A 38-year-old woman is seen by a gynecologist on a routine visit. A complete history is taken and is non-contributory except for the fact that the patient's menstrual irregularities apparently developed insidiously over the preceding decade. Screening physical examination is performed. Routine serum chemistries and complete blood count are sent, as are Pap smear studies. Pelvic ultrasound studies are also performed. Pregnancy test is negative. Endometrial biopsy shows proliferative endometrium. All other results are within normal limits, except for evidence of a mild iron deficiency anemia. Which of the following is the most likely diagnosis?
This patient most likely has dysfunctional uterine bleeding (DUB). Other, potentially more serious, diseases have been mostly excluded by the patient's extensive evaluation (more than many patients receive in this setting). Cervical dysplasia or carcinoma usually produce abnormal pap smears, and sometimes produce an abnormal vaginal examination. Endometrial carcinoma would usually be evident in either the endometrial biopsy or on the pelvic ultrasound examination.
Cervical carcinoma
Cervical dysplasia
Dysfunctional uterine bleeding
Endometrial carcinoma