Differential Diagnosis for Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) can be caused by a variety of factors, ranging from hormonal imbalances to structural anomalies of the uterus. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Hormonal Imbalance: This is often the most common cause of abnormal uterine bleeding, particularly in women of reproductive age. Hormonal fluctuations, especially anovulatory cycles, can lead to irregular and unpredictable bleeding patterns. Justification: High prevalence, common presentation in clinical practice.
• Other Likely Diagnoses
  • Uterine Fibroids: These are common benign tumors that can cause heavy, prolonged, or irregular menstrual bleeding. Justification: Common in reproductive-aged women, known to cause AUB.
  • Endometrial Hyperplasia: This condition involves the thickening of the endometrium, which can lead to abnormal bleeding. It's more common in perimenopausal women. Justification: Associated with unopposed estrogen exposure, common in certain age groups.
  • Polycystic Ovary Syndrome (PCOS): A hormonal disorder that can cause irregular periods and abnormal uterine bleeding. Justification: Common endocrine disorder in women of reproductive age, known to disrupt menstrual cycles.
• Do Not Miss Diagnoses
  • Endometrial Cancer: Although less common, it is crucial not to miss this diagnosis, especially in postmenopausal women or those with risk factors. Justification: Potentially life-threatening if not diagnosed and treated early.
  • Pregnancy-Related Complications: Ectopic pregnancy or a miscarriage can present with abnormal uterine bleeding. Justification: Emergency conditions that require immediate attention.
  • Bleeding Disorders: Conditions like von Willebrand disease can cause heavy menstrual bleeding. Justification: Important to diagnose due to potential for significant morbidity.
• Rare Diagnoses
  • Adenomyosis: A condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, leading to heavy or painful periods. Justification: Less common than other causes but can significantly impact quality of life.
  • Uterine Arteriovenous Malformations: Rare vascular anomalies that can cause abnormal uterine bleeding. Justification: Uncommon but can be life-threatening if not recognized and managed appropriately.
  • Thyroid Disorders: Both hyperthyroidism and hypothyroidism can affect menstrual regularity and cause abnormal uterine bleeding. Justification: Less common cause but important to consider due to the availability of effective treatment.

Each of these diagnoses has a different set of risk factors, clinical presentations, and management strategies. A thorough history, physical examination, and appropriate diagnostic tests are essential for determining the underlying cause of abnormal uterine bleeding.