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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 ConsiderationsImportant 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:

AdenomyosisEndometrial 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

AnticoagulantsAspirin

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

unctional Uterine Bleeding Differential Diagnoses http://emedicine.medscape.com/article/257007-d

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Ovarian Polycystic Disease

Uterine Cancer

Vaginitis

Workup

Contributor Information and Disclosures

Author

Millie A Behera, MDAssistant 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, MDAssociate 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
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, PhDAdjunct 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, MPHDirector 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


Chief Editor

Richard Scott Lucidi, MD, FACOGAssociate 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


Additional Contributors

Anthony Charles Sciscione, DOProfessor, 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


Acknowledgements

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

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