Differential Diagnosis for Heavy Menstrual Bleeding in a 14-Year-Old Girl
- Single Most Likely Diagnosis
- A) Anovulatory cycles: This is the most likely cause given the patient's age and the recent onset of menarche. Anovulatory cycles are common in the first year after menarche, leading to irregular and heavy menstrual bleeding due to the lack of progesterone to stabilize the endometrium.
- Other Likely Diagnoses
- E) von Willebrand disease: Although there's no family history, von Willebrand disease is a common cause of heavy menstrual bleeding in adolescents and should be considered, especially if other signs of bleeding tendency are present.
- B) Chlamydial cervicitis: Given the patient's sexual activity and inconsistent use of condoms, a sexually transmitted infection like chlamydia could be a cause of her symptoms, although it would more typically present with pelvic pain, abnormal discharge, or intermenstrual bleeding.
- Do Not Miss Diagnoses
- D) Hypothyroidism: Although less common, hypothyroidism can cause menstrual irregularities and heavy bleeding. It's crucial to consider and rule out due to its potential long-term effects on health if left untreated.
- C) Endometriosis: While endometriosis is less likely in this age group and typically presents with severe dysmenorrhea, it should not be entirely ruled out, especially if the patient's symptoms persist or worsen over time.
- Rare Diagnoses
- Other rare causes might include bleeding disorders (aside from von Willebrand disease), ovarian cysts, or other endocrine disorders affecting menstrual regularity and heaviness. However, these would be less likely given the information provided and would typically require additional symptoms or findings for consideration.