Differential Diagnosis for Postmenopausal Vaginal Bleeding

Single Most Likely Diagnosis

• Atrophic Vaginitis: This condition is the most common cause of postmenopausal bleeding, resulting from the thinning and drying of the vaginal walls due to decreased estrogen levels. The patient's age and the absence of other symptoms make this a likely diagnosis.

Other Likely Diagnoses

• Endometrial Hyperplasia: This condition involves the thickening of the uterine lining and can cause bleeding. It's more common in postmenopausal women and can be influenced by hormonal factors.
• Endometrial Polyps: These are growths in the lining of the uterus that can cause bleeding, especially in postmenopausal women.
• Vaginal or Cervical Polyps: Similar to endometrial polyps, these growths can cause bleeding due to their location and potential for irritation or ulceration.

Do Not Miss Diagnoses

• Endometrial Cancer: Although less likely, endometrial cancer is a critical diagnosis to consider due to its potential severity and the fact that postmenopausal bleeding can be an early symptom. Early detection significantly improves prognosis.
• Cervical Cancer: Another critical diagnosis, cervical cancer can present with vaginal bleeding in postmenopausal women. Regular screening can often detect precancerous changes, but new onset bleeding warrants investigation.

Rare Diagnoses

• Uterine Sarcoma: A rare type of cancer that originates in the muscle and supporting tissues of the uterine walls. It can cause postmenopausal bleeding among other symptoms.
• Vaginal Cancer: A rare type of cancer that can cause bleeding, especially if the tumor is located near the vaginal opening or is large enough to cause ulceration and bleeding.

Each of these diagnoses should be considered and investigated appropriately, with a focus on ruling out the "Do Not Miss" diagnoses due to their potential impact on the patient's health and outcome.