Evaluation and differential diagnosis of abnormal uterine bleeding (AUB) in nonpregnant reproductive-age women

Bleeding pattern	Other associated clinical features	Differential diagnosis		Evaluation
Bleeding pattern	Other associated clinical features	Common etiologies	Less common etiologies	Evaluation
Regular menses that are heavy or prolonged	Enlarged uterus on examination, discrete masses may be noted	Uterine leiomyoma		- Pelvic ultrasound - Saline infusion sonography or hysteroscopy (if intracavitary pathology is suspected)
	- Dysmenorrhea - Enlarged, boggy uterus on examination	Adenomyosis		Pelvic ultrasound
	- Family history of bleeding disorder - Symptoms of bleeding diathesis - Anticoagulant therapy	Bleeding disorder		Testing for bleeding disorder
	Risk factors for uterine malignancy		Endometrial carcinoma or uterine sarcoma	Endometrial sampling
Regular menses with intermenstrual bleeding		Endometrial polyp		- Pelvic ultrasound - Saline infusion sonography or hysteroscopy (if available)
	Risk factors for uterine malignancy		Endometrial carcinoma or uterine sarcoma	Endometrial sampling
	Recent history of uterine or cervical procedure or childbirth, particularly if infection was present		Chronic endometritis	Endometrial sampling
Irregular bleeding, may be more or less frequent than normal menses and volume and duration may vary		Ovulatory dysfunction:
	Hirsutism, acne, and/or obesity	PCOS		Total testosterone and/or other androgens (may not be increased in all women with PCOS)
	Galactorrhea	Hyperprolactinemia		Prolactin
	- Recent weight gain or loss - Heat or cold intolerance - Family history of thyroid dysfunction	Thyroid disease		Thyroid function tests
	Risk factors for uterine malignancy		Endometrial carcinoma or uterine sarcoma	Endometrial sampling
Secondary amenorrhea	History of irregular bleeding	Ovulatory dysfunction		Refer to ovulatory dysfunction above
	Poor nutrition or intense exercise	Hypothalamic amenorrhea		- Follicle-stimulating hormone - Luteinizing hormone - Estradiol
	Hot flushes	Premature ovarian insufficiency		Follicle-stimulating hormone
	Recent history of uterine or cervical procedure or childbirth, particularly if infection was present (menses may present, but abnormally light or brief)		Cervical stenosis	On pelvic examination, instrument cannot be passed through internal cervical os
			Intrauterine adhesions (Asherman syndrome)	Hysteroscopy
Irregular or heavy bleeding in a patient using hormonal contraceptives or with an intrauterine device		Iatrogenic AUB

Other uncommon etiologies of AUB include a uterine arteriovenous malformation or endometriosis.

PCOS: polycystic ovarian syndrome.

Graphic 90595 Version 5.0

خرید پکیج

Evaluation and differential diagnosis of abnormal uterine bleeding (AUB) in nonpregnant reproductive-age women