Differential Diagnosis for Skipping Menstrual Cycles at Age 38

Single Most Likely Diagnosis

• Perimenopause: This is the most likely diagnosis for a 38-year-old woman experiencing skipped menstrual cycles. Perimenopause is the transition period leading up to menopause, during which hormonal changes can cause irregular menstrual cycles, including skipped periods. It typically starts in a woman's 40s but can begin earlier.

Other Likely Diagnoses

• Polycystic Ovary Syndrome (PCOS): Although PCOS is often diagnosed in younger women, it can persist into the late 30s and 40s, causing irregular menstrual cycles due to hormonal imbalances.
• Thyroid Dysfunction: Both hypothyroidism and hyperthyroidism can affect menstrual regularity. Thyroid issues are common in women of this age group and can cause skipped periods.
• Stress and Weight Changes: Significant stress or changes in weight can disrupt the normal menstrual cycle, leading to skipped periods. This is due to the impact of stress and weight changes on hormonal balances.

Do Not Miss Diagnoses

• Pituitary Tumors: Although rare, pituitary tumors can cause hormonal imbalances that lead to skipped menstrual cycles. Early detection is crucial for effective treatment.
• Premature Ovarian Failure (POF): Now more commonly referred to as Premature Ovarian Insufficiency (POI), this condition involves the loss of normal ovarian function before the age of 40. It's a critical diagnosis not to miss, as it has significant implications for fertility and long-term health.
• Hyperprolactinemia: Elevated levels of prolactin can suppress the normal menstrual cycle, leading to skipped periods. This condition can be caused by pituitary tumors, certain medications, or other factors.

Rare Diagnoses

• Asherman’s Syndrome: A rare condition characterized by the formation of scar tissue in the uterus, which can lead to lighter or skipped periods. It often results from uterine surgery, such as a dilation and curettage (D&C).
• Congenital Adrenal Hyperplasia (CAH): A group of inherited disorders that affect the adrenal glands, leading to hormone imbalances. Although typically diagnosed in infancy or childhood, some milder forms may not be diagnosed until adulthood, potentially causing menstrual irregularities.