Differential Diagnosis for Irregular Heavy Menses in a 16-year-old Girl with Growth Spurt

• Single Most Likely Diagnosis
  • Anovulatory cycles: This is the most common cause of irregular heavy menses in adolescent girls, especially during the first few years after menarche. The hormonal imbalance and lack of ovulation lead to irregular and heavy bleeding.
• Other Likely Diagnoses
  • Thyroid disorders (hypo- or hyperthyroidism): Thyroid dysfunction can affect menstrual regularity and heaviness.
  • Polycystic Ovary Syndrome (PCOS): Although PCOS is more commonly diagnosed later in life, it can present in adolescence with irregular menses, acne, and signs of hyperandrogenism.
  • Pregnancy or ectopic pregnancy: Although less likely in a 16-year-old, pregnancy should always be considered in the differential diagnosis of irregular menses.
• Do Not Miss Diagnoses
  • Bleeding disorders (e.g., von Willebrand disease): These conditions can cause heavy menstrual bleeding and are crucial to diagnose to prevent severe complications.
  • Uterine or cervical abnormalities: Congenital anomalies or acquired conditions like uterine fibroids can cause irregular and heavy bleeding.
  • Coagulopathy: Conditions like thrombocytopenia or clotting factor deficiencies can lead to heavy menstrual bleeding.
• Rare Diagnoses
  • Androgen Insensitivity Syndrome: A rare condition where an individual with XY chromosomes is resistant to androgens, leading to primary amenorrhea or irregular menses.
  • Premature Ovarian Failure: A condition where the ovaries stop functioning before the age of 40, leading to irregular or absent menses.
  • Adrenal disorders (e.g., Congenital Adrenal Hyperplasia): These conditions can affect hormone production, leading to irregular menses and other symptoms.