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Differential Diagnosis for Prolonged Menses in a 26-Year-Old

Single Most Likely Diagnosis

  • Dysfunctional Uterine Bleeding (DUB): This is the most common cause of abnormal uterine bleeding in women of reproductive age, often related to hormonal imbalances, particularly anovulatory cycles. It's a diagnosis of exclusion after ruling out other causes.

Other Likely Diagnoses

  • Uterine Fibroids: These are common in women of reproductive age and can cause prolonged or heavy menstrual bleeding due to their location, size, and number.
  • Endometrial Hyperplasia: This condition, often associated with unopposed estrogen, can lead to prolonged and heavy menstrual bleeding.
  • Polycystic Ovary Syndrome (PCOS): Although PCOS is more commonly associated with oligomenorrhea or amenorrhea, some women may experience prolonged menses due to hormonal imbalances and anovulatory cycles.
  • Thyroid Dysfunction: Both hypothyroidism and hyperthyroidism can affect menstrual regularity and duration, leading to prolonged menses in some cases.

Do Not Miss Diagnoses

  • Pregnancy Complications: Ectopic pregnancy or a spontaneous abortion can present with prolonged vaginal bleeding and must be ruled out immediately due to their potential for severe morbidity and mortality.
  • Malignancies: Although rare in young women, endometrial or cervical cancer can cause abnormal vaginal bleeding, including prolonged menses, and must not be missed.
  • Bleeding Disorders: Conditions like von Willebrand disease can lead to heavy or prolonged menstrual bleeding and are critical to diagnose to manage bleeding risks.
  • Intrauterine Adhesions (Asherman Syndrome): This condition can cause abnormal menstrual bleeding, including prolonged menses, and is important to diagnose due to its implications for fertility.

Rare Diagnoses

  • Adenomyosis: A condition where endometrial tissue grows into the uterine wall, which can cause heavy or prolonged menstrual bleeding, though it's less common in younger women.
  • Uterine Arteriovenous Malformations: Rare vascular anomalies that can cause abnormal uterine bleeding.
  • Systemic Diseases: Certain systemic diseases, such as chronic kidney disease or liver disease, can affect the menstrual cycle, though they are less common causes of prolonged menses in a 26-year-old without other symptoms.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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