Differential Diagnosis of Abnormal Bleeding

Pregnancy
Ectopic pregnancy
Trophoblastic disease
Abnormal intrauterine pregnancy
Anovulatory
Transient anovulation
Polycystic ovary syndrome
Androgen disorder
Ovarian tumor
Adrenal tumor
Thyroid disorder
Ovulatory: Menorrhagia
Idiopathic
Endometrial polyp
Submucous leiomyoma
Coagulopathy (yon Willebrand’s disease, iatrogenic
cause, hematologic malignancies) Intrauterine device
Ovulatory: Not Cycle Related
Injury
Intravaginal foreign body
Endometritis
Cervicitis
Cancers of endometrium, cervix, vagina, or vulva latrogenic secondary to sex steroid use (eg, oral contraceptive)
Nongenital tract: bladder, kidney, colon, or rectum

Terminology of Abnormal Vaginal Bleeding Ovulatory

Menorrhagia/hypermenorrhea–heavy flow (>80 mL), longer flow (>7 days), or both
Intermenstrual bleeding–bleeding between otherwise-normal menses
Midcycle bleeding–bleeding at time of expected ovulation
Premenstrual spotting–light bleeding preceding regular menses
Polymenorrhea–periods too close together (<21 days)
Anovulatory
Metrorrhagia–irregular bleeding at frequent intervals
Menometrorrhagia–irregular heavy bleeding
Oligomenorrhea–bleeding at intervals of >40 days
Amenorrhea–no bleeding for at least 90 days
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