Differential Diagnosis
- Single most likely diagnosis:
- Irregular uterine bleeding due to hormonal contraceptive use: The patient is experiencing bleeding since the insertion of the Mirena coil and the use of the Evorel patch, which are both hormonal contraceptives. The change in hormonal balance can cause irregular bleeding, especially during the initial months of use. The recent increase in bleeding, presence of brown and bright red blood, and pelvic pain are consistent with this diagnosis.
- Other Likely diagnoses:
- Perforation or malposition of the Mirena coil: Although less common, the coil can cause perforation or become malpositioned, leading to irregular bleeding, pelvic pain, and other symptoms.
- Infection or inflammation: The patient may have developed an infection or inflammation related to the coil insertion, which can cause increased bleeding, pelvic pain, and other symptoms.
- Hormonal adjustment: The patient is using two hormonal contraceptives, which can cause hormonal imbalances, leading to mood changes, such as sadness, depression, and anxiety.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Ectopic pregnancy: Although the patient is using hormonal contraceptives, there is still a small chance of pregnancy, and an ectopic pregnancy can be life-threatening if not diagnosed promptly.
- Ovarian torsion: The patient's pelvic pain and irregular bleeding could be symptoms of ovarian torsion, which requires immediate medical attention.
- Uterine or ovarian cancer: Although rare, cancer can cause irregular bleeding, pelvic pain, and other symptoms, and it is essential to rule out these conditions.
- Rare diagnoses:
- Endometrial hyperplasia or polyps: These conditions can cause irregular bleeding and pelvic pain, but they are less common in patients using hormonal contraceptives.
- Adenomyosis: This condition can cause pelvic pain, heavy bleeding, and other symptoms, but it is relatively rare and often diagnosed in older women.