Differential Diagnosis for Prolonged Menstrual Cycle
A 38-year-old female experiencing a prolonged menstrual cycle of 14 days followed by a normal cycle can have various underlying causes. The differential diagnosis can be categorized as follows:
- Single Most Likely Diagnosis
- Anovulatory cycles: This is a common cause of irregular menstrual cycles in women, especially as they approach perimenopause. Anovulatory cycles occur when the ovaries do not release an egg, leading to irregular and prolonged menstrual bleeding.
- Other Likely Diagnoses
- Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder that can cause irregular menstrual cycles, including prolonged bleeding.
- Thyroid dysfunction: Both hypothyroidism and hyperthyroidism can affect menstrual cycles, leading to irregularities such as prolonged bleeding.
- Uterine fibroids: These non-cancerous growths in the uterus can cause heavy and prolonged menstrual bleeding.
- Endometrial hyperplasia: This condition, characterized by an overgrowth of the uterine lining, can lead to irregular and prolonged menstrual bleeding.
- Do Not Miss Diagnoses
- Endometrial cancer: Although rare, endometrial cancer can cause irregular and prolonged menstrual bleeding, making it essential to rule out this diagnosis.
- Uterine cancer: Like endometrial cancer, uterine cancer can also cause abnormal uterine bleeding and should not be missed.
- Bleeding disorders (e.g., von Willebrand disease): These disorders can cause heavy and prolonged menstrual bleeding due to impaired blood clotting.
- Rare Diagnoses
- Adenomyosis: A rare condition where tissue similar to the uterine lining grows into the uterine wall, leading to heavy and prolonged menstrual bleeding.
- Uterine arteriovenous malformations: Abnormal connections between arteries and veins in the uterus can cause irregular and prolonged menstrual bleeding.
- Pituitary tumors: Although rare, pituitary tumors can affect hormone production, leading to irregular menstrual cycles, including prolonged bleeding.
Each of these diagnoses has a unique set of symptoms and risk factors, and a thorough medical evaluation is necessary to determine the underlying cause of the prolonged menstrual cycle.