Differential Diagnosis for Heavy Vaginal Bleeding in a 14-Year-Old Girl
- Single Most Likely Diagnosis
- Anovulatory bleeding: This is the most common cause of heavy vaginal bleeding in adolescents, especially in the first few years after menarche. The irregular menstrual cycles and the absence of pain suggest anovulation, which can lead to unopposed estrogen stimulation of the endometrium, resulting in heavy and prolonged bleeding.
- Other Likely Diagnoses
- Thyroid dysfunction: Abnormal thyroid function can cause menstrual irregularities and heavy bleeding. Although not directly indicated, it's a common enough condition to consider in the differential diagnosis.
- Polycystic Ovary Syndrome (PCOS): PCOS can cause irregular menstrual cycles and heavy bleeding due to anovulation and hormonal imbalance. The patient's age and symptoms could align with early signs of PCOS.
- Pregnancy complications (despite negative urine test): Although the urine pregnancy test is negative, it's essential to consider the possibility of an early pregnancy or a pregnancy-related complication, such as a miscarriage or an ectopic pregnancy, especially if the patient has been sexually active.
- Do Not Miss Diagnoses
- Bleeding disorders (e.g., von Willebrand disease): These conditions can cause significant bleeding and may not always have a clear family history. The patient's mother requiring a blood transfusion during delivery could hint at an underlying bleeding disorder.
- Trauma or sexual abuse: It's crucial to consider the possibility of trauma or sexual abuse as a cause of vaginal bleeding, especially in adolescents.
- Malignancy (e.g., cervical or uterine cancer): Although rare in adolescents, cancer must be considered to consider to avoid missing a potentially life-threatening condition.
- Rare Diagnoses
- Adrenal or ovarian tumors: These can cause hormonal imbalances leading to irregular and heavy menstrual bleeding.
- Coagulopathy (e.g., factor deficiencies): Similar to bleeding disorders, coagulopathies can cause significant bleeding and may have a subtle presentation.
- Other endocrine disorders (e.g., hyperprolactinemia, congenital adrenal hyperplasia): These conditions can affect menstrual regularity and heaviness of flow, though they are less common.