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Dysfunctional uterine bleeding - Diagnosis
Last reviewed: 04.07.2025
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The diagnosis of "dysfunctional uterine bleeding" is a "diagnosis of exclusion". During puberty, first of all, it is necessary to exclude blood diseases accompanied by disorders of the coagulation and anticoagulation systems of the blood; diseases of the cardiovascular system; diseases of the hepatobiliary system; tuberculosis; pathology of the thyroid gland and adrenal glands.
In reproductive age, uterine bleeding may be a manifestation of a disrupted uterine and ectopic pregnancy, inflammatory lesions of the female reproductive system with gonorrhea and tuberculosis, endometriosis, fibroids, hormonally active ovarian tumors, malignant tumors of the cervix and, less commonly, the body of the uterus.
In the premenopausal period, dysfunctional uterine bleeding must be differentiated from benign and malignant tumors of the uterus and appendages.
In addition, it is necessary to exclude pathological conditions that are clinically manifested by vaginal bleeding: urethral polyps, colpitis, vaginal tumors.
The main diagnostic method to date remains separate curettage of the walls of the cervical canal and the uterine cavity with subsequent histological examination of the removed tissue. This manipulation simultaneously serves therapeutic purposes, since it can be used to quickly stop bleeding. Endometrial curettage is usually performed under hysteroscopy control, which significantly increases its diagnostic value, ensures complete removal of the endometrium, helps to identify endometrial polyposis and submucous nodes of uterine fibroids.
Histological examination of the removed endometrium helps to clarify the pathogenetic variant of dysfunctional uterine bleeding. Endometrium in a state of proliferation, glandular and glandular-cystic hyperplasia indicates anovulation, with the active form of glandular hyperplasia of the endometrium corresponding to the state of acute estrogenia, and the dormant form of glandular hyperplasia - chronic estrogenia. Atypical endometrial hyperplasia is not such a rare finding in anovulatory bleeding, especially in women of the premenopausal period.
Uneven and insufficient secretory transformation of the mucous membrane tissues indicates bleeding caused by corpus luteum insufficiency. With persistence of the corpus luteum, the structure of the endometrium is similar to the structure of the mucous membrane observed in early pregnancy.
In addition to the above-mentioned hysteroscopy, hysterography, gas gynecography, ultrasound, and laparoscopy are used as additional diagnostic methods to help exclude the organic nature of bleeding in practical gynecology.
Hysterography using water-soluble contrast agents, performed on the 5th-7th day after endometrial curettage, helps to identify not only the submucous form of uterine myoma, but also internal endometriosis. Gas gynecography allows to detect the presence of ovarian tumors, the hormonal activity of which can provoke uterine bleeding.
Ultrasound scanning is an extremely informative method, allowing to detect uterine myoma nodes, ovarian tumors. Endometrial pathology can be determined by studying the median uterine echo (M-echo). This method makes it possible to detect endometrial hyperplasia, glandular and glandular-fibrous polyps, adenocarcinoma, submucous uterine myoma.
Auxiliary diagnostic methods include laparoscopy, which can detect ovarian tumors, ovarian sclerocysts, the presence or absence of a mature follicle and corpus luteum.
Such examination methods as functional diagnostic tests (measuring basal temperature, determining the cervical number, colpocytology), immunological methods for determining pregnancy, colposcopy, bacterioscopic and bacteriological studies of discharge from the cervical canal and vagina also find their place in gynecology.
In girls and young women, a coagulogram is required; in adult women, the first step can be limited to monitoring the number of platelets, blood clotting, and prothrombin complex.
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