Differential Diagnosis for Vaginal Bleeding

Single Most Likely Diagnosis

• Menstrual irregularity: This is often the most common cause of vaginal bleeding, especially in women of reproductive age, due to hormonal changes or irregular ovulation.

Other Likely Diagnoses

• Pregnancy-related complications (e.g., miscarriage, ectopic pregnancy): These conditions can cause vaginal bleeding and are relatively common, especially in women who are sexually active and not using contraception.
• Infections (e.g., pelvic inflammatory disease, cervicitis): Infections of the reproductive tract can lead to vaginal bleeding and are common due to the prevalence of sexually transmitted infections.
• Hormonal contraceptive side effects: Many women use hormonal contraceptives, which can sometimes cause irregular vaginal bleeding as a side effect.
• Uterine fibroids or polyps: These are common benign growths in the uterus that can cause irregular vaginal bleeding.

Do Not Miss Diagnoses

• Ectopic pregnancy: Although not the most common cause, an ectopic pregnancy is life-threatening and must be ruled out, especially in women with severe abdominal pain and vaginal bleeding.
• Malignancy (e.g., cervical, uterine, ovarian cancer): While less common, cancers of the female reproductive system can present with vaginal bleeding and are critical to diagnose early for effective treatment.
• Placenta previa or placental abruption in pregnancy: These conditions can cause severe vaginal bleeding and are life-threatening to both the mother and the fetus.
• Severe pelvic infection (e.g., septic abortion): Infections that lead to sepsis can be life-threatening and require immediate medical attention.

Rare Diagnoses

• Bleeding disorders (e.g., von Willebrand disease): These conditions can cause heavy or prolonged menstrual bleeding but are less common.
• Uterine artery embolization complications: This is a rare cause of vaginal bleeding, usually seen in women who have undergone this procedure for fibroid treatment.
• Vaginal or cervical trauma: Physical injury to the vagina or cervix can cause bleeding and, while not common, should be considered, especially with a relevant history.
• Endometrial hyperplasia: A condition where the lining of the uterus grows too thick, which can lead to irregular vaginal bleeding, though it's less common than other causes.