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
Why have I missed my period?
Can oral contraceptives cause missed periods?
What are the symptoms of PCOS?
Can hypothyroidism cause menstrual irregularities?
Is weight gain related to hormonal imbalance?
What tests can diagnose my condition?
Should I see a healthcare provider for missed 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
Hi there, I understand you are concerned about missing your period for the past two months. Is that correct?
Patient
Yes, that's correct.
Cody, the AI Doctor
Good to meet you! My goal is to provide you with an accurate assessment and plan. Let's talk about your menstrual history. Have your periods been regular in the past?
Patient
Yes, they’ve been regular every month with my period lasting about five days.
Cody, the AI Doctor
Got it. Are you currently using any form of contraception?
Patient
Yes, I’ve been using oral contraceptives, the estrogen-progesterone type, for the past two years.
Cody, the AI Doctor
Okay, that’s useful information. Have you taken a home pregnancy test?
Patient
Yes, I took two tests, both were negative.
Cody, the AI Doctor
Glad to know. Are you experiencing any other symptoms like nausea, breast tenderness, abdominal pain, or vaginal discharge?
Patient
No, none of those symptoms.
Cody, the AI Doctor
Has this issue happened before or is this the first time?
Patient
It happened about eight months ago when I missed one month, but it only happened that one time.
Cody, the AI Doctor
Understood. Have you noticed any significant weight changes recently?
Patient
Yes, I've gained about 10 pounds in the last 12 months.
Cody, the AI Doctor
Thank you for sharing that. Have you experienced any changes in hair growth or skin issues?
Patient
Yes, I feel like I have more facial hair and I've had more skin breakouts over the past few months.
Cody, the AI Doctor
Thanks for sharing that. Have you felt excessively tired, cold, or noticed any changes in your bowel movements?
Patient
Not really; I feel a bit more tired than usual, but nothing extreme. No changes in bowel habits or feeling cold.
Cody, the AI Doctor
Have you had any issues with your periods being heavy or very light in the past?
Patient
No, they are typically normal, not too heavy or light.
Cody, the AI Doctor
Do you have any family history of hormonal issues, like thyroid problems or diabetes?
Patient
My mom has hypothyroidism, but I’m not sure about any other hormonal issues in the family.
Cody's AI Summary
- 26-year-old woman who has missed her periods for the past two months.
- Your periods have been regular in the past, lasting about five days.
- You have been on oral contraceptives for two years.
- Home pregnancy tests were negative and you are not experiencing nausea, breast tenderness, abdominal pain, or vaginal discharge.
- Missed period happened once before, eight months ago.
- You have gained 10 pounds over the last year, noticed more facial hair and skin breakouts, and feel slightly more tired than usual. You have no changes in bowel habits or feeling cold.
- Your mother has hypothyroidism.
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)( 60 % probability)
PCOS is a hormonal disorder common among women of reproductive age. Symptoms often include irregular menstrual cycles, weight gain, excess facial hair, and acne. It is caused by an imbalance of reproductive hormones, leading to issues with ovulation.
2. Contraceptive-Induced Amenorrhea(25 % probability)
Long-term use of oral contraceptives can sometimes lead to missed periods or lighter periods. The contraceptives regulate the hormonal cycle, and stopping or changing them can temporarily disrupt menstruation.
3. Thyroid Dysfunction(15 % probability)
Hypothyroidism occurs when the thyroid gland doesn't produce enough thyroid hormones, leading to a slow-down in many body functions. Symptoms can include weight gain, fatigue, and menstrual irregularities. Your family history of hypothyroidism makes this a possible diagnosis.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
This case involves a 26-year-old woman presenting with secondary amenorrhea (missed periods in someone who has had previous normal periods). The first step is to always rule out pregnancy. She also has weight gain, increased facial hair, and minor fatigue. This presentation raises suspicion for several potential diagnoses including Polycystic Ovary Syndrome (PCOS), contraceptive-induced amenorrhea, or hypothyroidism.
1. Polycystic Ovary Syndrome (PCOS)(25% probability)
PCOS presents with many symptoms the patient exhibits, such as irregular menstrual cycles, weight gain, increased facial hair, and acne. The chronic nature and combination of these symptoms make PCOS the most likely diagnosis.
2. Contraceptive-Induced Amenorrhea(60% probability)
The patient has been on oral contraceptives for two years, which can sometimes lead to missed periods. However, the additional symptoms of facial hair and acne are not typical side effects, reducing the likelihood of this being the primary cause.
3. Thyroid Dysfunction(15% probability)
Given the family history of hypothyroidism and some common symptoms like weight gain and fatigue, this condition is a potential diagnosis. Thyroid function tests would be essential to rule this 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 including a pelvic exam to check for any abnormalities.
Blood Tests:
Thyroid Function Tests: To confirm or rule out hypothyroidism.
Hormone Panel: Includes androgens, estrogen, and progesterone levels to check for hormonal imbalances
Imaging:
Pelvic Ultrasound: To evaluate the ovaries for cysts, which can support a diagnosis of PCOS.
Potential Treatment Modalities
PCOS: Lifestyle modifications, hormonal therapy like oral contraceptives, and medications such as metformin.
Hypothyroidism: Thyroid hormone replacement therapy.
Contraceptive-Induced Amenorrhea: If considered a significant issue, altering contraceptive methods might be beneficial.
Conclusion
In summary, the patient's symptoms strongly suggest PCOS as the most likely diagnosis, followed by contraceptive-induced amenorrhea and hypothyroidism. Laboratory tests to evaluate thyroid function and hormone levels, along with a pelvic ultrasound, will provide more definitive answers. Post-diagnosis, treatment should focus on hormonal regulation and managing individual symptoms.
Resource Center
Missed your period but not pregnant? 7 possible causes | UCLA Health
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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