Differential Diagnosis for 24 YOF with Severe Menstrual Cramping and Low Back Pain
- Single Most Likely Diagnosis
- Dysmenorrhea: This is the most common cause of severe menstrual cramping and low back pain in young women. It is caused by uterine contractions induced by prostaglandins, leading to ischemic pain.
- Other Likely Diagnoses
- Endometriosis: A condition where endometrial tissue grows outside the uterus, leading to chronic pelvic pain, dysmenorrhea, and dyspareunia. The presence of low back pain and severe menstrual cramping makes this a plausible diagnosis.
- Adenomyosis: A condition characterized by the growth of endometrial tissue into the uterine wall, leading to heavy menstrual bleeding, dysmenorrhea, and pelvic pressure.
- Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause pelvic pain, dysmenorrhea, and low back pain.
- Do Not Miss Diagnoses
- Ectopic Pregnancy: Although less likely in a patient with a regular menstrual cycle, an ectopic pregnancy can cause severe pelvic and low back pain, and is a life-threatening condition if not promptly diagnosed and treated.
- Ovarian Torsion: A rare but emergency condition where the ovary twists around its ligaments, cutting off blood supply and causing severe pelvic pain.
- Appendicitis: Although the pain is typically more localized to the right lower quadrant, appendicitis can sometimes present with pelvic and low back pain, especially in women.
- Rare Diagnoses
- Uterine Fibroids: Although more common in older women, uterine fibroids can cause dysmenorrhea, pelvic pressure, and low back pain in younger women.
- Interstitial Cystitis: A chronic condition causing bladder pressure, pain, and sometimes pelvic pain, which can be exacerbated by menstruation.
- Spinal Pathologies (e.g., disc disease, spondylosis): Although less likely, spinal pathologies can cause low back pain that coincides with menstruation, making it a differential diagnosis to consider.