Differential Diagnosis for Continuous Vaginal Bleeding
- Single most likely diagnosis + Breakthrough bleeding associated with Depo-Provera: This is the most likely diagnosis given the recent Depo-Provera injection and the presentation of continuous heavy vaginal bleeding. Breakthrough bleeding is a common side effect of Depo-Provera, especially in the first year of use.
- Other Likely diagnoses + Irregular menstrual bleeding: This could be due to various factors such as hormonal changes, stress, or other medical conditions. The heavy bleeding and passage of clots suggest a possible irregular menstrual bleeding pattern. + Uterine fibroids: Although not directly related to Depo-Provera, uterine fibroids can cause heavy and prolonged menstrual bleeding. The right lower quadrant abdominal pain could be related to the fibroids. + Endometrial hyperplasia: This condition can cause heavy and prolonged menstrual bleeding, especially in women with hormonal imbalances.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Ectopic pregnancy: Although the patient denies pregnancy, it is essential to rule out ectopic pregnancy, especially with the presentation of abdominal pain and heavy bleeding. + Ovarian torsion: The right lower quadrant abdominal pain could be indicative of ovarian torsion, which is a medical emergency. + Uterine rupture or perforation: Although rare, uterine rupture or perforation can occur, especially if there is an underlying condition such as a previous uterine surgery.
- Rare diagnoses + Von Willebrand disease: A bleeding disorder that can cause heavy menstrual bleeding. + Uterine arteriovenous malformation: A rare condition that can cause heavy and prolonged menstrual bleeding. + Malignancy (e.g., cervical or uterine cancer): Although rare, malignancy can cause abnormal vaginal bleeding and should be considered in the differential diagnosis, especially if other symptoms such as weight loss or pelvic pain are present.