Differential Diagnosis for Menses Concern
The patient presents with concerns about her menses, bloating, and left pelvic pain, with a history of ovarian cysts and a tubal ligation in 2018. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Ovarian Cyst: Given the patient's history of ovarian cysts and current symptoms of bloating and left pelvic pain, an ovarian cyst is a plausible explanation. The pain and bloating could be related to a new or recurring cyst.
Other Likely Diagnoses
- Hormonal Fluctuations: The patient's symptoms of bloating and pelvic pain could be related to hormonal changes, especially considering her concerns about her menses. These symptoms are common in the premenstrual phase.
- Constipation or Gastrointestinal Issues: Although the patient reports daily bowel movements without difficulty, intermittent constipation or other gastrointestinal issues could cause bloating and pelvic discomfort.
- Pelvic Adhesions: Post-surgical adhesions from the tubal ligation could potentially cause pelvic pain and discomfort, although this would be less likely if the pain is intermittent and related to the menstrual cycle.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although the patient had a tubal ligation, there is a small chance of an ectopic pregnancy, which is a medical emergency. The presence of pelvic pain and a history of tubal ligation warrants consideration of this diagnosis.
- Ovarian Torsion: This is a serious condition that can cause severe pelvic pain and requires immediate medical attention. A history of ovarian cysts increases the risk of ovarian torsion.
- Appendicitis: While the patient's symptoms do not strongly suggest appendicitis (e.g., no fever, chills, or significant right lower quadrant pain), it is a condition that should not be missed due to its potential for serious complications.
Rare Diagnoses
- Endometriosis: Although the patient denies pain with intercourse and does not report other classic symptoms of endometriosis, it could be considered, especially if other diagnoses are ruled out. Endometriosis can cause cyclic pelvic pain and bloating.
- Uterine Fibroids: These can cause pelvic pain, bloating, and changes in menstrual patterns. However, they are less likely to cause left pelvic pain specifically related to the menstrual cycle without other symptoms like heavy menstrual bleeding.