Differential Diagnosis for Heavy Vaginal Bleeding in an 18-Year-Old Woman
- Single Most Likely Diagnosis
- Endometrial hyperplasia: This is the most likely diagnosis given the patient's presentation of heavy vaginal bleeding, the presence of endometrial hyperplasia without atypia on the pathology report, and the resolution of bleeding after dilation and curettage. The patient's obesity (BMI 44 kg/m2) also increases her risk for endometrial hyperplasia due to unopposed estrogen exposure.
- Other Likely Diagnoses
- Dysfunctional uterine bleeding (DUB): This condition is characterized by abnormal uterine bleeding in the absence of other detectable causes and is common in young women. The patient's history of daily vaginal bleeding with clots could be consistent with DUB, although the pathology findings point more specifically to endometrial hyperplasia.
- Polycystic ovary syndrome (PCOS): Although not directly diagnosed, PCOS could be a contributing factor given the patient's obesity and history of irregular menstrual bleeding. PCOS often leads to anovulatory cycles, which can result in unopposed estrogen stimulation of the endometrium, potentially leading to hyperplasia.
- Do Not Miss Diagnoses
- Pregnancy complications (e.g., ectopic pregnancy, miscarriage): Although the pregnancy test was negative, it's crucial to consider pregnancy-related complications in any female of childbearing age presenting with vaginal bleeding. These conditions can be life-threatening if not promptly diagnosed and treated.
- Malignancy (e.g., endometrial cancer): Given the family history of endometrial cancer, it's essential to consider the possibility of malignancy, even though the pathology report showed hyperplasia without atypia. Endometrial cancer can present with abnormal vaginal bleeding and is more common in individuals with a family history.
- Coagulopathy: Bleeding disorders can cause heavy menstrual bleeding. Although less likely given the specific pathology findings, coagulopathies are important to consider, especially if the patient has a history of easy bruising, bleeding gums, or heavy bleeding with minor injuries.
- Rare Diagnoses
- Uterine arteriovenous malformation (AVM): A rare condition that can cause heavy, uncontrollable vaginal bleeding due to abnormal connections between arteries and veins in the uterus.
- Uterine leiomyomas (fibroids) with degeneration: Although more common in older women, fibroids can occur in younger women and may cause heavy menstrual bleeding, especially if they undergo degeneration.
- Gestational trophoblastic disease: Although the pregnancy test was negative, very early pregnancies or molar pregnancies might not be detected by standard pregnancy tests and can cause abnormal vaginal bleeding.