Differential Diagnosis for Heavy Abnormal Uterine Bleeding
Single Most Likely Diagnosis
- Anovulatory Bleeding with Iron Deficiency Anemia: The patient's presentation of heavy abnormal uterine bleeding, a mildly/prominent endometrium, and a low ferritin level (5) strongly suggests anovulatory bleeding as the cause, complicated by iron deficiency anemia due to chronic blood loss.
Other Likely Diagnoses
- Uterine Fibroids: The presence of a thickened endometrium and heavy bleeding could be indicative of uterine fibroids, which are common in reproductive-aged women and can cause significant bleeding and iron deficiency anemia.
- Endometrial Hyperplasia: This condition, often associated with anovulatory cycles, can lead to thickening of the endometrium and abnormal uterine bleeding. The patient's low ferritin level supports chronic blood loss.
- Ovarian Cyst with Hemorrhage: The 2.3 cm hemorrhagic ovarian cyst could be contributing to the patient's symptoms, either through direct bleeding or through hormonal effects leading to anovulation and subsequent uterine bleeding.
Do Not Miss Diagnoses
- Endometrial Cancer: Although less likely in younger women, endometrial cancer must be considered, especially with postmenopausal or heavy abnormal uterine bleeding. A thickened endometrium is a risk factor, and diagnosis requires endometrial sampling.
- Pregnancy-Related Complications: In women of childbearing age, pregnancy or complications of early pregnancy (e.g., ectopic pregnancy, miscarriage) must be ruled out, as these can present with abnormal bleeding and are potentially life-threatening if not promptly diagnosed.
Rare Diagnoses
- Bleeding Disorders (e.g., von Willebrand Disease): These conditions can present with heavy menstrual bleeding and are important to consider, especially if other diagnoses are ruled out and the patient continues to experience significant bleeding.
- Arteriovenous Malformations (AVMs) of the Uterus: A rare cause of abnormal uterine bleeding, AVMs can lead to significant, life-threatening bleeding and require specific diagnostic and therapeutic approaches.
- Gonadal Dysgenesis or Other Ovarian Abnormalities: In some cases, ovarian abnormalities or disorders of sex development can lead to anovulatory bleeding and should be considered in the differential diagnosis, especially if other findings suggest ovarian dysfunction or developmental anomalies.