Differential Diagnosis for Irregular Bleeding

The following differential diagnosis is organized into categories to help guide the thought process and ensure that no critical diagnoses are missed.

• Single Most Likely Diagnosis

  • Hormonal Imbalance: This is often the most common cause of irregular bleeding, particularly in women of reproductive age. Hormonal fluctuations can lead to changes in the menstrual cycle, including irregular bleeding. Justification: Common presentation, especially in the context of menstrual irregularities.

• Other Likely Diagnoses

  • Uterine Fibroids: These are growths in the uterus that can cause irregular bleeding, including heavy or prolonged menstrual bleeding. Justification: Common in reproductive-aged women and known to cause bleeding irregularities.
  • Polycystic Ovary Syndrome (PCOS): A condition characterized by irregular menstrual periods, often due to hormonal imbalance. Justification: PCOS is a common endocrine disorder in women of reproductive age and is known to cause irregular menstrual bleeding.
  • Endometrial Hyperplasia: A condition where the lining of the uterus grows too thick, which can cause irregular bleeding. Justification: Can be a result of unopposed estrogen exposure, which is a common issue in women with hormonal imbalances.

• Do Not Miss Diagnoses

  • Cancer (Endometrial, Cervical, or Uterine): Although less common, cancer can cause irregular bleeding and must be ruled out, especially in postmenopausal women or those with risk factors. Justification: Potentially life-threatening if not diagnosed and treated promptly.
  • Pregnancy-Related Complications: In women of childbearing age, irregular bleeding can be a sign of pregnancy complications such as a miscarriage or ectopic pregnancy. Justification: These conditions are medical emergencies that require immediate attention.
  • Bleeding Disorders: Conditions like von Willebrand disease can cause irregular and heavy menstrual bleeding. Justification: Important to diagnose due to implications for management of bleeding and potential for significant morbidity if untreated.

• Rare Diagnoses

  • Thyroid Disorders: Both hyperthyroidism and hypothyroidism can cause menstrual irregularities, including irregular bleeding. Justification: Less common cause but important to consider, especially if other symptoms of thyroid dysfunction are present.
  • Adenomyosis: A condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, leading to heavy or irregular bleeding. Justification: Less common than other causes but can significantly impact quality of life.
  • Intrauterine Devices (IUD) Complications: Certain IUDs, especially those that release hormones, can cause irregular bleeding as a side effect. Justification: Relevant in women with IUDs, as management may involve adjusting the contraceptive method.