What diseases can easily be confused with perimenopausal dysfunctional uterine bleeding?

In clinical work, it is not easy to accurately diagnose dysfunctional uterine bleeding, and misdiagnosis of "dysfunctional uterine bleeding" often occurs. Abnormal uterine bleeding can be caused by a variety of diseases.

1. Pregnancy and pregnancy-related diseases

(1) Abortion: When patients have no history of amenorrhea but have irregular, small amounts of vaginal bleeding, especially those in the perimenopausal period, it is easy to be misdiagnosed as dysfunctional uterine bleeding.

(2) Ectopic pregnancy: Some patients with ectopic pregnancy have no history of amenorrhea and the main symptom is irregular vaginal bleeding. Some may also present with heavy vaginal bleeding. If estrogen-progestin treatment is given for "dysfunctional uterine bleeding", it can often lead to serious consequences and may cause tubal pregnancy rupture.

(3) Trophoblastic disease: The possibility of pregnancy may be overlooked in perimenopausal patients with hydatidiform mole, and choriocarcinoma patients with no history of hydatidiform mole may also be misdiagnosed with dysfunctional uterine bleeding, delaying the diagnosis.

2. Reproductive organ tumors

(1) Uterine fibroids: small submucosal fibroids may be misdiagnosed in perimenopausal patients with irregular vaginal bleeding. It should be understood that when the uterus is basically normal in size, there is still the possibility of organic disease. If treatment for dysfunctional uterine bleeding is ineffective, the diagnosis should be further confirmed.

(2) Malignant tumors of the cervix and uterus: For example, endometrial cancer often presents irregular vaginal bleeding as the main symptom. If curettage is not performed in time, it may be misdiagnosed as dysfunctional uterine bleeding and treatment may be delayed.

(3) Functional ovarian tumors: such as ovarian granulosa cell tumors and thecomas, can cause excessive proliferation of the endometrium due to the effect of estrogen secreted by the tumor. If only endometrial lesions are treated, the diagnosis of ovarian tumors will be delayed.

3. Other common organic diseases of the genitals include endometriosis, adenomyosis, pelvic inflammatory disease, and pelvic tuberculosis. Especially in the early stages of endometrial tuberculosis, irregular vaginal bleeding caused by endometrial polyps and intrauterine contraceptive devices are often confused with dysfunctional uterine bleeding.

4. Systemic diseases including acute infection, thrombocytopenia, aplastic anemia, leukemia, cirrhosis, and anticoagulant therapy may be mistaken for "dysfunctional uterine bleeding" for a period of time.