Differential Diagnosis

The patient presents with a complex array of symptoms including irregular menstrual cycles, severe menstrual pain, muscle pain, chest pain, and throat tension. Considering these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Dysmenorrhea with possible underlying hormonal imbalance or endometriosis: This diagnosis is likely due to the patient's complaints of severe menstrual cramps, heavy bleeding, and irregular menstrual cycles. These symptoms are classic for dysmenorrhea, and the presence of heavy bleeding and irregular cycles may suggest an underlying hormonal imbalance or endometriosis.

• Other Likely Diagnoses

  • Anxiety or stress-related disorders: Given the patient's history of possible depression, estrangement from parents, and use of substances like marijuana and vaping, anxiety or stress could be contributing to or exacerbating her physical symptoms.
  • Musculoskeletal issues: The ongoing muscle pain could be related to musculoskeletal issues, possibly exacerbated by or unrelated to her menstrual cycle.
  • Gastroesophageal reflux disease (GERD): The complaint of throat tension when swallowing water could suggest GERD, especially if the patient experiences heartburn or regurgitation.

• Do Not Miss Diagnoses

  • Cardiac issues (e.g., pericarditis, myocarditis): Although less likely, the chest pain and possible palpitations are red flags for cardiac issues. These conditions can be life-threatening and must be ruled out.
  • Pulmonary embolism: Given the recent onset of cough and chest pain, pulmonary embolism, although unlikely in a young patient without clear risk factors, is a diagnosis that cannot be missed due to its high mortality rate.
  • Thyroid disorders: Thyroid dysfunction can cause menstrual irregularities, muscle pain, and other systemic symptoms. Given the breadth of symptoms, thyroid function tests are warranted.

• Rare Diagnoses

  • Adenomyosis: A condition where tissue similar to the lining inside the uterus is found outside its normal location, leading to severe menstrual cramps and heavy bleeding. It's less common than endometriosis but could explain some of the patient's symptoms.
  • Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. It could explain the patient's musculoskeletal pain and possibly her menstrual irregularities, though it is a rare condition.
  • Chiari malformation: A condition where the brain tissue extends into the spinal canal, which could potentially cause a variety of symptoms including muscle pain and possibly some of the other symptoms described, though it's quite rare and less directly related to the patient's primary complaints.