Consider age of patient presenting:
In girls, (consider the causes for 'older women of reproductive age' but keep them lower down the list)
1. Dysfunctional uterine bleeding (60% of premenopausal women)
a. Anovulatory (no ovulation, no corpus luteum and thus lack progesterone to stabilise endometrium - affects very young girls and perimenopausal women)
b. Ovulatory (Prostaglandin metabolism problems)
2. Pregnancy-related causes
a. Ectopic pregnancy
b. Miscarriage
3. Systemic
a. Coagulopathies
b. Thrombocytopenia
In older women of reproductive age, (also considering the above causes but further down the list)
1. Pelvic pathology
a. Fibroids (Most common pelvic pathology as cause of menorrhagia)
b. Polyps
d. Adenomyosis
e. Pelvic infection
f. Endometrial carcinoma
g. Atrophic vaginitis
2. Endocrine
a. Hypothyroidism
b. PCOS
3. Iatrogenic
a. IUD
b. PoP
c. Anticoagulation
4. Dysfunctional uterine bleeding (60% of premenopausal women)
a. Anovulatory (no ovulation, no corpus luteum and thus lack progesterone to stabilise endometrium - affects very young girls and perimenopausal women)
b. Ovulatory (Prostaglandin metabolism problems)
5. Pregnancy-related causes
a. Ectopic pregnancy
b. Miscarriage
6. Systemic
a. Coagulopathies
b. Thrombocytopenia
In post-menopausal women,
1. Exogenous hormones eg HRT/Mirena (30%)
2. Atrophic endometritis / vaginitis (30%)
3. Endometrial carcinoma (15%) / hyperplasia (5%)
4. Endometrial or cervical polyps (10%)
In girls, (consider the causes for 'older women of reproductive age' but keep them lower down the list)
1. Dysfunctional uterine bleeding (60% of premenopausal women)
a. Anovulatory (no ovulation, no corpus luteum and thus lack progesterone to stabilise endometrium - affects very young girls and perimenopausal women)
b. Ovulatory (Prostaglandin metabolism problems)
2. Pregnancy-related causes
a. Ectopic pregnancy
b. Miscarriage
3. Systemic
a. Coagulopathies
b. Thrombocytopenia
In older women of reproductive age, (also considering the above causes but further down the list)
1. Pelvic pathology
a. Fibroids (Most common pelvic pathology as cause of menorrhagia)
b. Polyps
d. Adenomyosis
e. Pelvic infection
f. Endometrial carcinoma
g. Atrophic vaginitis
2. Endocrine
a. Hypothyroidism
b. PCOS
3. Iatrogenic
a. IUD
b. PoP
c. Anticoagulation
4. Dysfunctional uterine bleeding (60% of premenopausal women)
a. Anovulatory (no ovulation, no corpus luteum and thus lack progesterone to stabilise endometrium - affects very young girls and perimenopausal women)
b. Ovulatory (Prostaglandin metabolism problems)
5. Pregnancy-related causes
a. Ectopic pregnancy
b. Miscarriage
6. Systemic
a. Coagulopathies
b. Thrombocytopenia
In post-menopausal women,
1. Exogenous hormones eg HRT/Mirena (30%)
2. Atrophic endometritis / vaginitis (30%)
3. Endometrial carcinoma (15%) / hyperplasia (5%)
4. Endometrial or cervical polyps (10%)