Differential Diagnosis for Prolonged Menstrual Bleeding
Single Most Likely Diagnosis
- Dysfunctional Uterine Bleeding (DUB): This is the most common cause of prolonged menstrual bleeding, especially in women of reproductive age. It is often related to hormonal imbalances, particularly anovulatory cycles, leading to irregular and prolonged bleeding.
Other Likely Diagnoses
- Uterine Fibroids: These are common benign tumors that can cause prolonged and heavy 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 prolonged and heavy menstrual bleeding. It's often associated with unopposed estrogen exposure.
- Adenomyosis: A condition where tissue similar to the lining inside the uterus is found outside its normal location, leading to heavy and prolonged menstrual bleeding, among other symptoms.
- Hormonal Contraceptive-Related Bleeding: Changes in menstrual bleeding patterns, including prolonged bleeding, can occur with the use of hormonal contraceptives, especially during the initial months of use.
Do Not Miss Diagnoses
- Cancer of the Uterus (Endometrial Cancer): Although less common, endometrial cancer can present with prolonged menstrual bleeding and must be considered, especially in postmenopausal women or those with risk factors such as obesity, diabetes, or a family history of cancer.
- Bleeding Disorders (e.g., von Willebrand Disease): These conditions can lead to prolonged menstrual bleeding due to difficulties in blood clotting. Identifying and managing these disorders is crucial to prevent severe bleeding complications.
- Pregnancy-Related Complications: In pregnant women, prolonged bleeding could be a sign of a miscarriage, ectopic pregnancy, or placental abnormalities, all of which are medical emergencies.
Rare Diagnoses
- Uterine Arteriovenous Malformations (AVMs): Rare vascular lesions that can cause abnormal and prolonged bleeding due to the direct connection between arteries and veins within the uterus.
- Systemic Diseases Affecting Coagulation: Certain rare systemic diseases that affect blood clotting, such as thrombocytopenia or other coagulopathies, can lead to prolonged menstrual bleeding.
- Inherited Bleeding Disorders: Besides von Willebrand Disease, other rare inherited disorders like factor XI deficiency can cause prolonged menstrual bleeding due to impaired coagulation pathways.