How to differentiate functional uterine bleeding from reproductive system diseases?

Dysfunctional uterine bleeding refers to abnormal uterine bleeding caused by the neuroendocrine regulation mechanism of the hypothalamus-pituitary-ovarian axis. It is necessary to exclude organic lesions of the internal and external genitalia. Therefore, the diagnosis of functional uterine bleeding must be differentiated from reproductive system diseases to exclude the possibility of these diseases. The differentiation should be made from the following aspects:

(1) Pregnancy-related diseases Abnormal pregnancy or pregnancy complications, such as miscarriage, ectopic pregnancy, trophoblastic disease, postpartum uterine involution, placental retention, placental polyps, etc. The latter have a history of amenorrhea, pregnancy and delivery. Gynecological examination, HCG measurement, B-ultrasound, etc. can help assist in diagnosis.

(2) Tumors Uterine tumors such as myomas (intermuscular and submucosal), cervical cancer, endometrial cancer or sarcoma, choriocarcinoma, ovarian tumors (especially sex cord-stromal tumors that secrete estrogen), and fallopian tube cancer can be differentiated through gynecological examination, B-ultrasound, diagnostic curettage and related special examinations.

(3) General or specific inflammation (tuberculosis, sexually transmitted diseases) Endometritis, uterine tenderness during gynecological examination

(4) Cervical lesions: Chronic cervicitis and cervical cancer are manifested by irregular vaginal bleeding and contact bleeding. Gynecological examination combined with cervical smear and biopsy can help to differentiate them.

(5) Others such as adenomyosis, endometriosis, endometrial polyps, genital tract trauma, foreign bodies, uterine arteriovenous fistula, endometrial hemangioma, etc.