Abnormal Uterine Bleeding Differential Diagnosis
Abnormal uterine bleeding (AUB) refers to any bleeding from the uterus that deviates from the normal menstrual pattern. The differential diagnosis for AUB is broad and can be categorized based on the likelihood and potential impact of missing the diagnosis.
- Single Most Likely Diagnosis
- Hormonal Imbalance: This is often the most common cause of AUB, particularly in women of reproductive age. Hormonal fluctuations can lead to irregular ovulation, affecting the normal menstrual cycle and resulting in abnormal bleeding patterns.
- Other Likely Diagnoses
- Uterine Fibroids: These are common benign tumors that can cause heavy or irregular menstrual bleeding due to their location, size, and effect on the uterine lining.
- Endometrial Hyperplasia: This condition involves the thickening of the uterine lining, often due to hormonal imbalance, and can lead to abnormal uterine bleeding.
- Polycystic Ovary Syndrome (PCOS): A hormonal disorder that can cause irregular periods and abnormal uterine bleeding among other symptoms.
- Intrauterine Devices (IUDs): Certain types of IUDs, especially those that release hormones, can cause changes in menstrual bleeding patterns.
- 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.
- Cervical Cancer: Abnormal vaginal bleeding can be a symptom of cervical cancer, making it essential to consider in the differential diagnosis.
- Pregnancy-Related Complications: Ectopic pregnancy or a miscarriage can cause abnormal uterine bleeding and are medical emergencies.
- 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.
- Bleeding Disorders: Such as von Willebrand disease, which can affect clotting and lead to heavy menstrual bleeding.
- Thyroid Disorders: Both hyperthyroidism and hypothyroidism can affect menstrual regularity and bleeding.
Each of these diagnoses has a different set of risk factors, symptoms, and diagnostic approaches. A thorough medical history, physical examination, and appropriate diagnostic tests are essential for determining the underlying cause of abnormal uterine bleeding.