Differential Diagnosis for Heavy Menses with No Pregnancy
Single Most Likely Diagnosis
- Dysfunctional Uterine Bleeding (DUB): This is the most common cause of heavy menstrual bleeding in the absence of pregnancy, often related to hormonal imbalances, particularly anovulatory cycles leading to prolonged and heavy bleeding.
Other Likely Diagnoses
- Uterine Fibroids: These are common benign tumors that can cause heavy menstrual bleeding due to their location, size, and effect on uterine contraction and blood flow.
- Endometrial Hyperplasia: A condition where the lining of the uterus grows too thick, which can lead to heavy and prolonged menstrual bleeding.
- Adenomyosis: A condition where tissue similar to the lining inside the uterus is found outside its normal location, leading to heavy and painful periods.
- Hormonal Imbalance: Including conditions like polycystic ovary syndrome (PCOS) or thyroid disorders, which can disrupt normal menstrual cycles and lead to heavy bleeding.
Do Not Miss Diagnoses
- Cancer (Endometrial or Cervical): Although less common, cancer of the uterus or cervix can present with abnormal vaginal bleeding, including heavy menses, and is critical to diagnose early for effective treatment.
- Bleeding Disorders (e.g., von Willebrand Disease): These conditions can lead to heavy menstrual bleeding due to difficulties in blood clotting and are important to identify for appropriate management.
- Pregnancy-Related Conditions (e.g., Ectopic Pregnancy): Even though the question specifies "no pregnancy," it's crucial to rule out pregnancy-related complications, especially if there's any chance of an undiagnosed pregnancy.
Rare Diagnoses
- Uterine Arteriovenous Malformations (AVMs): Abnormal connections between arteries and veins in the uterus can cause heavy, unpredictable bleeding.
- Uterine Infections or Inflammatory Conditions: Certain infections or inflammatory conditions of the uterus can lead to heavy menstrual bleeding, though these are less common causes.
- Systemic Conditions Affecting Coagulation: Conditions like liver disease or severe thrombocytopenia can affect blood clotting and lead to heavy menstrual bleeding, though these would typically be associated with other symptoms as well.