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DIFFERENTIAL DIAGNOSIS OF COMMON GYNECOLOGICAL COMPLAINTS . . . CONT.

ABNORMAL UTERINE BLEEDING

abnormal vaginal bleeding

first trimester

pregnant

2nd and 3rd

  • see obstetric section

intrauterine

extrauterine

• trophoblastic

• ectopic

normal pregnancy

  • implantation bleed

  • abortion

abnormal pregnancy

not pregnant

common causes vary according to adolescent

  • anovulatory

  • exogenous hormone use

  • coagulopathy

reproductive

  • anovulatory

  • exogenous hormone use

  • fibroids

  • cervical and endometrial polyp

  • thyroid dysfunction

Figure 1. Approach to Abnormal Vaginal Bleeding

Gynecological Causes increased bleeding with menses • polyps • adenomyosis • leiomyomata • endometriosis • IUD bleeding following a missed period • ectopic pregnancy • abortion - missed, threatened, inevitable, incomplete, or complete • implantation bleed • trophoblastic disease • placental polyp irregular bleeding • dysfunctional uterine bleeding • polycystic ovarian disease • vulvovaginitis • PID • benign or malignant tumours of vulva, vagina, cervix, or uterus • ovarian malignancy • anovulation (e.g. stress amenorrhea) • oral contraceptive use • polyps postmenopausal bleeding • endometrial ca until proven otherwise • atrophic vaginitis (most common cause) • ovarian malignancy • benign or malignant tumours of vulva, vagina or cervix • withdrawal from exogenous estrogens • atrophic endometrium • endometrial/endocervical polyps • endometrial hyperplasia • trauma • polyps • lichen sclerosis

MCCQE 2000 Review Notes and Lecture Series

Notes

age group premenopause

  • anovulatory

  • fibroid

  • cervical and endometrial polyp

  • thyroid dysfunction

post menopausal

  • endometrial cancer until proven

otherwise

  • other endometrial lesion

  • exogenous hormone use

  • atrophic vaginitis

  • other tumour (vulvar, vaginal,

cervix)

Gynecology 7

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