[19F] Experiencing back pain, nausea, and irregular menstrual cycles

Patient Description

A 19-year-old female presents with sudden onset upper back pain rated at 6 out of 10, occurring intermittently over the past few days. The pain is not relieved by changes in position or activity. She also reports mild chest pain on both sides, random episodes of nausea exacerbated by eating, decreased appetite, and unintentional weight loss. Additionally, she has noticed an increase in brown vaginal discharge and irregular menstrual cycles, with recent cycles lasting 39 to 42 days and characterized by blood clots. Her medical history includes frequent urinary tract infections, kidney stones, and a small ovarian cyst diagnosed in 2019. There is a family history of diabetes and anxiety. The patient does not currently take any medications and has no known allergies. She reports occasional marijuana use but no other substance use.

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Arora's Assessment

What might be happening

Based on your symptoms, here are some possibilities:

  1. Musculoskeletal Pain: Your upper back and chest pain could be related to muscle strain or tension, especially if there's no specific injury. This can sometimes occur with poor posture or stress.

  2. Gastroesophageal Reflux Disease (GERD): The combination of chest pain, nausea, and heartburn-like symptoms could suggest GERD, where stomach acid irritates the esophagus. This can also lead to nausea, especially after eating.

  3. Hormonal Changes or Menstrual Irregularities: The brown discharge and irregular periods with blood clots might be related to hormonal imbalances or changes in your menstrual cycle. Ovarian cysts can sometimes contribute to these symptoms.

  4. Kidney or Urinary Tract Issues: Given your history of UTIs and kidney stones, it's important to consider these as potential contributors to your symptoms, although they may not directly explain all of them.

Typical treatments or testing might include:

  • For musculoskeletal pain, rest, heat or cold therapy, and over-the-counter pain relief.
  • For GERD, lifestyle changes such as diet modification, avoiding triggers, and possibly antacids or other medications.
  • For menstrual irregularities, a healthcare provider might suggest hormonal evaluations or imaging studies like an ultrasound.

What you can do

Nausea and Back Pain:

  • Try to eat smaller, more frequent meals to help manage nausea.
  • Avoid foods that are spicy, acidic, or high in fat, as they can worsen GERD symptoms.
  • Consider using a heating pad on your back to help relieve muscle tension.
  • Over-the-counter medications like antacids may help with nausea related to acid reflux.

Brown Discharge and Menstrual Irregularities:

  • Keep track of your menstrual cycle and any changes in discharge using a journal or an app like MDandMe. This can help your healthcare provider identify patterns or triggers.
  • If the discharge persists or is accompanied by a strong odor or discomfort, consider seeing a healthcare provider for further evaluation.

General Health:

  • Stay hydrated, especially if you're experiencing nausea.
  • Engage in gentle physical activity, like walking, to help with overall well-being and stress reduction.

What you should look out for

  • If your chest pain becomes severe, is accompanied by shortness of breath, or radiates to your arm or jaw, seek medical attention immediately, as these could be signs of a more serious condition.
  • If you experience severe abdominal pain, fever, or a significant increase in discharge, it would be wise to consult a healthcare provider.
  • Monitor your weight and appetite changes, and if they continue, discuss them with a healthcare provider.

Remember, while this information can be helpful, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to reach out.

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2 mo ago

People Also Ask


What could be causing my upper back and chest pain?

Your upper back and chest pain could be due to musculoskeletal issues such as muscle strain or tension, possibly related to poor posture or stress. It could also be related to gastroesophageal reflux disease (GERD), which can cause chest pain and discomfort.


How can I manage my nausea and decreased appetite?

To manage nausea and decreased appetite, try eating smaller, more frequent meals and avoid foods that are spicy, acidic, or high in fat. These dietary changes can help reduce GERD symptoms. Staying hydrated and using over-the-counter antacids may also help.


What might be the reason for my irregular menstrual cycles and brown discharge?

Irregular menstrual cycles and brown discharge could be due to hormonal imbalances or changes, possibly influenced by ovarian cysts. Keeping track of your menstrual cycle and any changes in discharge can help your healthcare provider identify patterns or triggers.


Could my history of kidney stones and UTIs be related to my current symptoms?

While your history of kidney stones and UTIs may not directly explain all your current symptoms, they could contribute to some of the discomfort. It's important to monitor for any signs of urinary issues and discuss them with your healthcare provider.


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