Uterine Bleeding, Acute Abnormal — DDX of Abnormal Uterine Bleeding — Clinical Pathway: Emergency

Uterine Bleeding, Acute Abnormal Clinical Pathway — Emergency Department

Differential Diagnosis of Post-Pubertal Bleeding

  • Ovulatory dysfunction and coagulopathy are the most common causes
  • 1st year after menarche, 85% of teens have anovulatory cycles
  • AUB and bleeding disorder (BD)
    • 20% of adolescents have BD
    • 30% of those requiring hospitalization have BD
    • Von Willebrand Disease most common
    • Often present at menarche
Abnormal Uterine Bleeding
  • Heavy menstrual bleeding (AUB/HMB)
  • Intermenstrual bleeding (AUB/IMB)
PALM—Structural Causes
  • Polyp (AUB-P)
  • Adenomyosis (AUB-A)
  • Leiomyoma (AUB-L)
    • Submucosal leiomyoma (AUB-LSM)
    • Other leiomyoma (AUB-LO)
  • Malignancy and hyperplasia (AUB-M)
Rare in adolescents
COEIN—Nonstructural Causes
  • Coagulopathy (AUB-C)
  • Ovulatory dysfunction (AUB-O)
  • Endometrial (AUB-E)
  • Iatrogenic (AUB-I)
  • Not yet classified (AUB-N)

Reference

Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women  

Pregnancy Ectopic, other complications
Infection Cervicitis, PID
Trauma Sexual assault, foreign body
Coagulopathy Family history, current diagnosis
Ovulatory Dysfunction Physiologic anovulatory cycles
Thyroid disease
Ovarian failure
Polycystic ovarian disease
Hyperprolactinemia
Endometrial Polyps, tumors (rare in teens)
Medications, Toxins Combined oral contraceptive (COC), Depo-Provera, IUD
Marijuana
Steroids