Differential Diagnosis for Vaginal Bleeding in a 17-Year-Old with Nexplanon
- Single Most Likely Diagnosis
- Irregular menstrual bleeding due to Nexplanon: This is the most likely diagnosis because Nexplanon, a progestin-only contraceptive implant, is known to cause irregular menstrual bleeding, especially in the first year after insertion. However, it can continue to cause irregular bleeding beyond the first year.
- Other Likely Diagnoses
- Breakthrough bleeding: This is a common side effect of hormonal contraceaths, including Nexplanon, and can occur at any time.
- Anovulatory cycles: These are common in adolescents and can cause irregular and heavy menstrual bleeding.
- Uterine fibroids or polyps: Although less common in adolescents, these can cause heavy and prolonged menstrual bleeding.
- Do Not Miss Diagnoses
- Pregnancy complications (e.g., ectopic pregnancy, miscarriage): Although Nexplanon is a highly effective contraceptive, pregnancy complications must be ruled out, especially if there is a possibility of contraceptive failure.
- Infection or pelvic inflammatory disease (PID): These can cause abnormal vaginal bleeding and are important to diagnose and treat promptly to prevent long-term complications.
- Malignancy (e.g., cervical cancer): Although rare in adolescents, cancer must be considered in the differential diagnosis, especially if the bleeding is persistent and unexplained.
- Rare Diagnoses
- Bleeding disorders (e.g., von Willebrand disease): These can cause heavy and prolonged menstrual bleeding, but are relatively rare.
- Thyroid disorders: Hypothyroidism or hyperthyroidism can cause menstrual irregularities, including heavy and prolonged bleeding.
- Adrenal disorders (e.g., Cushing's syndrome): These can cause menstrual irregularities, including heavy and prolonged bleeding, but are rare in adolescents.