Delayed Period with Breast Tenderness: Differential Diagnosis
A missed period with breast tenderness has several potential causes; pregnancy is the most common in reproductive-age women.
Differential
| Cause | Key Features |
|---|---|
| Pregnancy | Missed period, breast tenderness, nausea, fatigue, +hCG |
| Hormonal imbalance | PCOS, thyroid dysfunction, hyperprolactinemia, perimenopause |
| Stress | Hypothalamic amenorrhea (↓ GnRH); weight loss, exercise, emotional stress |
| Medications | OCPs, depot progestin, antipsychotics, chemotherapy |
| Ovarian cyst | Follicular/corpus luteum cyst → hormonal fluctuation |
Stepwise Approach
- Urine pregnancy test (first-morning). If positive → prenatal care.
- If negative: repeat in 1 week. If still negative + no period → see clinician.
- Workup: TSH, prolactin, FSH/LH/estradiol (day 3), androgen panel, pelvic US.
- Treat underlying cause (thyroid, PCOS, stress reduction, medication adjustment).
Do not assume pregnancy is excluded by a single negative test if period is delayed.
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