Gastroesophageal Reflux Disease (GERD): This is often the most common cause of chest pain in females, especially if the pain is related to eating or lying down. GERD can cause a burning sensation in the chest that may be mistaken for cardiac pain.

Anxiety or Panic Disorder: These conditions can cause chest pain or discomfort, often accompanied by other symptoms like shortness of breath, palpitations, and fear of dying. They are common in females and can be triggered by stress or specific situations.
Musculoskeletal Pain: Strain or injury to the muscles or bones in the chest wall can cause pain, which might be exacerbated by movement or deep breathing. This is a common cause of chest pain in both genders.
Asthma or Chronic Obstructive Pulmonary Disease (COPD): Respiratory conditions can cause chest pain or tightness, especially during exacerbations or if the condition is not well-managed.

Acute Coronary Syndrome (ACS): Although less common in premenopausal women, ACS (including myocardial infarction) is a critical diagnosis that must not be missed. The presentation can be atypical, with symptoms like chest discomfort, shortness of breath, or fatigue.
Pulmonary Embolism (PE): This is a life-threatening condition that requires immediate diagnosis and treatment. Symptoms can include sudden onset of chest pain, shortness of breath, and possibly cough or hemoptysis.
Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that radiates to the back. It is less common but critical to diagnose promptly due to its high mortality rate.
Pneumonia: Infection of the lung can cause chest pain, especially if it involves the pleura. It's crucial to diagnose and treat promptly to avoid complications.

Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that improves with sitting up and leaning forward. It is less common but can be associated with viral infections or systemic diseases.
Esophageal Spasm or Esophageal Rupture: These conditions can cause severe chest pain and are related to the esophagus. They are less common than other causes of chest pain but require specific treatment.
Pneumothorax: Air in the pleural space can cause chest pain and shortness of breath. It is more common in tall, thin males but can occur in females, especially if there is an underlying lung condition.