Differential Diagnosis for Vaginal Bleeding in a 37-year-old Female

Single Most Likely Diagnosis

• Dysfunctional Uterine Bleeding (DUB): This is the most common cause of abnormal vaginal bleeding in women of reproductive age. It is often related to hormonal changes, particularly anovulatory cycles, which can lead to irregular and heavy bleeding.

Other Likely Diagnoses

• Uterine Fibroids: These are common in women of reproductive age and can cause heavy, prolonged, or irregular menstrual bleeding due to their location, size, and effect on the uterine lining.
• Endometrial Polyps: Growths in the lining of the uterus that can cause irregular menstrual bleeding, including heavy or prolonged periods.
• Intrauterine Device (IUD) Complications: If the patient has an IUD, complications such as improper placement, expulsion, or associated infection can lead to abnormal vaginal bleeding.
• Hormonal Contraceptive-Related Bleeding: Changes in or initiation of hormonal contraceptives can lead to breakthrough bleeding or irregular menstrual cycles.

Do Not Miss Diagnoses

• Cancer (Endometrial, Cervical, or Ovarian): Although less common, cancer must be considered, especially if there are other risk factors or symptoms such as pelvic pain, weight loss, or abnormal Pap smear results.
• Pregnancy-Related Complications (Ectopic Pregnancy, Miscarriage): Any pregnant woman with vaginal bleeding needs immediate evaluation for these potentially life-threatening conditions.
• Infection (Pelvic Inflammatory Disease, PID): Infections of the reproductive organs can cause bleeding, especially if associated with an IUD or after an abortion.
• Bleeding Disorders (e.g., Von Willebrand Disease): Underlying coagulopathies can manifest as heavy or prolonged menstrual bleeding.

Rare Diagnoses

• Adenomyosis: A condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, leading to heavy or painful periods.
• Uterine Arteriovenous Malformation (AVM): A rare condition characterized by abnormal connections between arteries and veins in the uterus, which can cause life-threatening bleeding.
• Thyroid Disorders: Both hyperthyroidism and hypothyroidism can affect menstrual regularity and cause abnormal bleeding.
• Pituitary or Adrenal Gland Disorders: Certain conditions affecting these glands can disrupt hormonal balances, leading to irregular menstrual bleeding.