Differential Diagnosis for Lower Back Pain (LBP) in a Female Patient Occurring at the Same Time Each Month

• Single Most Likely Diagnosis
  • Menstrual Cramps (Dysmenorrhea): This condition is characterized by painful cramps in the lower abdomen and back, occurring just before and during menstruation. The cyclic nature of the pain, coinciding with the menstrual cycle, makes dysmenorrhea a highly plausible diagnosis.
• Other Likely Diagnoses
  • Endometriosis: A condition where tissue similar to the lining inside the uterus grows outside of it, leading to pain, often cyclic and related to menstrual periods. Lower back pain can be a symptom, especially if the endometrial implants are located near the spine or on the pelvic organs.
  • Premenstrual Syndrome (PMS): While primarily known for mood changes, PMS can also include physical symptoms such as lower back pain, which can occur in the premenstrual phase and resolve once menstruation begins.
  • Ovarian Cysts: These can cause periodic pain, including lower back pain, especially if they rupture or twist, potentially leading to severe pain that could coincide with the menstrual cycle.
• Do Not Miss Diagnoses
  • Ectopic Pregnancy: Although less likely if the patient is experiencing regular menstrual cycles, an ectopic pregnancy can cause lower back pain and must be considered, especially if there's a chance of pregnancy. This condition is life-threatening and requires immediate medical attention.
  • Ovarian Torsion: A rare but emergency condition where the ovary twists around its ligaments, cutting off blood supply. It can cause severe, sudden pain and must be promptly diagnosed and treated.
  • Kidney Stones or Pyelonephritis: While not directly related to the menstrual cycle, these conditions can cause lower back pain and must be considered, especially if other symptoms like fever, urinary frequency, or pain during urination are present.
• Rare Diagnoses
  • Adenomyosis: A condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, leading to an enlarged uterus and painful periods. It's less common than other causes of cyclic lower back pain but should be considered in the differential diagnosis.
  • Uterine Fibroids: These can cause a variety of symptoms, including lower back pain, especially if they are large or numerous. However, the pain is not always cyclic and can be constant or intermittent.