Differential Diagnosis for Heavy Vaginal Bleeding
The patient presents with heavy vaginal bleeding, passing large clots, dizziness upon standing, and lower abdominal pain. These symptoms suggest significant blood loss and potential hemodynamic instability. The differential diagnosis can be categorized as follows:
- Single Most Likely Diagnosis
- Abnormal Uterine Bleeding (AUB) due to Hormonal Imbalance: This is a common cause of heavy vaginal bleeding in women of reproductive age, often related to anovulatory cycles or hormonal imbalances. The patient's symptoms of heavy bleeding and clotting are consistent with this diagnosis.
- Other Likely Diagnoses
- Uterine Fibroids: These can cause heavy menstrual bleeding, pelvic pain, and pressure symptoms. The patient's age and symptoms make this a plausible diagnosis.
- Pelvic Inflammatory Disease (PID): Although PID typically presents with pelvic pain, fever, and abnormal vaginal discharge, it can also cause irregular bleeding. The presence of lower abdominal pain in this patient makes PID a consideration.
- Ectopic Pregnancy: Although less likely given the duration of bleeding, ectopic pregnancy must be considered in any woman of childbearing age presenting with abdominal pain and vaginal bleeding.
- Do Not Miss Diagnoses
- Pregnancy-Related Complications (e.g., Miscarriage, Placenta Previa): These conditions can present with heavy vaginal bleeding and are potentially life-threatening if not promptly diagnosed and managed.
- Uterine Rupture or Perforation: Although rare, these conditions are emergencies that require immediate surgical intervention.
- Malignancy (e.g., Uterine or Cervical Cancer): While less common in younger women, cancer can cause abnormal vaginal bleeding and must be considered to ensure timely diagnosis and treatment.
- Rare Diagnoses
- Bleeding Disorders (e.g., von Willebrand Disease): These can cause heavy menstrual bleeding due to coagulopathy but are less common than other causes listed here.
- Arteriovenous Malformation (AVM) of the Uterus: A rare condition that can cause significant vaginal bleeding due to abnormal blood vessel formation within the uterus.
- Uterine Agenesis or Other Müllerian Anomalies: Congenital anomalies of the uterus can sometimes present with abnormal bleeding patterns, although these are rare and often diagnosed earlier in life.
Workup
The workup for this patient should include:
- Complete Blood Count (CBC) to assess for anemia and severity of blood loss.
- Type and Screen in case blood transfusion is needed.
- Pregnancy Test to rule out pregnancy-related complications.
- Pelvic Ultrasound to evaluate for uterine fibroids, ovarian cysts, or other structural abnormalities.
- Coagulation Studies if a bleeding disorder is suspected.
- Endometrial Biopsy may be considered if cancer is a concern, especially in older women or those with risk factors for endometrial cancer.
Given the patient's symptoms of dizziness and significant blood loss, hemodynamic stability should be assessed and maintained throughout the diagnostic process, with consideration for fluid resuscitation and potential blood transfusion as needed.