Cause | Comments/associated clinical features |
Causes of bleeding from the uterus | |
Anovulatory uterine bleeding related to immature HPO axis at the onset of menarche* | Most common cause in adolescents; unpredictable timing of bleeding and variable amounts of flow |
Other causes of ovulatory dysfunction | |
| Hyperandrogenism (acne, hirsutism, clitoromegaly) |
| Weight loss or gain; heat or cold intolerance; fatigue |
| Galactorrhea, vision change, headaches |
| Stress, intense exercise, change in weight (loss or gain) |
| Ovarian enlargement or mass |
| Central obesity, proximal muscle weakness, purplish striae |
| Impaired vision, headache, pituitary hormone deficiencies (eg, fatigue, cold intolerance, decreased appetite) or excess (eg, hyperprolactinemia) |
| Polyuria, polydipsia, nocturia |
| Primary ovarian insufficiency in adolescents can be associated with chromosomal abnormalities (eg, Turner syndrome), thyroid or adrenal abnormalities, and fragile X syndrome¶[1] |
| |
Infection | |
| Fever, mucopurulent discharge, lower abdominal or pelvic pain, pelvic organ tenderness (eg, cervical motion tenderness, adnexal tenderness), inflammation of the genital tract |
| Vague, crampy, lower abdominal pain Intrauterine foreign objects Uterine radiation |
Endometriosis | Cyclic pain with menses that may progress to acyclic pain; bowel symptoms (rectal pain, constipation, painful defecation, rectal bleeding); bladder symptoms (dysuria, urgency, hematuria) |
Bleeding disorders (coagulopathy)*
| Suggested by 1 of the following:[2]
|
Structural uterine problems
| May be identified through imaging or histopathology |
IUD-related bleeding | Intermenstrual: All IUDs Excessive volume: Primarily copper IUD Irregular bleeding: Primarily levonorgestrel IUDs Amenorrhea: Primarily IUDs containing 52 mg levonorgestrel |
Causes of vaginal bleeding from sites other than the uterus | |
Ovary: Cyst, tumor | |
Cervix: Carcinoma, cervicitis, ectropion, hemangioma, polyp | |
Vagina: Carcinoma/sarcoma, foreign body (eg, retained tampon), trauma, vaginitis | |
Vulva: Trauma, sexually transmitted diseases (eg, ulcers), dermatologic conditions | |
Gastrointestinal tract: Hemorrhoids, infectious colitis, inflammatory bowel disease, vascular malformation, rectal prolapse | |
Urinary tract: Urinary tract infection, irritation of the urethral meatus, urethral trauma |
CAH: congenital adrenal hyperplasia; HPO: hypothalamic-pituitary-ovarian; ITP: immune thrombocytopenic purpura; IUD: intrauterine device; PCOS: polycystic ovary syndrome.
* Most common causes in adolescents.
¶ Refer to UpToDate content on primary ovarian insufficiency for additional information.Additional data from:
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