Differential Diagnosis for Prolonged Bleeding with Late Period on Progesterone Only Contraception and Left Iliac Fossa Pain
- Single Most Likely Diagnosis
- Irregular Uterine Bleeding due to Progesterone Only Contraception: This is a common side effect of progesterone-only contraception, which can cause changes in menstrual bleeding patterns, including prolonged bleeding and irregular periods. The left iliac fossa pain could be related to the bleeding or a separate issue like constipation or musculoskeletal strain.
- Other Likely Diagnoses
- Ovarian Cyst: These are common in women of reproductive age and can cause pelvic pain, irregular menstrual bleeding, and can sometimes rupture, leading to severe pain. The use of progesterone-only contraception might influence ovarian cyst formation or rupture.
- Ectopic Pregnancy: Although less likely if the contraception is used correctly, it's a possibility, especially if there's a failure of the contraceptive method. Ectopic pregnancy can present with abdominal pain and irregular bleeding.
- Constipation or Gastrointestinal Issues: These can cause left iliac fossa pain and might be unrelated to the menstrual irregularities but are common enough to consider.
- Do Not Miss Diagnoses
- Ectopic Pregnancy: As mentioned, this is critical to rule out due to its potential for severe consequences, including death. Any suspicion of ectopic pregnancy warrants immediate investigation.
- Ovarian Torsion: This is a surgical emergency that can cause severe pain and might be associated with an ovarian cyst. It's less common but critical not to miss.
- Appendicitis: Although the pain is typically in the right lower quadrant, atypical presentations can occur, especially in women, and appendicitis can sometimes mimic gynecological conditions.
- Rare Diagnoses
- Malignancy (e.g., Ovarian Cancer): While rare, especially in younger women, any persistent or unexplained symptoms should prompt consideration of malignancy.
- Endometriosis: This can cause pelvic pain and irregular bleeding but is less directly linked to the use of progesterone-only contraception and the specific symptom of left iliac fossa pain.
- Adnexal Torsion: Similar to ovarian torsion but involves the fallopian tube and can cause severe pain. It's rare but requires urgent attention.