Differential Diagnosis for Abnormal Vaginal Bleeding and Pelvic Pain
- Single most likely diagnosis
- Perforation of the uterus by the IUD: This is a possible complication of IUD insertion, especially given the patient's history of amenorrhea followed by vaginal spotting and the development of constant pelvic pain. The presence of uterine tenderness on examination supports this diagnosis.
- Other Likely diagnoses
- Infection or pelvic inflammatory disease (PID): The patient's symptoms of pelvic pain, uterine and adnexal tenderness, and vaginal spotting could be indicative of an infection, possibly related to the IUD.
- IUD malposition: If the IUD is not properly positioned, it could cause symptoms like pelvic pain and vaginal bleeding.
- Ovarian cysts: These can cause pelvic pain and are common in women of reproductive age. The adnexal tenderness noted on examination could suggest an ovarian cyst.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although the urine pregnancy test is negative, it's crucial to consider ectopic pregnancy due to its potentially life-threatening nature. A negative test does not entirely rule out pregnancy, especially if it's very early.
- Appendicitis: While less directly related to the IUD or vaginal bleeding, appendicitis can present with pelvic pain and must be considered due to its potential for serious complications if not promptly treated.
- Rare diagnoses
- Uterine or cervical cancer: Although rare in a 24-year-old, any abnormal vaginal bleeding warrants consideration of malignancy, especially if other causes are ruled out.
- Endometriosis: This condition can cause pelvic pain and abnormal bleeding, though it might not directly relate to the IUD's presence. It's less likely given the patient's age and the specific context of IUD use but remains a consideration for chronic pelvic pain.