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Evaluation and differential diagnosis of abnormal uterine bleeding (AUB)

in nonpregnant reproductive-age women

Other Differential diagnosis

Bleeding associated
Evaluation
pattern clinical Common Less common
features etiologies etiologies

Regular menses Enlarged uterus Uterine leiomyoma   - Pelvic

that are heavy on examination, ultrasound
or prolonged discrete masses
- Saline infusion
may be noted
sonography or
hysteroscopy (if
intracavitary
pathology is
suspected)

- Dysmenorrhea Adenomyosis   Pelvic

ultrasound
- Enlarged,
boggy uterus on
examination

- Family history Bleeding disorder   Testing for

of bleeding bleeding
disorder disorder

- Symptoms of
bleeding
diathesis

- Anticoagulant
therapy

Risk factors for   Endometrial Endometrial

uterine carcinoma or sampling
malignancy uterine sarcoma

Regular menses   Endometrial polyp   - Pelvic

with ultrasound
intermenstrual
- Saline infusion
bleeding
sonography or
hysteroscopy (if
available)
 Risk factors for   Endometrial Endometrial
uterine carcinoma or sampling
malignancy uterine sarcoma

Recent history   Chronic Endometrial

of uterine or endometritis sampling
cervical
procedure or
childbirth,
particularly if
infection was
present

Irregular   Ovulatory    
bleeding, may dysfunction:
be more or less
Hirsutism, acne, PCOS   Total
frequent than
and/or obesity testosterone
normal menses
and/or other
and volume and
androgens (may
duration may
not be
vary
increased in all
women with
PCOS)

Galactorrhea Hyperprolactinemia   Prolactin

- Recent weight Thyroid disease   Thyroid function

gain or loss tests

- Heat or cold
intolerance

- Family history
of thyroid
dysfunction

Risk factors for   Endometrial  Endometrial

uterine carcinoma or sampling
malignancy uterine sarcoma

Secondary History of Ovulatory   Refer to

amenorrhea irregular dysfunction ovulatory
bleeding dysfunction
above

Poor nutrition Hypothalamic   - Follicle-

or intense amenorrhea stimulating
exercise hormone
- Luteinizing
hormone

- Estradiol

Hot flushes Premature ovarian   Follicle-

insufficiency stimulating
 hormone

Recent history   Cervical stenosis On pelvic

of uterine or examination,
cervical instrument
procedure or cannot be
childbirth, passed through
particularly if internal cervical
infection was os
present (menses
  Intrauterine Hysteroscopy
may present,
adhesions
but abnormally
(Asherman
light or brief)
syndrome)

Irregular or   Iatrogenic AUB    

heavy bleeding
in a
patient using
hormonal
contraceptives
or with an
intrauterine
device

Other uncommon etiologies of AUB include a uterine arteriovenous malformation or

endometriosis.

PCOS: polycystic ovarian syndrome.

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