Abnormal uterine bleeding.

Abnormal uterine bleeding occurs across the entire age spectrum. Pregnancy, infection, birth-control methods, psychogenic causes, organic pathology, endocrine disorders, blood dyscrasias, systemic diseases and dysfunctional uterine bleeding are considered in the differential diagnosis. While the historical questions are similar regardless of age, the diagnostic methods, differential diagnosis and the management plan vary within each age bracket. Pregnancy-related disorders, infection, birth-control methods and psychogenic factors are the most common etiologies in younger women, but endocrine, systemic and hematologic disorders must be considered. In the middle years, irregular bleeding frequently occurs due to perimenopausal ovarian failure. With postmenopausal bleeding, endometrial carcinoma must always be ruled out. Treatment consists of correcting the underlying disorder. If no organic cause is identified, hormonal therapy or more invasive procedures are used.