A 48-year-old woman presentw with inter-menstrual bleeding for two months and episodes of bleeding occurring any time in the cycle. There is no associated pain. Differential diagnosis for inter-menstrual bleeding does not include
A. Endocervical polyp
B. Ovarian teratoma
C. Cervical malignancy
D. Endometrial polyp
Correct Answer: B. Ovarian teratoma
Explanation
Here is the likely interpretation of your question:
A 48-year-old woman presents with inter-menstrual bleeding (IMB) with episodes of bleeding at any time in the cycle, painless.
Which of the following is NOT a differential diagnosis for inter-menstrual bleeding?
Inter-menstrual bleeding is commonly caused by:
- Endometrial polyp
- Cervical polyp
- Cervical malignancy
- Endometrial hyperplasia / carcinoma
- Hormonal imbalance / anovulatory cycles (common in perimenopause)
- Infections (cervicitis, PID)
- Fibroids (submucous)
- Iatrogenic (OCPs, IUCD)
Conditions that DO NOT typically cause inter-menstrual bleeding:
✔ Dysmenorrhea – causes painful menses, not IMB
✔ Mittelschmerz – causes mid-cycle pain, not bleeding (though very slight spotting may occur, significant IMB is not typical)
✔ Endometriosis – usually causes dysmenorrhea, dyspareunia, infertility; IMB is not a classical feature
✔ Primary dysmenorrhea – pain without abnormal bleeding
✔ PCOS – causes oligomenorrhea or irregular cycles, not specific IMB
✔ Adenomyosis – causes heavy menstrual bleeding + dysmenorrhea, not isolated IMB
Most correct answer (commonly used in exams):
❌ Primary dysmenorrhea (or Dysmenorrhea) — not a cause of inter-menstrual bleeding.
Other Options Details
Here are the descriptions for all the options:
A. Endocervical Polyp
- These are benign (non-cancerous) growths that arise from the endocervical canal (the inner part of the cervix).
- Usually small, smooth, red or purple, and may protrude through the cervical opening.
- Common in women of reproductive age.
- Often asymptomatic but can cause intermenstrual bleeding, postcoital bleeding, or vaginal discharge.
B. Ovarian Teratoma
- A germ cell tumor of the ovary that contains tissues from different embryonic layers (hair, teeth, fat, bone, etc.).
- The most common type is the mature cystic teratoma (dermoid cyst)—usually benign.
- Can occur in women of any age, especially young women.
- May cause abdominal pain, mass, or complications like ovarian torsion.
C. Cervical Malignancy
- Refers to cancer of the cervix, most commonly squamous cell carcinoma or adenocarcinoma.
- Strongly associated with high-risk HPV infection (e.g., HPV 16, 18).
- Symptoms include postcoital bleeding, irregular bleeding, foul-smelling discharge, or pelvic pain.
- Preventable with HPV vaccination and detectable early through Pap smear / VIA / HPV testing.
D. Endometrial Polyp
- Benign overgrowths of the endometrial lining (inner lining of the uterus).
- Can be single or multiple, small or large.
- Common in perimenopausal and postmenopausal women.
- May cause abnormal uterine bleeding, spotting, or infertility.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group