Purple Menstrual Bleeding Differential Diagnosis Table

Purple Menstrual Bleeding Algorithm

Purple Menstrual Bleeding Differential Diagnosis Table:

Symptomsky	Increased Estrogen	Uterine Fibroids	Endometriosis	Pelvic Inflammatory Disease	Adenomyosis	Miscarriage	Ectopic Pregnancy
Irregular menstrual cycles	Rare	Rare	Rare	Rare	Rare	No	Rare
Prolonged menstrual bleeding	Rare	Yes	Rare	Rare	Rare	Rare	Rare
Painful periods	Rare	Rare	Yes	Yes	Yes	Rare	Rare
Fever	No	No	Rare	Yes	No	Rare	Rare
Tender uterus	Rare	Yes	Rare	Yes	Yes	No	Rare
Pregnancy tissue loss	No	No	No	No	No	Yes	No
Unilateral pain	No	No	Rare	Rare	No	No	Yes
Breast tenderness	Yes	No	No	No	No	No	Yes
Diagnostics	Blood tests, elevated estrogen levels, ultrasound, ovarian cysts or abnormalities, hormone panels, imbalanced hormone ratios	Pelvic ultrasound, fibroid size and location, hysteroscopy, fibroid presence in the uterine cavity, MRI, fibroid size and detailed imaging	Laparoscopy, endometrial tissue presence, pelvic ultrasound, cysts or adhesions, MRI, endometriosis lesions or deep infiltrative disease	Pelvic exam, tenderness in pelvic area, cervical motion tenderness, ultrasound, fluid or abscesses, blood tests, elevated white blood cell count, pelvic MRI, inflammation or infection indicators	Pelvic ultrasound, thickened uterine wall, MRI, diffuse uterine enlargement, hysteroscopy, no visible abnormalities, biopsy, adenomyosis confirmation	Ultrasound, gestational sac presence, fetal heartbeat, blood tests, hCG levels, declining or low hCG, pelvic exam, tissue or clot expulsion	Pelvic ultrasound, extrauterine gestational sac, blood tests, hCG levels (higher than expected), MRI, abnormal sac location, laparoscopy, ectopic tissue presence

Menstrual bleeding is a natural process that occurs inside the uterus and is completely normal. It consists of bleeding through the vagina that normally occurs cyclically once a month. This blood comes from the detachment of the walls of the uterus that had formed to accommodate a possible embryo.
The variations in the color of menstrual bleeding are completely normal and can be caused by different factors that modify the color of the blood; however, different tones can guide in the detection of possible diseases related to this symptom.
Certain changes in color, texture, and volume are normal. Some discomfort is also normal during the first few days of menstruation; however, when there is disabling pain or abnormal bleeding changes, there may be underlying health problems. In this case, the most common disorders associated with this symptom are polycystic syndrome, adenomyosis, uterine fibroids, and endometriosis.

How to Recognize Which Disease Is Causing Purple Menstrual Bleeding

How to Recognize if Increased Estrogen Is Causing Purple Menstrual Bleeding

High estrogen levels are associated with this symptom and many other significant clinical conditions. Among the most frequent symptoms of increased estrogen levels are swelling and tenderness of the breasts, decreased sexual desire, irregular menstrual periods, headache, weight gain, hair loss, insomnia, and fluid retention.

How to Recognize if Uterine Fibroids are Causing Purple Menstrual Bleeding

Uterine fibroids are growths inside the uterus that, in addition to purple menstrual bleeding, are accompanied by fertility problems, back pain, miscarriages, vaginismus, constipation, anemia, and bleeding between periods.

How to Recognize if Increased Endometriosis is Causing Purple Menstrual Bleeding

It consists of the appearance of endometrial tissue growth in locations outside the uterine cavity. Additional symptoms are pain during and after periods, vaginismus, dysuria, chronic pelvic pain, metrorrhagia, infertility, flatulence, fatigue, and psychological conditions such as depression or anxiety crises.

How to Recognize if Pelvic Inflammatory Disease is Causing Purple Menstrual Bleeding

It is an infection of the uterus and its adnexa. Purple menstrual bleeding is accompanied by pain in the abdominopelvic region, abnormal vaginal secretions, vaginismus, fever, nausea, abnormal bleeding, metrorrhagia, and dysuria.

How to Recognize if Adenomyosis is Causing Purple Menstrual Bleeding

These are changes that occur inside the uterus. Purple menstrual bleeding is accompanied by dysmenorrhea, dyspareunia, and chronic pelvic pain.

How to Recognize if Miscarriage is Causing Purple Menstrual Bleeding

Symptoms will vary depending on the stage of the pregnancy. Some of the symptoms are severe abdominal pain, purple vaginal bleeding accompanied by cramps, chills, and back pain.

How to Recognize if Ectopic Pregnancy is Causing Purple Menstrual Bleeding

It is accompanied by typical pregnancy symptoms such as missed periods and breast tenderness, but is mostly characterized by a dull pain in the lower abdomen, especially the right flank, vaginal bleeding or purple bleeding, scapular pain, and dizziness.

Common Red Flags With Purple Menstrual Bleeding

Finally, there is no single bleeding pattern that ensures the proper functioning of the female genital tract, but in the event of any abrupt change, it is best to consult a professional.
A specialist should be consulted in case of irregular cycles with drastic changes from one month to the next, considerable pain, presence of added symptoms such as dizziness, paleness that may indicate anemia, bleeding between each period, postcoital bleeding, bleeding during menopause, or any bleeding during pregnancy.