Differential Diagnosis
- Single most likely diagnosis:
- Breakthrough bleeding due to extended use of birth control pills: This is the most likely diagnosis given the patient's history of taking birth control pills back to back, which can lead to irregular menstrual bleeding, including breakthrough bleeding.
- Other Likely diagnoses:
- Hormonal imbalance: The patient's irregular menstrual bleeding could be due to hormonal imbalances caused by the extended use of birth control pills.
- Menstrual irregularity: The patient's menstrual cycle has been disrupted due to the back-to-back use of birth control pills, leading to irregular and prolonged menstrual bleeding.
- Ibuprofen and fluoxetine interaction: Although less likely, the interaction between ibuprofen and fluoxetine could potentially contribute to increased menstrual bleeding, as the patient has suggested.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Ectopic pregnancy: Although unlikely, given the patient's use of birth control pills, an ectopic pregnancy could present with irregular vaginal bleeding and must be ruled out.
- Uterine cancer or other gynecological malignancies: Unusual or prolonged vaginal bleeding can be a symptom of uterine cancer or other gynecological malignancies, and must be considered in the differential diagnosis.
- Rare diagnoses:
- Bleeding disorders (e.g., von Willebrand disease): Although rare, bleeding disorders could potentially contribute to the patient's prolonged and heavy menstrual bleeding.
- Thyroid disorders: Certain thyroid disorders, such as hypothyroidism, can cause menstrual irregularities, including heavy or prolonged bleeding.