Differential Diagnosis for Heavy Menses and Pelvic Pain
Single Most Likely Diagnosis
- Dysfunctional Uterine Bleeding (DUB): This condition is characterized by abnormal uterine bleeding that is not associated with any other recognizable pathology. It is a common cause of heavy and prolonged menstrual bleeding, which aligns with the patient's symptoms of heavy menses for 9 days. The pelvic pain could be secondary to the heavy bleeding or associated with menstrual cramps.
Other Likely Diagnoses
- Uterine Fibroids: These are common in women of reproductive age and can cause heavy menstrual bleeding and pelvic pain due to their size, location, and potential to cause uterine distortion.
- Endometriosis: A condition where tissue similar to the lining inside the uterus grows outside of it, leading to inflammation, scarring, and adhesions. It is a common cause of pelvic pain and can also lead to heavy or irregular menstrual bleeding.
- Adenomyosis: Similar to endometriosis but involves the growth of endometrial tissue into the uterine wall, leading to heavy bleeding and pelvic pain.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although less likely if the patient is not pregnant, an ectopic pregnancy can present with pelvic pain and irregular vaginal bleeding. It is a medical emergency that requires immediate attention.
- Ovarian Torsion: A condition where the ovary twists around its ligaments, cutting off its blood supply. It presents with severe pelvic pain and can be associated with vaginal bleeding. It is an emergency that requires prompt surgical intervention.
- Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause pelvic pain, fever, and abnormal vaginal discharge or bleeding. If left untreated, it can lead to serious complications.
Rare Diagnoses
- Uterine Arteriovenous Malformation (AVM): A rare condition characterized by an abnormal connection between arteries and veins in the uterus, which can cause heavy, prolonged menstrual bleeding.
- Uterine Cancer: Although rare in younger women, uterine cancer can present with abnormal vaginal bleeding and pelvic pain. It is essential to consider this diagnosis, especially in postmenopausal women or those with risk factors.
- Bleeding Disorders: Conditions like von Willebrand disease can cause heavy menstrual bleeding due to clotting abnormalities. While not directly causing pelvic pain, the heavy bleeding can lead to discomfort.