Differential Diagnosis for Heavy Bleeding
The following is a list of potential causes for heavy bleeding outside of the regular menstrual cycle:
- Single most likely diagnosis
- Breakthrough bleeding due to hormonal contraception: This is a common cause of irregular bleeding, especially in women who have recently started or changed their hormonal contraceptive method.
- Other Likely diagnoses
- Ovulatory dysfunction: Irregular ovulation can lead to changes in menstrual bleeding patterns, including heavy bleeding at unexpected times.
- Uterine fibroids: These non-cancerous growths in the uterus can cause heavy or irregular bleeding.
- Endometrial polyps: Growths on the lining of the uterus can lead to abnormal bleeding.
- Infection or inflammation: Pelvic inflammatory disease (PID) or other infections can cause irregular bleeding.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although unlikely if the patient is using hormonal contraception, an ectopic pregnancy can cause irregular bleeding and is a life-threatening condition if not promptly diagnosed.
- Malignancy: Uterine or cervical cancer can cause abnormal bleeding, and early detection is crucial for effective treatment.
- Bleeding disorders: Conditions like von Willebrand disease or other coagulopathies can increase the risk of heavy bleeding.
- Rare diagnoses
- Thyroid disorders: Both hyperthyroidism and hypothyroidism can affect menstrual bleeding patterns.
- Pituitary tumors: Rare tumors in the pituitary gland can disrupt hormonal balance, leading to irregular bleeding.
- Adenomyosis: A condition where tissue similar to the lining of the uterus grows into the uterine walls, causing heavy or irregular bleeding.