Differential Diagnosis for 46 y/o Female with Irregular Uterine Bleeding and Ultrasound Findings

• Single Most Likely Diagnosis
  • Anovulatory bleeding due to perimenopause: This is the most likely diagnosis given the patient's age and symptoms. Perimenopause is a time of hormonal fluctuation that can lead to irregular ovulation, resulting in irregular uterine bleeding. The mildly thickened endometrium and presence of a probable hemorrhagic cyst are consistent with this diagnosis.
• Other Likely Diagnoses
  • Endometrial hyperplasia: The thickened endometrium (14mm) could be indicative of endometrial hyperplasia, a condition where the lining of the uterus grows too thick. This is a common cause of irregular uterine bleeding in perimenopausal women.
  • Ovarian cysts (hemorrhagic or non-hemorrhagic): The ultrasound finding of a probable hemorrhagic cyst within the right ovary could be contributing to the patient's symptoms. Ovarian cysts are common in women of reproductive age and can cause irregular bleeding.
  • Uterine fibroids: Although not mentioned in the ultrasound findings, uterine fibroids are a common cause of irregular uterine bleeding in women of this age group and could be contributing to the patient's symptoms.
• Do Not Miss Diagnoses
  • Endometrial cancer: Although less likely, endometrial cancer must be considered in any woman with irregular uterine bleeding and a thickened endometrium. A biopsy would be necessary to rule out this diagnosis.
  • Ovarian cancer: The presence of a hemorrhagic cyst could be a sign of ovarian cancer, although this is less likely. Ovarian cancer is often asymptomatic until late stages, making it crucial to consider in the differential diagnosis.
• Rare Diagnoses
  • Adenomyosis: A condition where tissue similar to the lining of the uterus grows into the uterine walls, causing irregular bleeding and pelvic pain. This diagnosis is less likely but could be considered if other diagnoses are ruled out.
  • Polycystic ovary syndrome (PCOS): Although PCOS is typically diagnosed in younger women, it could be considered in this patient if she has other symptoms such as hirsutism, acne, or obesity, in addition to irregular uterine bleeding.