Differential Diagnosis for Prolonged Menstrual Bleeding

The patient's complaint of having her period for 12 days can be approached by considering various potential causes. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Dysfunctional Uterine Bleeding (DUB): This is the most common cause of abnormal uterine bleeding in women of reproductive age, often related to hormonal imbalances, particularly anovulatory cycles. It's characterized by irregular, heavy, or prolonged menstrual bleeding without any identifiable structural cause.

• Other Likely Diagnoses

  • Uterine Fibroids: These are common benign tumors that can cause heavy or prolonged menstrual bleeding due to their location, size, and effect on the uterine lining.
  • Endometrial Hyperplasia: This condition involves the thickening of the uterine lining, often due to unopposed estrogen, which can lead to prolonged or heavy bleeding.
  • Intrauterine Device (IUD) Complications: Certain types of IUDs, especially those that are non-hormonal, can cause changes in menstrual bleeding patterns, including prolonged periods.
  • Thyroid Dysfunction: Both hypothyroidism and hyperthyroidism can affect menstrual regularity and duration, leading to prolonged bleeding in some cases.

• Do Not Miss Diagnoses

  • Endometrial Cancer: Although less common, endometrial cancer can present with abnormal uterine bleeding, including prolonged menstrual periods. It's crucial to rule out this diagnosis, especially in older women or those with risk factors like obesity or unopposed estrogen exposure.
  • Uterine Artery Embolization Complications: If the patient has undergone this procedure for fibroid treatment, complications can lead to prolonged or abnormal bleeding.
  • Coagulopathy: Bleeding disorders, such as von Willebrand disease, can cause prolonged or heavy menstrual bleeding due to difficulties in achieving proper clotting.

• Rare Diagnoses

  • Uterine Arteriovenous Malformation (AVM): A rare condition characterized by abnormal connections between arteries and veins in the uterus, which can cause prolonged or heavy bleeding.
  • Uterine Adenomyosis: A condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, potentially leading to heavy or prolonged menstrual bleeding.
  • Systemic Diseases: Certain systemic diseases, such as liver or kidney disease, can affect coagulation and lead to abnormal bleeding patterns, including prolonged menstrual bleeding.