Differential diagnosis of abnormal uterine bleeding

• pregnancy and pregnancy related conditions
  • abruptio placenta, placenta praevia
  • ectopic pregnancy
  • miscarriage
  • trophoblastic disease
• polyp – endometrial and endocervical
• adenomyosis
• leiomyoma
• hyperplasia
• malignancy – endometrial cancer, cervical cancer, uterine sarcoma
• ovulatory dysfunction;
  • polycystic ovarian syndrome (PCOS)
  • hyperprolactinaemia
  • hypothyroidism
  • mental stress
  • obesity
  • anorexia
  • weight loss or extreme exercise such as that associated with elite athletic training
  • extremes of reproductive age: adolescence and the menopause transition
• coagulopathy
  • Von Willebrand disease
  • anticoagulant and antiplatelet therapy
• endometrial
  • endometriosis
  • endometritis
• iatrogenic
  • antidepressants (selective serotonin reuptake inhibitors and tricyclics)
  • hormonal contraceptives
  • tamoxifen
  • antipsychotics (first generation and risperidone)
  • corticosteroids
  • herbs: ginseng, chaste berry, danshen
• other causes
  • arteriovenous malformations
  • endometrial pseudoaneurysms
  • myometrial hypertrophy (1,2,3)

References:

1. Munro MG et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13
2. Whitaker L, Critchley HOD. Abnormal uterine bleeding. Best Practice & Research Clinical Obstetrics & Gynaecology. 2016;34:54-65.
3. Sweet MG et al. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012;85(1):35-43.