Differential Diagnosis for Pelvic Pain and Abnormal Bleeding

The following differential diagnosis is organized into categories to help guide the thought process:

• Single most likely diagnosis
  • Endometriosis: This condition is a common cause of pelvic pain and abnormal bleeding in women of reproductive age. The presence of endometrial implants outside the uterus can lead to inflammation, scarring, and adhesions, resulting in pain and bleeding.
• Other Likely diagnoses
  • Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder that can cause irregular menstrual cycles, heavy bleeding, and pelvic pain. It is a common endocrine disorder in women of reproductive age.
  • Adenomyosis: This condition occurs when endometrial tissue grows into the uterine wall, leading to heavy bleeding, pelvic pain, and discomfort.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Ectopic Pregnancy: Although less common, an ectopic pregnancy can be life-threatening if not diagnosed promptly. It is essential to consider this diagnosis in any woman of reproductive age presenting with pelvic pain and abnormal bleeding.
  • Endometrial or Cervical Cancer: Although rare in younger women, these cancers can present with abnormal bleeding and pelvic pain. It is crucial to rule out these diagnoses, especially in women with risk factors or abnormal screening results.
• Rare diagnoses
  • Ovarian torsion: This is a rare but potentially life-threatening condition that occurs when the ovary twists around its ligaments, cutting off blood supply.
  • Uterine sarcoma: This is a rare type of cancer that can present with pelvic pain and abnormal bleeding.

Each of these diagnoses has a unique set of risk factors, symptoms, and diagnostic criteria. A thorough medical history, physical examination, and diagnostic testing (e.g., ultrasound, laparoscopy, endometrial biopsy) are necessary to determine the underlying cause of pelvic pain and abnormal bleeding.