Differential Diagnosis for Missed Period with Negative Pregnancy Tests
- Single most likely diagnosis:
- Anovulatory cycle: This is a common cause of missed periods in women of reproductive age, especially if they have a history of irregular menstrual cycles. The negative pregnancy tests support this diagnosis.
- Other Likely diagnoses:
- Early pregnancy with low hCG levels: It's possible that the patient is pregnant, but the hCG levels are not yet high enough to be detected by home pregnancy tests or the ER urine test.
- Polycystic ovary syndrome (PCOS): This condition is characterized by irregular menstrual cycles, and the negative pregnancy tests do not rule out PCOS.
- Thyroid dysfunction: Hypothyroidism or hyperthyroidism can cause menstrual irregularities, including missed periods.
- Stress or weight changes: Significant stress or weight changes can disrupt menstrual cycles, leading to missed periods.
- Do Not Miss diagnoses:
- Ectopic pregnancy: Although the ER urine test was negative, it's essential to consider ectopic pregnancy, especially if the patient has risk factors such as a history of pelvic surgery or infertility.
- Ovarian torsion: This is a rare but life-threatening condition that can cause severe abdominal pain and missed periods.
- Pituitary or adrenal gland disorders: Certain disorders, such as a pituitary tumor or adrenal insufficiency, can cause menstrual irregularities and require prompt medical attention.
- Rare diagnoses:
- Premature ovarian failure (POF): This condition is characterized by the loss of ovarian function before the age of 40, leading to irregular or missed periods.
- Asherman's syndrome: This is a rare condition where scar tissue forms in the uterus, leading to menstrual irregularities and infertility.
- Other endocrine disorders: Certain rare endocrine disorders, such as congenital adrenal hyperplasia or Cushing's syndrome, can cause menstrual irregularities and require specialized medical attention.