Differential Diagnosis for Prolonged Bleeding after Mirena Coil Insertion
- Single most likely diagnosis:
- Irregular uterine bleeding due to hormonal adjustment to the Mirena coil and Evorel patch. This is a common side effect, especially in the first few months after insertion, as the body adjusts to the new hormonal environment.
- Other Likely diagnoses:
- Perforation or malposition of the Mirena coil, which could cause irregular bleeding, pain, and potentially lead to more serious complications if not addressed.
- Infection or pelvic inflammatory disease (PID) following the insertion of the Mirena coil, which could present with prolonged bleeding, pelvic pain, and other systemic symptoms.
- Endometrial hyperplasia or polyps, which could be exacerbated by or unrelated to the hormonal treatments and cause prolonged or irregular bleeding.
- Do Not Miss diagnoses:
- Ectopic pregnancy, although less likely given the patient's use of the Mirena coil and Evorel patch, it is crucial to rule out due to its potential severity and the fact that no form of contraception is 100% effective.
- Ovarian cysts or torsion, which could cause severe pain and might be associated with hormonal treatments, although this is less directly related to the bleeding.
- Malignancy (e.g., endometrial or cervical cancer), which, although rare, especially in younger populations, must be considered in the differential diagnosis of abnormal uterine bleeding.
- Rare diagnoses:
- Systemic disorders affecting coagulation (e.g., von Willebrand disease), which could be exacerbated by or unrelated to the hormonal treatments and cause prolonged bleeding.
- Adenomyosis, a condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, potentially causing prolonged and heavy bleeding.
- Uterine arteriovenous malformations, rare vascular anomalies that could cause abnormal uterine bleeding.