Differential Diagnosis for 37 yo Female with Missed Period
- Single most likely diagnosis: + Stress-induced amenorrhea: The patient's history of regular periods, recent stress at work, and lack of sleep (4-5 hours) could be contributing to her missed period. Stress can disrupt the hypothalamic-pituitary-adrenal axis, leading to changes in menstrual cycle.
- Other Likely diagnoses: + Pregnancy (despite tubal ligation, there is a small chance of ectopic pregnancy or tubal ligation failure): Although the patient has a history of tubal ligation, it is essential to rule out pregnancy, especially ectopic pregnancy, which can be life-threatening. + Polycystic ovary syndrome (PCOS): The patient's irregular period could be a sign of PCOS, especially if she has other symptoms such as weight gain, acne, or hirsutism. + Thyroid dysfunction: Hypothyroidism or hyperthyroidism can cause changes in menstrual cycle, and the patient's stress and sleep disturbance could be contributing to thyroid dysfunction.
- Do Not Miss diagnoses: + Ectopic pregnancy: As mentioned earlier, despite tubal ligation, ectopic pregnancy is a life-threatening condition that requires immediate attention. + Pituitary tumor: A pituitary tumor can cause amenorrhea, and it is essential to rule out this condition, especially if the patient has other symptoms such as headaches or vision changes. + Adrenal insufficiency: Adrenal insufficiency can cause changes in menstrual cycle, and it is a life-threatening condition if left untreated.
- Rare diagnoses: + Premature ovarian failure (POF): POF is a rare condition where the ovaries stop functioning before the age of 40, leading to amenorrhea. + Asherman's syndrome: Asherman's syndrome is a rare condition where scar tissue forms in the uterus, leading to amenorrhea. + Sheehan's syndrome: Sheehan's syndrome is a rare condition where the pituitary gland is damaged, leading to hypopituitarism and amenorrhea.