Differential Diagnosis for Irregular Menses in a Female Person
Single Most Likely Diagnosis
- Polycystic Ovary Syndrome (PCOS): This is a common endocrine disorder among women of reproductive age, often presenting with irregular menstrual cycles, which can range from oligomenorrhea (infrequent periods) to amenorrhea (absence of periods). The hormonal imbalance, particularly high levels of androgens, disrupts ovulation, leading to irregular menses.
Other Likely Diagnoses
- Thyroid Dysfunction: Both hypothyroidism and hyperthyroidism can affect menstrual regularity. Thyroid hormones play a role in regulating the menstrual cycle, and abnormalities can lead to irregular periods.
- Stress and Weight Changes: Significant stress and changes in weight can disrupt the normal functioning of the hypothalamic-pituitary-ovarian axis, leading to irregular menses.
- Premature Ovarian Failure (POF): Also known as premature ovarian insufficiency, this condition occurs when the ovaries stop functioning and menstruation ceases before the age of 40. It can present with irregular periods before the cessation of menstruation.
Do Not Miss Diagnoses
- Pituitary Tumors: Although rare, tumors of the pituitary gland, such as prolactinomas, can cause an overproduction of prolactin, leading to irregular menses or amenorrhea. Early detection is crucial for effective management.
- Hyperprolactinemia: Elevated levels of prolactin can disrupt the normal menstrual cycle, leading to irregular periods. Causes can include pituitary tumors, certain medications, and thyroid disease.
- Uterine or Ovarian Cancer: Though less common, cancers of the uterus or ovaries can present with irregular vaginal bleeding, including irregular menses.
Rare Diagnoses
- Congenital Adrenal Hyperplasia: A group of inherited disorders that affect the adrenal glands, leading to hormone imbalances that can cause irregular menses among other symptoms.
- Androgen Insensitivity Syndrome: A rare condition where an individual is genetically male (XY chromosomes) but has a partial or complete inability to respond to androgens, leading to the development of female external genitalia but with undescended testes and no uterus, which can present with primary amenorrhea.
- Asherman Syndrome: A rare condition characterized by the formation of adhesions or scar tissue in the uterus, often as a result of uterine surgery, which can lead to irregular periods or amenorrhea.