Differential Diagnosis for Heavy Bleeding after Plan B
The patient's symptoms of heavy bleeding outside of her normal cycle, shortly after taking Plan B, can be evaluated through the following differential diagnoses:
- Single most likely diagnosis:
- Breakthrough bleeding or irregular menstrual bleeding: This is a common side effect of emergency contraceptive pills like Plan B, which can disrupt the normal menstrual cycle, leading to irregular or heavy bleeding.
- Other Likely diagnoses:
- Hormonal changes: The hormonal fluctuations caused by Plan B can lead to changes in menstrual flow, including heavier bleeding.
- Menstrual irregularity: The patient's normal menstrual cycle may be irregular, and the bleeding could be an exacerbation of this existing condition.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Ectopic pregnancy: Although unlikely if Plan B was taken correctly and in a timely manner, an ectopic pregnancy can cause heavy bleeding and is a life-threatening condition that requires immediate medical attention.
- Miscarriage: If the patient was pregnant before taking Plan B, heavy bleeding could be a sign of a miscarriage.
- Uterine rupture or perforation: Although extremely rare, these conditions can cause severe bleeding and require emergency medical intervention.
- Rare diagnoses:
- Bleeding disorders: Underlying bleeding disorders, such as von Willebrand disease or platelet function disorders, can cause heavy menstrual bleeding.
- Uterine or cervical pathology: Rare conditions like uterine fibroids, cervical polyps, or cancer can cause abnormal uterine bleeding.
- Infection or sepsis: In rare cases, heavy bleeding can be a sign of an underlying infection, such as pelvic inflammatory disease or sepsis, which requires prompt medical attention.