Abnormal Uterine Bleeding

Abnormal uterine bleeding is a common reason for women of all ages to consult their family physicians. Terms used to describe patterns of abnormal uterine bleeding are based on periodicity and quantity of flow . Dysfunctional uterine bleeding (DUB), defined as abnormal uterine bleeding not caused by pelvic pathology, medications, systemic disease or pregnancy, is the most common cause of abnormal uterine bleeding but remains a diagnosis of exclusion.

Terminology Used to Describe Abnormal Uterine Bleeding

Term Definition
Menorrhagia Prolonged or excessive bleeding at regular intervals
Metrorrhagia Irregular, frequent uterine bleeding of varying amounts but not excessive
Menometrorrhagia Prolonged or excessive bleeding at irregular intervals
Polymenorrhea Regular bleeding at intervals of less than 21 days
Oligomenorrhea Bleeding at intervals greater than every 35 days
Amenorrhea No uterine bleeding for at least 6 months
Intermenstrual Uterine bleeding between regular cycles

Differential Diagnosis of Abnormal Uterine Bleeding

  • Complications of pregnancy
  • Intrauterine pregnancy
  • Ectopic pregnancy
  • Spontaneous abortion
  • Gestational trophoblastic disease
  • Placenta previa
  • Placenta previa
  • Infection
  • Cervicitis
  • Endometritis
  • Trauma
  • Laceration, abrasion
  • Foreign body
  • Malignant neoplasm
  • Cervical
  • Endometrial
  • Ovarian
  • Benign pelvic pathology
  • Cervical polyp
  • Endometrial polyp
  • Leiomyoma
  • Adenomyosis
  • Systemic disease
  • Hepatic disease
  • Renal disease
  • Coagulopathy
  • Thrombocytopenia
  • von Willebrand’s disease
  • Leukemia
  • Medications/iatrogenic
  • Intrauterine device
  • Hormones (oral contraceptives, estrogen, progesterone)
  • Anovulatory cycles
  • Hypothyroidism
  • Hyperprolactinemia
  • Cushing’s disease
  • Polycystic ovarian syndrome
  • Adrenal dysfunction/tumor
  • Stress (emotional, excessive exercise)
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