Differential diagnoses

But Grandma had some of those symptoms, but they told her it was her thyroid that wasn’t working properly!

Yes, the clinician must always exclude other causes for the above symptoms. It tells you below how to rule them out;

The most important thing is to take a good comprehensive history.

Differential diagnoses

Amenorrhea.

An Hcg test can be done to exclude pregnancy.

Irregular bleeding could be due to;

  • endometrial polyps
  • uterine Fibroids
  • adenomyosis
  • endometrial hypoplasia
  • cancer
  • vulval/vaginal malignancy
  • cervical lesions

Check for any abdominal pain, weight loss, make sure cervical smears are up to date, have they had a recent scan, swabs or blood tests?

Hot flushes could be due to;

  • hypothyroidism
  • phaeochromoytoma
  • tumours e.g. pancreatic
  • mastocytoma
  • excess alcohol consumption
  • panic disorders
  • tuberculosis
  • dumping syndrome

-Dumping Syndrome – What’s that? Sounds like a fly tipping turtle!Also called rapid gastric emptying, it is a set of symptoms that happen after gastric surgery to aid weight loss.

-Dumping Syndrome – What’s that? Sounds like a fly tipping turtle!Also called rapid gastric emptying, it is a set of symptoms that happen after gastric surgery to aid weight loss.

Check for any hair changes, tiredness, thyroid masses, weight gain or weight loss, jaundice, ask about alcohol consumption, breast pain or any issues around anxiety or stress. Ask about past surgical procedures.

Some drugs can cause symptoms similar to the menopause e.g. nitrates, SSRI’s, diltiazem, levodopa, gonadotrophin releasing hormone, anti-oestrogens.

So, take a drug history including the date the woman started the medication.

Vaginal Atrophy could also be caused by;

  • Trauma or infection

Ask about any pain during intercourse, any vaginal discharge and check temperature

Urinary Incontinence may be due to;

  • obesity
  • previous gynae surgery
  • multiparity