Differential Diagnosis for a 17-Year-Old with a Period That Will Not Stop
Single Most Likely Diagnosis
- Dysfunctional Uterine Bleeding (DUB): This is the most common cause of abnormal uterine bleeding in adolescents, often due to anovulatory cycles which are common in the first few years after menarche. The irregularity in hormonal balance leads to unpredictable and sometimes prolonged menstrual bleeding.
Other Likely Diagnoses
- Hormonal Imbalance: Fluctuations in estrogen and progesterone levels can lead to irregular menstrual bleeding. This is common in teenagers due to the immaturity of the hypothalamic-pituitary-ovarian axis.
- Polycystic Ovary Syndrome (PCOS): Although PCOS is more commonly associated with oligomenorrhea or amenorrhea, some individuals may experience irregular, heavy, or prolonged menstrual bleeding due to the hormonal disturbances characteristic of the syndrome.
- Thyroid Disorders: Both hypothyroidism and hyperthyroidism can affect menstrual regularity and flow, leading to prolonged or heavy periods in some cases.
Do Not Miss Diagnoses
- Pregnancy Complications: Although less likely in someone presenting with ongoing menstrual bleeding, complications such as a miscarriage or an ectopic pregnancy could potentially present with abnormal vaginal bleeding.
- Bleeding Disorders: Conditions like von Willebrand disease or other coagulopathies can lead to heavy or prolonged menstrual bleeding. These are critical to identify due to the potential for significant morbidity.
- Uterine or Cervical Pathology: Abnormalities such as uterine fibroids, cervical polyps, or cervical cancer (though rare in this age group) could cause abnormal bleeding.
Rare Diagnoses
- Adenomyosis: Although more common in older women, adenomyosis can occur in younger individuals and may cause heavy or prolonged menstrual bleeding.
- Uterine Agenesis or Other Müllerian Anomalies: While these congenital anomalies might not directly cause prolonged menstrual bleeding, they can be associated with reproductive tract abnormalities that might lead to bleeding issues.
- Systemic Diseases: Certain systemic diseases, such as liver or kidney disease, can affect coagulation or hormone metabolism, potentially leading to abnormal menstrual bleeding. However, these would be rare in a previously healthy 17-year-old without other symptoms.