Differential Diagnosis
The patient's symptoms and history suggest several possible diagnoses. Here's a breakdown of the differential diagnosis:
- Single most likely diagnosis
- Withdrawal bleeding: This is the most likely diagnosis, given the patient's history of taking progesterone suppository from Oct 4th to Oct 16th, followed by mild bleeding after stopping the medication. The 14mm uterus lining on Oct 20th scan also supports this diagnosis, as it indicates a prepared endometrium that would shed after progesterone withdrawal.
- Other Likely diagnoses
- Early pregnancy loss: Although the patient had a negative pregnancy test, it's possible that the test was taken too early or the pregnancy was not viable. The mild bleeding and single large clot could be indicative of an early miscarriage.
- Decidual bleeding: This type of bleeding occurs when the endometrium prepares for a pregnancy, but the embryo does not implant. The bleeding is usually mild and can be mistaken for a period.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although unlikely, an ectopic pregnancy can present with mild bleeding and a negative pregnancy test. It's essential to rule out this diagnosis, as it can be life-threatening if left untreated.
- Molar pregnancy: A molar pregnancy can also cause abnormal bleeding and a negative pregnancy test. Although rare, it's crucial to consider this diagnosis to avoid missing a potentially serious condition.
- Rare diagnoses
- Luteal phase defect: This condition occurs when the corpus luteum does not produce enough progesterone, leading to irregular bleeding. However, this diagnosis is less likely, given the patient's history of taking progesterone suppository.
- Thyroid dysfunction: Certain thyroid disorders can cause irregular menstrual bleeding. However, this diagnosis is less likely, given the patient's presentation and lack of other symptoms suggestive of thyroid dysfunction.
It's essential to note that a definitive diagnosis can only be made after further evaluation and testing. The patient should consult their healthcare provider to discuss the symptoms and determine the best course of action.