QuestionSBA
QuestionChoice
A sensible differential. Polycystic ovarian syndrome may present with irregular or missed periods, however core features are weight gain, acne and hirsutism, making it less likely.
10034965
d
Polycystic ovarian syndrome
QuestionChoice
This is not likely in this case as bloating and changes in bowel motion are not mentioned and the difficulties are primarily gynaecological.
10034964
c
Irritable bowel syndrome
QuestionChoice
A sensible differential which shares many symptoms with endometriosis. The patient's ethnicity and age render this less common as fibroids tend to develop in Afro-Caribbean women over 40 years of age. In addition, the family history and PR bleeding are more in keeping with endometriosis.
10034963
b
Fibroids
QuestionChoice
This may cause heavy bleeding with a family history but none of the other listed symptoms.
10034966
e
Von Willebrand Disease
QuestionChoice
This is correct. The family history, dyspareunia, dysmenorrhea and rectal bleeding are all in keeping with endometriosis.
10034962
a
Endometriosis
QuestionComment
In her youth suggests that her mother no longer has those symptoms and fibroids improve with age... anyone else find the stem a bit misleading?
39387
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Myotonia Kawasaki
QuestionComment
Thought you did not have heavy menstrual bleeding in endometriosis 
51655
User
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Metabolism Loose
QuestionComment
PR BLEEDING? 

52503
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passmed user 1 
QuestionComment
why on earth is there rectal bleeding 
52810
QuestionComment
In endometriosis you can have endometrium-like tissue growing and attaching to outside of/into the rectum, which can result in painful bowel movements, constipation, and rectal bleeding, with the latter particularly around the time of menstruation
53276
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Digital Teaching Fellow @ Quesmed
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C.difficult
Concept
Chapter
2693
6111
Endometriosis
Topic
333
Obstetrics and Gynaecology
19396
Endometriosis is a condition characterized by the growth of endometrial-like tissue outside the uterus, leading to pelvic pain, dysmenorrhea, menorrhagia, dyspareunia, and potentially infertility. Gastrointestinal symptoms are also common.
A 20-year-old caucasian nulligravida comes to the GP surgery complaining of dysmenorrhoea and heavy periods. She further reports dyspareunia and occasionally passing fresh red blood per rectum. She reports her mother suffering from similar issues in her youth.

What is the most likely diagnosis?
a