What is the diagnosis and treatment plan for a patient presenting with menorrhagia (abnormal uterine bleeding), anemia, and atypical chest pain, who is due for a Depo-Provera (medroxyprogesterone) injection and repeat laboratory tests, and has a history of smoking and gastrointestinal upset?

Differential Diagnosis

The patient presents with two main concerns: significant menorrhagia and occasional chest pain with GI upset. The differential diagnosis for these symptoms can be categorized as follows:

• Single Most Likely Diagnosis

  • Menorrhagia: Dysfunctional Uterine Bleeding (DUB) due to hormonal imbalance, given the patient's history of heavy and prolonged menstrual bleeding.
  • Chest pain: Gastroesophageal Reflux Disease (GERD), considering the association with GI upset, burping, and potential triggers like posture and smoking.

• Other Likely Diagnoses

  • Menorrhagia:
    • Uterine Fibroids, which can cause heavy and prolonged menstrual bleeding.
    • Adenomyosis, characterized by heavy and painful periods.
    • Hypothyroidism, which can lead to menstrual irregularities and heavy bleeding.
  • Chest pain:
    • Musculoskeletal Chest Pain, given the patient's belief that symptoms may be related to posture.
    • Gastritis or Peptic Ulcer Disease, considering the GI upset and potential irritants like smoking.

• Do Not Miss Diagnoses

  • Menorrhagia:
    • Uterine Cancer, although less likely, it's crucial to rule out due to the potential severity.
    • Bleeding Disorders, such as von Willebrand disease, which can cause significant menstrual bleeding.
  • Chest pain:
    • Acute Coronary Syndrome (ACS), including myocardial infarction, which must be ruled out despite the absence of typical symptoms like diaphoresis or crushing chest pain.
    • Pulmonary Embolism, a life-threatening condition that can present with chest pain and anxiety.

• Rare Diagnoses

  • Menorrhagia:
    • Uterine Arteriovenous Malformation (AVM), a rare condition that can cause heavy menstrual bleeding.
    • Systemic Diseases like lupus or rheumatoid arthritis, which can have menstrual irregularities as part of their presentation.
  • Chest pain:
    • Esophageal Spasm or Esophageal Rupture, rare conditions that can cause chest pain and GI symptoms.
    • Cardiac Sarcoidosis, a rare inflammatory condition affecting the heart, which can present with chest pain and other cardiac symptoms.