A 24-year-old college student with 20 days of intermittent heavy vaginal bleeding with clots, fatigue, lightheadedness, and irregular menses but no bruising. What is the most likely cause of heavy menses?

A 24-year-old college student with 20 days of intermittent heavy vaginal bleeding with clots, fatigue, lightheadedness, and irregular menses but no bruising. What is the most likely cause of heavy menses?

• A. Anovulation
• B. Endometrial hyperplasia
• C. Von Willebrand disease
• D. Uterine fibroids

Answer: (A)

Heavy menses with irregular cycles in a young woman is most often due to anovulatory cycles. When ovulation doesn’t occur, there’s no progesterone produced after ovulation. Estrogen continues to drive endometrial growth, so the lining becomes thick and unstable. It then sheds in a piecemeal, unpredictable way, producing prolonged or heavy bleeding with clots and symptoms of anemia like fatigue and lightheadedness. This pattern fits someone with irregular menses and heavy bleeding, without signs of a bleeding disorder. Why the other possibilities fit less well: a bleeding disorder like von Willebrand disease would typically show mucosal bleeding or easy bruising, which aren’t described here. Endometrial hyperplasia results from prolonged unopposed estrogen and is more common in older individuals or those with risk factors; it’s less likely in a healthy 24-year-old without such risks. Uterine fibroids can cause heavy bleeding but usually present with a pelvic mass or pressure symptoms and are less common in someone this age without other indicators.

Heavy menses with irregular cycles in a young woman is most often due to anovulatory cycles. When ovulation doesn’t occur, there’s no progesterone produced after ovulation. Estrogen continues to drive endometrial growth, so the lining becomes thick and unstable. It then sheds in a piecemeal, unpredictable way, producing prolonged or heavy bleeding with clots and symptoms of anemia like fatigue and lightheadedness. This pattern fits someone with irregular menses and heavy bleeding, without signs of a bleeding disorder.

Why the other possibilities fit less well: a bleeding disorder like von Willebrand disease would typically show mucosal bleeding or easy bruising, which aren’t described here. Endometrial hyperplasia results from prolonged unopposed estrogen and is more common in older individuals or those with risk factors; it’s less likely in a healthy 24-year-old without such risks. Uterine fibroids can cause heavy bleeding but usually present with a pelvic mass or pressure symptoms and are less common in someone this age without other indicators.