Differential Diagnosis for Irregular Menstrual Cycle

Single Most Likely Diagnosis

• Polycystic Ovary Syndrome (PCOS): Given the patient's irregular menstrual cycle, previous regular cycles, and BMI of 31.4, PCOS is a strong consideration. PCOS is often associated with obesity, irregular menstrual cycles, and hyperandrogenism.

Other Likely Diagnoses

• Thyroid Dysfunction: Thyroid disorders, particularly hypothyroidism, can cause irregular menstrual cycles. The patient's symptoms could be related to an underlying thyroid issue.
• Stress or Weight-Related Amenorrhea: Significant weight changes or stress can disrupt the menstrual cycle. Although the patient's BMI is high, recent changes in weight or stress levels could contribute to her symptoms.
• Pituitary Adenoma: A non-cancerous tumor in the pituitary gland can affect hormone production, leading to irregular menstrual cycles.

Do Not Miss Diagnoses

• Pregnancy: Although the patient reports irregular bleeding, pregnancy should always be considered, especially if there has been any chance of conception.
• Uterine or Ovarian Cancer: While less common, cancer of the uterus or ovaries can cause irregular vaginal bleeding. Given the patient's age and symptoms, this is a critical diagnosis not to miss.
• Bleeding Disorders: Conditions like von Willebrand disease can cause heavy or irregular menstrual bleeding.

Rare Diagnoses

• Premature Ovarian Failure (POF): Also known as premature ovarian insufficiency, this condition is characterized by the loss of ovarian function before the age of 40, leading to irregular or ceased menstrual cycles.
• Asherman's Syndrome: A rare condition where scar tissue forms in the uterus, often due to uterine surgery, which can cause irregular menstrual bleeding.
• Hyperprolactinemia: Elevated levels of prolactin can disrupt menstrual cycles, although this is less common and often associated with other symptoms like galactorrhea.