Differential Diagnosis for Patient with Altered Bowel Habits, Cyclic Pain, Dysmenorrhea, History of Abortion and Infertility, and Uterus Size 863

• Single Most Likely Diagnosis
  • Endometriosis: This condition is characterized by the presence of endometrial tissue outside the uterus, leading to cyclic pain, dysmenorrhea, and infertility. The altered bowel habits could be related to endometriosis affecting the bowel. The history of abortion might be incidental or related to underlying fertility issues. The uterus size could be normal or slightly enlarged due to associated conditions like adenomyosis.
• Other Likely Diagnoses
  • Adenomyosis: This condition involves the growth of endometrial tissue into the uterine wall, which could explain the dysmenorrhea, cyclic pain, and the slightly enlarged uterus. Infertility and altered bowel habits might be associated symptoms or consequences of adenomyosis.
  • Uterine Fibroids: Fibroids can cause an enlarged uterus, dysmenorrhea, and infertility. They might also lead to altered bowel habits if they are large enough to press on the bowel or if they cause significant menstrual bleeding leading to anemia and associated symptoms.
  • Pelvic Inflammatory Disease (PID): PID can lead to infertility, chronic pelvic pain, and dysmenorrhea. Altered bowel habits might be a secondary effect of the inflammation or associated adhesions affecting the bowel.
• Do Not Miss Diagnoses
  • Ovarian Cancer: Although less likely, ovarian cancer can present with nonspecific symptoms such as altered bowel habits, pelvic pain, and infertility. A history of infertility and previous abortion might be risk factors. It's crucial to consider this diagnosis due to its severe implications and the need for early detection.
  • Colon Cancer: This could explain the altered bowel habits and, if advanced, could involve the uterus or cause pelvic pain. Although less directly related to dysmenorrhea and infertility, it's a critical diagnosis not to miss.
• Rare Diagnoses
  • Uterine Sarcoma: A rare type of cancer that could explain the enlarged uterus, pain, and other symptoms. It's less common than other uterine conditions but should be considered in the differential due to its severity.
  • Müllerian Agenesis (Mayer-Rokitansky-Küster-Hauser Syndrome): This rare congenital condition involves the underdevelopment or absence of the vagina and uterus, which could explain infertility. However, it would not directly explain the enlarged uterus size mentioned unless there was a variant of the condition or an associated anomaly.