Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Resource Center
Testimonials
Share this Case Study
Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What can cause irregular periods in a 20-year-old female?
Can stress cause irregular periods?
How can AI help diagnose irregular periods?
What is Polycystic Ovary Syndrome (PCOS)?
Are irregular periods a sign of thyroid dysfunction?
How can I manage stress to improve my menstrual cycle?
Should I see a doctor for irregular periods?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
What health issue do you want to work on today?
Patient
Irregular periods
Cody, the AI Doctor
So you want to focus on your irregular periods today, is that correct?
Patient
Yes
Cody, the AI Doctor
My goal is to provide you with an accurate assessment and plan. Let's talk about your concerns regarding irregular periods. Can you please confirm your sex? For example, are you female, male, or do you identify differently?
Patient
Female
Cody, the AI Doctor
Got it, thank you for sharing that. When did you first start experiencing irregular periods? For example, did it begin 6 months ago or 1 year ago?
Patient
6 months ago
Cody, the AI Doctor
Irregular periods can be caused by various factors, including stress, hormonal imbalances, or changes in weight. Can you describe the pattern of your irregular periods? For example, are they more frequent, less frequent, or do they vary in length from month to month?
Patient
They vary, sometimes they come every two weeks, then they can change to every 6 weeks, and back.
Cody, the AI Doctor
Have you been diagnosed with any medical conditions that could affect your menstrual cycle? For example, polycystic ovary syndrome (PCOS), thyroid disorders, or endometriosis?
Patient
No, none of those.
Cody, the AI Doctor
Alright, noted. In what year were you born?
Patient
I'm 20 years old.
Cody, the AI Doctor
At 20 years old, it's not uncommon for individuals to experience irregular periods, especially if they have recently started menstruating or if there are lifestyle factors such as stress, diet, or exercise that could be influencing your cycle. How would you describe the pattern of your irregular periods? For example, are they getting worse, getting better, staying the same, or do they vary from month to month?
Patient
They are more irregular.
Cody, the AI Doctor
Are you taking any medications or using any hormonal types of birth control?
Patient
No, I take none of these.
Cody, the AI Doctor
Can you describe how your irregular periods started? For example, did they begin suddenly, or have they been gradually becoming more irregular over time?
Patient
They were fine for about 5 years then got more irregular over time gradually.
Cody, the AI Doctor
On a scale of 1 to 10, how severe would you rate the impact of your irregular periods on your daily life? For example, does it affect your mood, work, or social activities?
Patient
6
Cody, the AI Doctor
Irregular periods can significantly impact daily life, affecting mood and social activities. Have you noticed any lifestyle changes that might be affecting your menstrual cycle? For example, changes in your diet, exercise routine, or sleep patterns?
Patient
I am more stressed lately due to school work and family stresses. I don't sleep more than 5 hours per night.
Cody, the AI Doctor
Have you experienced any other symptoms along with your irregular periods? For example, do you have any unusual fatigue, weight changes, or changes in your appetite?
Patient
Yes, I am always exhausted, I have lost about 5 pounds, no change in appetite.
Cody's AI Summary
- You are 20 years woman with irregular periods.
- Your periods have been irregular for the past 6 months.
- The pattern of your periods varies, sometimes occurring every two weeks and other times every six weeks.
- You have not been diagnosed with any medical conditions affecting your menstrual cycle.
- Your irregular periods started gradually after being regular for about 5 years.
- You rate the impact of your irregular periods on your daily life as a 6 out of 10.
- You have been experiencing increased stress due to school work and family issues.
- You are getting less than 5 hours of sleep per night.
- You feel exhausted and have lost about 5 pounds without a change in appetite.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Polycystic Ovary Syndrome (PCOS)( 50 % probability)
A hormonal disorder causing irregular periods and other metabolic issues.
2. Stress-Induced Amenorrhea(30 % probability)
A condition where stress affects the hormonal balance, leading to irregular or missed periods.
3. Thyroid Dysfunction(20 % probability)
An imbalance in thyroid hormones that can lead to menstrual irregularities and other symptoms.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
Irregular periods can be due to a myriad of factors. Based on the history provided, the irregularity of the patient's menstrual pattern and lifestyle changes are crucial elements for consideration in the differential diagnosis.
1. Stress-Induced Amenorrhea(60% probability)
Stress can significantly affect menstrual cycles. Stress can cause ovulatory dysfunction, where the body’s stress response interferes with the hormones responsible for ovulation. Without regular ovulation, the menstrual cycle becomes irregular. The patient's high stress, poor sleep, and recent weight loss strongly support this diagnosis.
2. Polycystic Ovary Syndrome (PCOS)(25% probability)
While PCOS is a common cause of menstrual irregularities, the absence of other typical symptoms like hirsutism, acne, or significant weight gain makes it slightly less likely. Further tests such as hormonal panels and ultrasound should be done to confirm this diagnosis.
3. Thyroid Dysfunction(15% probability)
Thyroid issues are common in young women and can cause fatigue, weight changes, and menstrual irregularities. A simple blood test can rule this in or out.
Next Steps for Evaluation
Thorough History and Physical Exam:
This includes a comprehensive review of the patient’s health history and a physical exam. A pelvic exam to check for any abnormalities and a urine pregnancy test to rule out pregnancy are essential first steps.
Blood Tests: These tests should check hormone levels such as LH, FSH, androgens, cortisol, and thyroid function to evaluate for any endocrine disorders.
Hormonal Panels:
To detect any imbalances that might suggest PCOS or other endocrine issues.
Thyroid Function Tests:
To assess hypothyroidism or hyperthyroidism.
Ultrasound:
A pelvic ultrasound to visualize the ovaries and uterine lining, looking for signs of PCOS or other structural abnormalities.
Potential Treatment Modalities
Hormonal Therapy: If the blood tests indicate a hormonal imbalance, hormonal therapy such as birth control pills can be prescribed to regulate the menstrual cycle. Birth control pills help manage hormone levels and can induce regular periods, alleviate ovulatory dysfunction, and manage other symptoms like acne and excessive hair growth if they are present.
Lifestyle Modification: Alongside medical treatments, it's important to address the underlying stress through lifestyle changes. This includes stress management techniques, improving sleep hygiene, and possibly consulting with a mental health professional.
Nutritional and Exercise Counseling: Maintaining a balanced diet and regular exercise can help manage the overall well-being, potentially aiding in the regulation of the menstrual cycle.
Conclusion
To summarize, the patient's menstrual irregularities are likely multifactorial with stress-induced ovulatory dysfunction being the primary concern. Stress and lifestyle factors are significant contributors, but ruling out PCOS and thyroid dysfunction is crucial. Implementing stress reduction strategies, addressing sleep hygiene, and targeted diagnostics should provide a clearer path forward. Hormonal therapy may play a significant role in managing and regulating the patient's menstrual cycle based on the diagnostic outcomes.
Resource Center
Irregular Periods (Abnormal Menstruation): Causes & Treatment - Cleveland Clinic
Irregular Periods: Possible Causes of a Missed Period - WebMD
Polycystic ovary syndrome (PCOS) - Symptoms and causes - Mayo Clinic
PCOS (Polycystic Ovary Syndrome): Symptoms & Treatment - Cleveland Clinic
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Testimonials
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