What is the most likely diagnosis for a 38-year-old woman, gravida (number of times pregnant) 3, para (number of viable births) 3, presenting with abnormal uterine bleeding, amenorrhea (absence of menstruation), and a large pelvic mass, with no chronic medical conditions and a history of bilateral tubal ligation (surgical procedure for female sterilization)?

Differential Diagnosis for Abnormal Uterine Bleeding

The patient presents with abnormal uterine bleeding, amenorrhea, and a large pelvic mass. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Uterine Leiomyoma (Fibroids): The patient's symptoms of abnormal uterine bleeding, intermenstrual spotting, and a large pelvic mass are consistent with uterine leiomyoma. The presence of coarse hair on the upper lip and bitemporal hair thinning may suggest an androgenetic effect, but this is not a primary indicator. The patient's age, parity, and symptoms align with the typical presentation of uterine fibroids.
• Other Likely diagnoses
  • Polycystic Ovary Syndrome (PCOS): Although the patient's symptoms of abnormal uterine bleeding and amenorrhea could be consistent with PCOS, the presence of a large pelvic mass and the patient's age make this diagnosis less likely. However, the presence of coarse hair on the upper lip and bitemporal hair thinning could suggest an androgen excess, which is common in PCOS.
  • Endometrial Hyperplasia: This condition can cause abnormal uterine bleeding, but it is less likely to cause a large pelvic mass. However, it is still a possible diagnosis, especially given the patient's age and symptoms.
• Do Not Miss
  • Ovarian Tumor: Although less likely, an ovarian tumor could cause a large pelvic mass and abnormal uterine bleeding. It is essential to consider this diagnosis due to its potential severity and impact on the patient's health.
  • Uterine Cancer: This is another critical diagnosis to consider, as it can cause abnormal uterine bleeding and a pelvic mass. Although less likely in a 38-year-old woman, it is essential to rule out this diagnosis due to its severity.
• Rare diagnoses
  • Adenomyosis: This condition can cause abnormal uterine bleeding and a large uterus, but it is less likely to cause a distinct pelvic mass.
  • Uterine Sarcoma: This is a rare and aggressive tumor that can cause abnormal uterine bleeding and a pelvic mass. Although unlikely, it is essential to consider this diagnosis due to its severity and potential impact on the patient's health.