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READ CASE BELOW- Chief Complaint: Pelvic pain and irregular menstrual cycles. Demographics: • Age: 28 years • Gender: Female • Occupation: OAice worker • Marital Status: Single • Ethnicity: Caucasian Previous Medical History (PMHx): • Polycystic Ovary Syndrome (PCOS) diagnosed at age 22 • Mild asthma, well-controlled with inhaler Previous Surgical History (PSHx): • Laparoscopic appendectomy at age 18 Allergies: • Penicillin (rash) Lifestyle: • Non-smoker • Occasional alcohol consumption • Sedentary lifestyle with minimal exercise • Diet high in processed foods History of Present Illness (HPI): The patient reports experiencing pelvic pain for the past three months, which she describes as a dull ache that occasionally becomes sharp. The pain is often worse during her menstrual period, which has become increasingly irregular over the past year. She notes that her cycles can range from 35 to 60 days. She denies any fever, nausea, or vomiting but reports occasional bloating and fatigue. She has not noticed any significant weight changes. Analysis of Risk Factors/Demographics • PCOS: Known to cause irregular menstrual cycles and can contribute to pelvic pain. • Sedentary Lifestyle and Diet: May exacerbate symptoms of PCOS and contribute to metabolic issues. • Age and Gender: Reproductive age women are more likely to experience gynecological issues. DiAerential Diagnoses 1. Endometriosis o Pathophysiology: Endometrial-like tissue grows outside the uterus, causing inflammation and pain. o Rationale: Common cause of pelvic pain and can lead to irregular menstrual cycles (Dydyk & Gupta, 2020). 2. Uterine Fibroids o Pathophysiology: Benign tumors of the uterine muscle can cause pain, heavy bleeding, and irregular cycles. o Rationale: Common in women of reproductive age and can present with similar symptoms (Guirguis-Blake et al., 2017). 3. Pelvic Inflammatory Disease (PID) o Pathophysiology: Infection of the female reproductive organs, often due to sexually transmitted infections. o Rationale: Can cause pelvic pain and irregular bleeding, though typically associated with fever and discharge. Comparison of DiAerential Diagnoses • Occurrence: o Endometriosis is common in women of reproductive age, often underdiagnosed. o Uterine fibroids are prevalent, especially in women over 30. o PID is less common but significant due to its infectious nature. • Pathophysiology: o Endometriosis involves ectopic endometrial tissue, leading to chronic inflammation. o Fibroids are benign muscular tumors, often hormonally driven.

o PID involves infection and inflammation of the reproductive tract. • Presentation: o Endometriosis often presents with chronic pelvic pain and dysmenorrhea (Dydyk & Gupta, 2020). o Fibroids may cause heavy menstrual bleeding and pressure symptoms. o PID typically presents with acute pelvic pain, fever, and abnormal discharge (Rasquin & Mayrin, 2025) Relevant Testing 1. Endometriosis: o Laparoscopy: Gold standard for diagnosis. o Ultrasound/MRI: May help in identifying endometriomas (Dydyk & Gupta, 2020). 2. Uterine Fibroids: o Pelvic Ultrasound: First-line imaging to identify fibroids. o MRI: Used for detailed mapping if needed. 3. Pelvic Inflammatory Disease: o Pelvic Exam and Cultures: To identify causative organisms. o Ultrasound: To assess for abscesses or fluid collections (Rasquin & Mayrin, 2025). National Guidelines • Endometriosis: Laparoscopy is recommended for definitive diagnosis, with imaging as supportive. • Uterine Fibroids: Ultrasound is the primary diagnostic tool, with MRI for complex cases. • PID: Empirical treatment based on clinical findings, with cultures to guide therapy Instructions below-

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