Differential Diagnosis

The patient's symptoms of anger, irritability, emotional changes, bloating, weight gain, and heavy cramping before and during her period suggest a range of possible diagnoses. Here is a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Premenstrual Dysphoric Disorder (PMDD): This condition is characterized by severe mood and physical symptoms that occur in the premenstrual phase of a woman's cycle and then decline once menstruation starts. The patient's symptoms of anger, irritability, emotional changes, bloating, and weight gain are classic for PMDD.

• Other Likely Diagnoses

  • Premenstrual Syndrome (PMS): While similar to PMDD, PMS tends to have less severe symptoms. However, the significant bloating and weight gain, along with mood changes, could still align with a more severe form of PMS.
  • Dysmenorrhea: This condition is marked by painful menstrual cramps, which can be severe enough to interfere with daily activities. The patient's description of heavy cramping that keeps her bedridden suggests dysmenorrhea.
  • Depression and Anxiety: The patient mentions untreated depression and anxiety, which could be exacerbated by premenstrual symptoms, creating a complex clinical picture.

• Do Not Miss Diagnoses

  • Endometriosis: Although not directly implied by the premenstrual symptoms, the severe cramping and heavy bleeding could be indicative of endometriosis, a condition where tissue similar to the lining inside the uterus grows outside of it, leading to pain and other complications.
  • Polycystic Ovary Syndrome (PCOS): This hormonal disorder can cause irregular periods, weight gain, and mood changes. While the primary symptoms don't directly point to PCOS, it's a condition that can have a wide range of effects and should be considered.
  • Thyroid Disorders: Both hypothyroidism and hyperthyroidism can cause mood changes, weight gain, and menstrual irregularities. These conditions can sometimes be overlooked but are crucial to diagnose due to their significant impact on health.

• Rare Diagnoses

  • Adenomyosis: A condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, leading to painful periods and heavy bleeding. It's less common but could explain the severe cramping and bloating.
  • Ovarian Cysts: While often asymptomatic, large ovarian cysts can cause bloating, pain, and changes in menstrual patterns. They are less likely to cause the full range of symptoms described but should be considered in the differential diagnosis.