Differential Diagnosis for Abnormal Vaginal Bleeding

Single Most Likely Diagnosis

• Hormonal Imbalance: This is often the most common cause of abnormal vaginal bleeding, particularly in women of reproductive age. Hormonal fluctuations can lead to irregular ovulation, thickening of the uterine lining, and subsequent bleeding.

Other Likely Diagnoses

• Uterine Fibroids: These are common benign tumors that can cause heavy or irregular menstrual bleeding due to their location and effect on the uterine lining.
• Endometrial Hyperplasia: A condition where the lining of the uterus grows too thick, which can lead to abnormal bleeding. It's more common in women who are overweight, have high blood pressure, or are taking estrogen without progesterone.
• Polycystic Ovary Syndrome (PCOS): A hormonal disorder that can cause irregular periods and abnormal bleeding due to ovulation problems and hormonal imbalance.
• Intrauterine Device (IUD) Complications: Certain types of IUDs, especially those that release hormones, can cause changes in menstrual bleeding patterns.

Do Not Miss Diagnoses

• Endometrial Cancer: Although less common, it's crucial to rule out cancer as a cause of abnormal vaginal bleeding, especially in postmenopausal women or those with risk factors such as obesity, family history, or unopposed estrogen therapy.
• Cervical Cancer: Abnormal vaginal bleeding can be a symptom of cervical cancer, making it essential for screening and early detection.
• Pregnancy Complications: Ectopic pregnancy or miscarriage can present with abnormal vaginal bleeding and are medical emergencies.
• Bleeding Disorders: Conditions like von Willebrand disease can cause heavy menstrual bleeding and should not be overlooked.

Rare Diagnoses

• Uterine Arteriovenous Malformations: Rare vascular lesions that can cause abnormal bleeding due to the abnormal connection between arteries and veins.
• Uterine Sarcomas: Rare and aggressive cancers of the uterus that can present with abnormal vaginal bleeding among other symptoms.
• Ovarian Tumors: Certain types of ovarian tumors can cause hormonal imbalances leading to abnormal vaginal bleeding, though this is less common.
• Thyroid Disorders: Both hyperthyroidism and hypothyroidism can affect menstrual regularity and cause abnormal bleeding, though they are less direct causes compared to other hormonal imbalances.