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.