraria from ABOG for board membership.
Specialty Editor Board
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College
of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.

Frances E Casey, MD, MPH Director of Family Planning Services, Department of Obstetrics and Gynecology,
VCU Medical Center
Frances E Casey, MD, MPH is a member of the following medical societies: American College of Obstetricians
and Gynecologists, Association of Reproductive Health Professionals, Society of Family Planning, National
Abortion Federation, Physicians for Reproductive Health
Disclosure: Nothing to disclose.

Chief Editor
Richard Scott Lucidi, MD, FACOG Associate Professor of Reproductive Endocrinology and Infertility,
Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine
Richard Scott Lucidi, MD, FACOG is a member of the following medical societies: American College of
Obstetricians and Gynecologists, American Society for Reproductive Medicine
Disclosure: Nothing to disclose.

Additional Contributors
Anthony Charles Sciscione, DO Professor, Department of Obstetrics and Gynecology, Drexel University College
of Medicine; Director, Maternal and Fetal Medicine, Christiana Care Health System; Director, Delaware Center for
Maternal and Fetal Medicine
Anthony Charles Sciscione, DO is a member of the following medical societies: American College of Obstetricians
and Gynecologists, American Medical Association
Disclosure: Nothing to disclose.

Acknowledgements
The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous
author John T Queenan, Jr, MD, to the development and writing of this article.

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