Differential Diagnosis of Abnormal Vaginal Bleeding in the Adolescent Girl
| Abnormal uterine bleeding | Cervical problems |
| Pregnancy-related complications | Cervicitis (including cystic fibrosis) PolypHemangiomaCarcinoma or sarcoma |
| Threatened abortion | |
| Spontaneous, incomplete, or missed abortion | |
| Ectopic pregnancy | |
| Gestational trophoblastic disease | Uterine problems |
| Complications of termination procedures | Submucous myoma |
| Infection | Congenital anomalies |
| Pelvic inflammatory disease | Polyp |
| Endometritis | Carcinoma |
| Cervicitis | Use of intrauterine device |
| Vaginitis | Breakthrough bleeding associated with hormonal contraceptives |
| Bleeding disorders | Ovulation bleeding |
| Thrombocytopenia (eg, idiopathic thrombocytopenic purpura, leukemia, aplastic anemia, hypersplenism, chemotherapy) | Ovarian problems |
| Coagulation disorders (eg, von Willebrand disease, other disorders of platelet function, liver dysfunction, vitamin K deficiency) | Cyst |
| Endocrine disorders | Tumor (benign, malignant) |
| Hypo- or hyperthyroidism | Endometriosis |
| Adrenal disease | Trauma |
| Hyperprolactinemia | Foreign body (eg, retained tampon) |
| PCOS | Systemic diseases |
| Primary ovarian insufficiency | Diabetes mellitus |
| Vaginal abnormalities | Renal disease |
| Carcinoma or sarcoma | Systemic lupus erythematosus |
| Laceration | Medications |
| Hormonal contraceptives | |
| Anticoagulants | |
| Platelet inhibitors | |
| Androgens | |
| Spironolactone | |
| Antipsychotics |
Reprinted with permission from Gray SH, Emans SJ. Abnormal vaginal bleeding in the adolescent. In: Emans SJ, Laufer MR, eds. Emans, Laufer, and Goldstein’s Pediatric and Adolescent Gynecology. 6th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2011:159–167.