Differential Diagnosis for a 36-year-old Woman with Heavy Menses, Urinary Frequency, and Pelvic Fullness
- Single Most Likely Diagnosis
- Uterine Fibroids: The patient's symptoms of heavy menses, urinary frequency, and a feeling of fullness in the pelvis, along with an enlarged and irregularly shaped uterus on exam, strongly suggest uterine fibroids. These benign tumors are common in women of reproductive age and can cause significant menstrual bleeding and pelvic pressure symptoms.
- Other Likely Diagnoses
- Adenomyosis: This condition, where endometrial tissue grows into the uterine wall, can cause heavy menstrual bleeding, pelvic pain, and an enlarged uterus. The patient's symptoms and the irregular shape of her uterus could also be consistent with adenomyosis.
- Endometrial Hyperplasia: Although less likely to cause an irregularly shaped uterus, endometrial hyperplasia can lead to heavy menstrual bleeding due to the thickening of the uterine lining. This condition is more common in women around the age of menopause but can occur in younger women, especially those with risk factors like obesity or unopposed estrogen exposure.
- Do Not Miss Diagnoses
- Uterine Cancer: While less common than benign conditions like fibroids, uterine cancer (endometrial carcinoma) is a critical diagnosis not to miss. Risk factors include unopposed estrogen exposure, obesity, and a family history of certain cancers. The patient's age and symptoms of heavy bleeding and pelvic fullness necessitate consideration of this diagnosis.
- Ovarian Cancer: Ovarian cancer can present with non-specific symptoms like pelvic fullness and pressure. Although less directly linked to heavy menses, it's a diagnosis that must be considered due to its potential severity and the fact that early stages may have vague symptoms.
- Rare Diagnoses
- Uterine Sarcoma: A rare type of cancer that originates in the muscle and supporting tissues of the uterine walls. Symptoms can mimic those of more common conditions like fibroids but are much less likely.
- Vascular Malformations: Rare vascular anomalies within the uterus could potentially cause heavy menstrual bleeding and pelvic symptoms, though they are much less common than other diagnoses listed here.