Differential Diagnosis for a 23-Year-Old Female with Prolonged Menstruation and Associated Symptoms

• Single Most Likely Diagnosis
  • Dysmenorrhea: This condition is characterized by painful menstrual cramps, often accompanied by other symptoms such as nausea and vomiting. The patient's history of period pains since menarche and the timing of symptoms in relation to her menstrual cycle support this diagnosis. The vomiting on the second day could be related to the severity of the pain or associated with the stress and discomfort of menstruation.
• Other Likely Diagnoses
  • Menorrhagia: Although the primary complaint is the duration of menstruation and associated symptoms, menorrhagia (heavy menstrual bleeding) could contribute to or exacerbate the patient's condition, potentially leading to symptoms like vomiting due to iron deficiency anemia or the physical and emotional toll of heavy bleeding.
  • Premenstrual Dysphoric Disorder (PMDD): While the primary symptoms described are related to menstruation, some women with PMDD can experience severe physical symptoms during their menstrual cycle, including nausea and vomiting, in addition to the more commonly recognized mood symptoms.
• Do Not Miss Diagnoses
  • Ectopic Pregnancy: Although less likely given the regularity of the patient's menstrual cycle and the absence of reported missed periods or positive pregnancy tests, ectopic pregnancy can present with abdominal pain and vomiting. It's crucial to rule out pregnancy, especially if there's any chance of the patient being pregnant.
  • Pelvic Inflammatory Disease (PID): This condition can cause severe pelvic pain, nausea, and vomiting. While the cyclic nature of the patient's symptoms might suggest a menstrual cause, PID needs to be considered, especially if there are risk factors for sexually transmitted infections.
  • Ovarian Cysts or Torsion: Ovarian cysts can cause periodic pain and other symptoms that might coincide with menstruation. Ovarian torsion is a surgical emergency that can present with severe pain, nausea, and vomiting, making it a critical diagnosis not to miss.
• Rare Diagnoses
  • Bleeding Disorders: Conditions like von Willebrand disease can lead to heavy menstrual bleeding and potentially to symptoms like those described, although they would be less common and typically associated with a history of easy bruising or bleeding.
  • Endometriosis: While endometriosis can cause dysmenorrhea, its diagnosis often requires laparoscopic confirmation. The symptoms can be similar to those described, but endometriosis might also include symptoms like dyspareunia or bowel symptoms during menstruation.