Differential Diagnosis for a 45-year-old Female with Heavy Periods, Constipation, and Night Sweats

• Single Most Likely Diagnosis
  • Menopause or Perimenopause: This is the most likely diagnosis given the patient's age and symptoms. Heavy periods, constipation, and night sweats are common symptoms associated with the hormonal changes of menopause or perimenopause.
• Other Likely Diagnoses
  • Uterine Fibroids: These can cause heavy menstrual bleeding and constipation due to pressure on the rectum. While not directly related to night sweats, the overall symptom profile could fit, especially if the patient is experiencing significant menstrual irregularities.
  • Hypothyroidism: This condition can cause constipation and heavy menstrual periods. Night sweats are less commonly associated with hypothyroidism but can occur, making it a plausible diagnosis.
  • Polycystic Ovary Syndrome (PCOS): Although PCOS is more commonly diagnosed in younger women, it can persist into older age. Symptoms can include heavy periods, although more commonly, patients experience irregular periods. Constipation and night sweats are less typical but can be part of the broader metabolic and hormonal disturbances seen in PCOS.
• Do Not Miss Diagnoses
  • Endometrial Cancer: While less likely, endometrial cancer can cause heavy vaginal bleeding and should be considered, especially if the patient has risk factors such as obesity, diabetes, or a family history of endometrial or colorectal cancer.
  • Ovarian Cancer: Although night sweats are not a typical presenting symptom, ovarian cancer can cause a variety of nonspecific symptoms including abdominal bloating, constipation, and changes in menstrual patterns. It's crucial to consider this diagnosis due to its potential severity.
  • Thyroid Storm (Hyperthyroidism): This is a life-threatening condition that can cause night sweats, among other symptoms like weight loss, palpitations, and heat intolerance. While less directly related to heavy periods and constipation, the severity of thyroid storm necessitates its consideration.
• Rare Diagnoses
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause night sweats, among other symptoms like hypertension, palpitations, and headache. Menstrual irregularities and constipation are less common presentations but could be part of the broader symptom complex.
  • Carcinoid Syndrome: This rare condition, caused by a neuroendocrine tumor, can lead to a variety of symptoms including flushing, diarrhea (less commonly constipation), and potentially menstrual irregularities due to the systemic effects of the tumor's secretions. Night sweats can also occur.