Differential Diagnosis for Amenorrhea in a Postpartum Woman
- Single most likely diagnosis
- Hypothalamic amenorrhea due to breastfeeding: This is the most likely cause of amenorrhea in this patient, given that she is breastfeeding exclusively. Breastfeeding can suppress the hypothalamic-pituitary-ovarian axis, leading to amenorrhea. The fact that she has not resumed menstruation 12 weeks postpartum and is experiencing hot flushes, which can be associated with the hormonal changes of breastfeeding, supports this diagnosis.
- Other Likely diagnoses
- Sheehan syndrome: Although less common, Sheehan syndrome (postpartum pituitary necrosis) is a possible cause of amenorrhea in this patient, given her history of postpartum hemorrhage. However, the presence of hot flushes and the absence of other symptoms such as fatigue, headache, or visual disturbances make this diagnosis less likely.
- Hyperprolactinemia: Elevated prolactin levels can cause amenorrhea, and breastfeeding is a common cause of hyperprolactinemia. However, this diagnosis is closely related to hypothalamic amenorrhea due to breastfeeding and may not be a distinct entity in this case.
- Do Not Miss diagnoses
- Pituitary apoplexy: This is a rare but potentially life-threatening condition that can cause amenorrhea. Although the patient's symptoms do not strongly suggest pituitary apoplexy, it is essential to consider this diagnosis due to its potential severity.
- Asherman syndrome: This condition, characterized by intrauterine adhesions, can cause amenorrhea. Given the patient's history of retained placenta and manual extraction, Asherman syndrome is a possible cause of her amenorrhea, although it is less likely than hypothalamic amenorrhea due to breastfeeding.
- Rare diagnoses
- Premature ovarian failure: This condition is rare in a 25-year-old woman but can cause amenorrhea. There is no clear indication of premature ovarian failure in this patient's history or symptoms.
- Thyroid dysfunction: Thyroid disorders can cause amenorrhea, but there is no indication of thyroid dysfunction in this patient's presentation.