Differential Diagnosis for a 16-year-old with Heavy Menstrual Cycle and Hgb 6.6
- Single most likely diagnosis:
- Menorrhagia due to Anovulatory Cycles: This is a common cause of heavy menstrual bleeding in adolescents, often resulting from immature hypothalamic-pituitary-ovarian axis leading to anovulatory cycles. The low hemoglobin (Hgb) level of 6.6 supports this diagnosis, indicating significant blood loss.
- Other Likely diagnoses:
- Dysfunctional Uterine Bleeding (DUB): Similar to anovulatory cycles, DUB is a common cause of heavy menstrual bleeding and can lead to significant anemia.
- Bleeding Disorders (e.g., von Willebrand disease): These conditions can cause heavy menstrual bleeding due to impaired coagulation.
- Uterine Anomalies or Fibroids: Although less common, these structural issues can cause heavy menstrual bleeding.
- Do Not Miss diagnoses:
- Pregnancy Complications: Although the patient is 16, pregnancy should always be considered, especially if there's a chance of sexual activity. A miscarriage or ectopic pregnancy could cause heavy bleeding.
- Trauma: Physical or sexual trauma could lead to heavy vaginal bleeding.
- Malignancy (e.g., cervical or uterine cancer): Although rare in adolescents, any possibility of cancer must be ruled out.
- Rare diagnoses:
- Thrombocytopenia or Other Coagulopathies: Conditions affecting platelet count or function can lead to heavy menstrual bleeding.
- Hypothyroidism: Sometimes associated with menorrhagia, though less common.
- Adenomyosis: A rare condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, potentially causing heavy bleeding.