Differential Diagnosis for Secondary Amenorrhea
- Single most likely diagnosis
- Menopause: The patient is 43 years old and has not had a menstrual period since 2023, which suggests she may be experiencing premature menopause or perimenopause, given her age and the cessation of menstruation.
- Other Likely diagnoses
- Polycystic Ovary Syndrome (PCOS): Although PCOS is more commonly diagnosed in younger women, it can persist into the 40s and cause amenorrhea due to hormonal imbalances.
- Hypothyroidism: This condition can cause menstrual irregularities, including amenorrhea, and is more common in women, especially as they age.
- Hyperprolactinemia: Elevated prolactin levels can disrupt menstrual cycles, leading to amenorrhea, and can be caused by various factors, including pituitary tumors.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pituitary Tumor: Although rare, a pituitary tumor can cause hyperprolactinemia or disrupt other hormonal balances, leading to amenorrhea. Early detection is crucial for effective treatment.
- Ovarian Failure due to Chemotherapy or Radiation: If the patient has undergone cancer treatment, her ovaries may have been damaged, leading to premature ovarian failure.
- Asherman Syndrome: This condition, characterized by scarring in the uterus, can cause amenorrhea and is often associated with previous uterine surgery or infection.
- Rare diagnoses
- Sheehan Syndrome: A rare condition caused by necrosis of the pituitary gland, often following severe postpartum hemorrhage, which can lead to hormonal deficiencies and amenorrhea.
- Autoimmune Disorders (e.g., autoimmune oophoritis): These conditions can cause ovarian failure and subsequent amenorrhea, although they are less common.
- Genetic Disorders (e.g., Turner Syndrome): While typically diagnosed earlier in life, some genetic disorders can lead to ovarian dysgenesis and amenorrhea, presenting later in life in rare cases.