Differential Diagnosis for a 50-year-old Woman with Prolonged Menstrual Bleeding
Single Most Likely Diagnosis
- Perimenopausal Bleeding: This is the most likely diagnosis given the patient's age and symptoms. Perimenopause is the transition period leading up to menopause, during which hormonal changes can cause irregular menstrual cycles, including more frequent or prolonged periods.
Other Likely Diagnoses
- Uterine Fibroids: These are common in women of this age group and can cause prolonged or heavy menstrual bleeding.
- Endometrial Hyperplasia: This condition, characterized by the thickening of the uterine lining, can lead to irregular and prolonged menstrual bleeding.
- Hormonal Imbalance: Changes in hormone levels, not necessarily related to perimenopause, can affect menstrual cycle regularity and duration.
Do Not Miss Diagnoses
- Endometrial Cancer: Although less likely, endometrial cancer is a critical diagnosis to consider, especially given the patient's age and symptoms of abnormal uterine bleeding. A normal Pap smear does not rule out endometrial cancer.
- Cervical Cancer: While the Pap smear was normal 5 months ago, cervical cancer can present with abnormal vaginal bleeding, and the possibility, although small, should not be entirely dismissed without further evaluation if warranted.
Rare Diagnoses
- Bleeding Disorders: Conditions like von Willebrand disease can cause heavy or prolonged menstrual bleeding but are less common and typically present earlier in life.
- Uterine Polyps or Other Uterine Abnormalities: These can cause irregular menstrual bleeding but are less likely to be the primary cause of the patient's symptoms compared to other diagnoses listed.
- Thyroid Disorders: Both hyperthyroidism and hypothyroidism can affect menstrual regularity, but these would be less common causes of the patient's specific symptoms without other supporting signs or symptoms.