Table 2.

Differential Diagnosis of Abnormal Vaginal Bleeding in the Adolescent Girl

Abnormal uterine bleedingCervical problems
Pregnancy-related complications Cervicitis (including cystic fibrosis) PolypHemangiomaCarcinoma or sarcoma
 Threatened abortion
 Spontaneous, incomplete, or missed abortion
 Ectopic pregnancy
 Gestational trophoblastic diseaseUterine 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 hyperthyroidismEndometriosis
 Adrenal diseaseTrauma
 HyperprolactinemiaForeign body (eg, retained tampon)
 PCOSSystemic diseases
 Primary ovarian insufficiency Diabetes mellitus
Vaginal abnormalities Renal disease
 Carcinoma or sarcoma Systemic lupus erythematosus
 LacerationMedications
 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.