Differential Diagnosis for Abnormal Uterine Bleeding
The patient presents with intermenstrual bleeding and monthly menses with moderate bleeding, which requires a thorough evaluation to determine the underlying cause. The following differential diagnoses are categorized based on their likelihood and potential impact on the patient's health.
- Single Most Likely Diagnosis
- Endometrial polyps: The patient's symptoms of intermenstrual bleeding and the presence of bright red blood at the os on speculum examination suggest a possible endometrial polyp. These growths are common in women of this age group and can cause irregular bleeding.
- Other Likely Diagnoses
- Anovulatory bleeding: Although the patient's FSH, TSH, and prolactin levels are normal, anovulatory cycles can still occur, leading to irregular bleeding. This diagnosis is more common in women with irregular menstrual cycles, but it's still a possibility in this case.
- Uterine fibroids: The patient's history of multiparity and age increase the likelihood of uterine fibroids, which can cause abnormal uterine bleeding. However, the absence of palpable uterine enlargement or tenderness on bimanual examination makes this diagnosis less likely.
- Intrauterine adhesions (Asherman's syndrome): Although the patient had a bilateral tubal ligation, which is not typically associated with intrauterine adhesions, this condition can still occur, especially if there was any instrumentation or infection of the uterus in the past.
- Do Not Miss Diagnoses
- Endometrial hyperplasia or cancer: These conditions are less common but can be life-threatening if not diagnosed and treated promptly. The patient's normal FSH level and lack of other symptoms do not rule out these diagnoses, and further evaluation with endometrial sampling may be necessary.
- Cervical cancer: Although the speculum examination did not reveal any visible cervical or vaginal lesions, cervical cancer can still present with abnormal uterine bleeding. A Pap smear and further evaluation may be necessary to rule out this diagnosis.
- Rare Diagnoses
- Uterine sarcoma: This is a rare and aggressive tumor that can cause abnormal uterine bleeding. Although it is unlikely, it should be considered in the differential diagnosis, especially if other evaluations do not reveal a clear cause for the patient's symptoms.
- Bleeding disorders: Conditions such as von Willebrand disease or platelet function disorders can cause abnormal uterine bleeding. However, these diagnoses are rare and typically present with other symptoms, such as easy bruising or bleeding after trauma.