Differential Diagnosis for Abnormal Uterine Bleeding
The patient's symptoms of irregular menstrual bleeding, sometimes occurring every two weeks and sometimes every month, can be evaluated under the following categories:
- Single Most Likely Diagnosis + Anovulatory bleeding: This condition is common in women of reproductive age, especially during the perimenopausal transition. It occurs due to the absence of ovulation, leading to irregular and unpredictable bleeding patterns. The patient's age and the irregularity of her bleeding make this a plausible diagnosis.
- Other Likely Diagnoses + Uterine fibroids: These are benign tumors that can cause irregular bleeding, including frequent or prolonged menstrual periods. They are common in women of reproductive age and could explain the patient's symptoms. + Endometrial polyps: These growths on the lining of the uterus can cause irregular bleeding, including bleeding between periods or heavier-than-usual periods. + Hormonal imbalance: Changes in hormone levels, such as those caused by polycystic ovary syndrome (PCOS) or thyroid disorders, can lead to irregular menstrual bleeding.
- Do Not Miss Diagnoses + Endometrial cancer: Although less common, endometrial cancer can cause irregular vaginal bleeding and must be considered, especially in women over 40. It's crucial to rule out this potentially life-threatening condition. + Uterine cancer: Similar to endometrial cancer, uterine cancer can cause abnormal uterine bleeding and should not be overlooked. + Bleeding disorders: Conditions like von Willebrand disease can cause heavy or prolonged menstrual bleeding and should be considered, especially if the patient has a history of easy bruising or bleeding.
- Rare Diagnoses + Adenomyosis: A condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, potentially causing heavy or painful periods. + Uterine sarcoma: A rare type of cancer that begins in the muscle and supporting tissues of the uterine walls, which can cause abnormal uterine bleeding among other symptoms. + Hyperplasia: An overgrowth of the lining of the uterus, which can be caused by an imbalance of hormones and may lead to irregular bleeding.
Each of these diagnoses should be considered and evaluated based on the patient's complete medical history, physical examination, and appropriate diagnostic tests to determine the underlying cause of her abnormal uterine bleeding.