Differential Diagnosis for Extended Menstrual Bleeding

Single Most Likely Diagnosis

• Dysfunctional Uterine Bleeding (DUB): This is the most common cause of extended menstrual bleeding, often related to hormonal imbalances, particularly anovulatory cycles, which are common in adolescents and perimenopausal women.

Other Likely Diagnoses

• Uterine Fibroids: These are benign tumors that can cause prolonged and heavy menstrual bleeding due to their location and effect on the uterine lining.
• Endometrial Hyperplasia: A condition where the lining of the uterus grows too thick, which can lead to extended and heavy menstrual bleeding, often associated with anovulatory cycles and unopposed estrogen.
• Polycystic Ovary Syndrome (PCOS): A hormonal disorder that can cause irregular periods, including extended menstrual bleeding, due to ovulation problems and hormonal imbalance.
• Thyroid Disorders: Both hypothyroidism and hyperthyroidism can affect menstrual regularity and lead to extended bleeding due to their impact on the body's hormonal balance.

Do Not Miss Diagnoses

• Cancer of the Uterus or Cervix: Although less common, these conditions can present with abnormal vaginal bleeding, including extended menstrual bleeding, and are critical to diagnose early for effective treatment.
• Bleeding Disorders (e.g., von Willebrand Disease): These can cause heavy and prolonged menstrual bleeding due to difficulties in blood clotting.
• Pregnancy-Related Complications: Ectopic pregnancy or a miscarriage can present with abnormal bleeding, which might be mistaken for extended 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 and prolonged menstrual bleeding.
• Uterine Arteriovenous Malformations: Rare vascular lesions that can cause abnormal uterine bleeding.
• Systemic Diseases (e.g., Liver or Kidney Disease): Certain systemic diseases can affect the body's ability to clot blood or regulate hormones, potentially leading to extended menstrual bleeding.

Each of these diagnoses has a different set of risk factors, symptoms, and diagnostic approaches, highlighting the importance of a thorough medical evaluation to determine the underlying cause of extended menstrual bleeding.