Differential Diagnosis for Syncope and Vomiting around the Menstrual Cycle
Single Most Likely Diagnosis
- Premenstrual Syndrome (PMS): This condition is characterized by physical, emotional, and behavioral symptoms that occur in the premenstrual phase of a woman's cycle and resolve with the onset of menses. Symptoms can include nausea, vomiting, and in some cases, syncope due to vasovagal reactions or dehydration from vomiting.
Other Likely Diagnoses
- Dysmenorrhea: Severe menstrual cramps can lead to nausea, vomiting, and syncope, especially if the pain is extreme and leads to a vasovagal response.
- Anxiety or Panic Disorder: These conditions can exacerbate around the menstrual cycle due to hormonal changes and may cause symptoms of nausea, vomiting, and syncope.
- Hormonal Migraines: Migraines related to hormonal fluctuations during the menstrual cycle can cause nausea, vomiting, and in severe cases, lead to syncope.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although less likely if the patient has a regular menstrual cycle, an ectopic pregnancy can cause syncope and vomiting due to internal bleeding and should always be considered, especially if there's a possibility of pregnancy.
- Ovarian Torsion: This is a surgical emergency that can cause severe abdominal pain, nausea, vomiting, and syncope. It's crucial to consider, especially if the pain is sudden and severe.
- Cardiac Conditions (e.g., Long QT Syndrome): Certain cardiac conditions can cause syncope and may be exacerbated by hormonal changes or other factors related to the menstrual cycle.
Rare Diagnoses
- Sheehan Syndrome: A rare condition caused by necrosis of the pituitary gland, usually following severe postpartum hemorrhage, but could potentially be related to menstrual cycle irregularities and cause a variety of symptoms including syncope and vomiting.
- Catamenial Pneumothorax: A rare condition where the menstrual cycle triggers a spontaneous pneumothorax, which could lead to symptoms including syncope and vomiting due to the sudden onset of chest pain and shortness of breath.
- Endometriosis: While not typically causing syncope directly, severe endometriosis can lead to significant pain, nausea, and vomiting, and in rare cases, may contribute to conditions that result in syncope.