Differential Diagnosis for 55F with Heavy Periods and Night Sweats
- Single Most Likely Diagnosis
- Menopause: The patient's age, symptoms of heavy periods, irregular menstrual cycles, and night sweats are consistent with perimenopause or menopause. The duration and irregularity of her periods, along with night sweats, are classic symptoms of this transition.
- Other Likely Diagnoses
- Uterine Fibroids: These are common in women of this age group and can cause heavy, prolonged menstrual bleeding. The patient's history of multiple pregnancies (G4P4) also increases her risk for fibroids.
- Thyroid Dysfunction: Both hypothyroidism and hyperthyroidism can cause menstrual irregularities and heavy bleeding. The patient's symptoms of trouble sleeping and night sweats could also be related to thyroid issues, although they are more commonly associated with hyperthyroidism.
- Polycystic Ovary Syndrome (PCOS): Although PCOS is typically diagnosed earlier in life, some women may not be diagnosed until later. The irregular periods and heavy bleeding could be consistent with PCOS, especially if she has other signs such as hirsutism or obesity.
- Do Not Miss Diagnoses
- Endometrial Hyperplasia or Cancer: Postmenopausal bleeding or irregular, heavy bleeding in perimenopausal women can be a sign of endometrial hyperplasia or cancer. Given the patient's age and symptoms, it's crucial to rule out these conditions.
- Bleeding Disorders: Conditions like von Willebrand disease can cause heavy menstrual bleeding. Although less common, these disorders should be considered, especially if the patient has a history of easy bruising or bleeding.
- Rare Diagnoses
- Adenomyosis: This condition, where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, can cause heavy and painful periods. It's less common but should be considered if other diagnoses are ruled out.
- Ovarian Tumors: Although rare, ovarian tumors can cause irregular bleeding and should be considered in the differential diagnosis, especially if there are other symptoms such as pelvic pain or a palpable mass.