Differential Diagnosis for Abnormal Uterine Bleed and Irregular Menses

To differentiate between abnormal uterine bleeding and irregular menses, it's crucial to understand the underlying causes of each condition. Here's a categorized differential diagnosis to guide the thought process:

• Single Most Likely Diagnosis
  • Anovulatory Cycles: This is often the most common cause of irregular menses, particularly in adolescents and perimenopausal women. Anovulatory cycles occur when the ovaries do not release an egg, leading to irregular and often heavy menstrual bleeding.
• Other Likely Diagnoses
  • Hormonal Imbalance: Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and hyperprolactinemia can lead to hormonal imbalances that cause irregular menses and abnormal uterine bleeding.
  • Uterine Fibroids: These are common benign tumors that can cause heavy, prolonged, or irregular menstrual bleeding.
  • Endometrial Hyperplasia: This condition involves the thickening of the uterine lining, which can lead to abnormal uterine bleeding.
• Do Not Miss Diagnoses
  • Endometrial Cancer: Although less common, endometrial cancer is a critical diagnosis not to miss, as it can present with abnormal uterine bleeding, especially in postmenopausal women.
  • Pregnancy-Related Complications: Ectopic pregnancy or a miscarriage can cause abnormal uterine bleeding and must be considered, especially in women of childbearing age.
  • Bleeding Disorders: Conditions like von Willebrand disease can lead to heavy menstrual bleeding and should not be overlooked.
• 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.
  • Uterine Arteriovenous Malformations: Rare vascular lesions that can cause abnormal uterine bleeding.
  • Systemic Diseases: Certain systemic diseases, such as liver or kidney disease, can affect menstrual regularity and bleeding, though these are less common causes.

Each diagnosis has a unique set of risk factors, symptoms, and diagnostic approaches. A thorough medical history, physical examination, and appropriate diagnostic tests (e.g., ultrasound, endometrial biopsy) are essential for accurately differentiating between abnormal uterine bleeding and irregular menses.