[20F] Experiencing abdominal pain, irregular menstruation, and acne

Patient Description

A 20-year-old female presents with a range of symptoms including a bloated and painful stomach, irregular menstruation despite being on birth control, and persistent acne. The patient has been experiencing these symptoms for about a year, with the bloating described as intermittent but severe, resembling pregnancy and responding somewhat to heat application. Menstrual periods have been notably irregular, with the current episode lasting five weeks and accompanied by significant pain, which is worse at night and during menstruation. The patient also reports fatigue, pain after sexual intercourse in the lower stomach area, and recurrent UTIs or bladder infections. Acne is present, predominantly on the jawline and cheeks, and has not improved with the use of birth control and spironolactone. The patient is on a daily regimen of Zoloft (100mg), birth control pills (presumed Monalyna), and spironolactone (25mg). There is no known family history of reproductive health issues, but the patient suspects a possible diagnosis of endometriosis. No known drug allergies, no recent weight changes, and no use of recreational drugs or substances have been reported.

Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few conditions that could be causing your symptoms:

Endometriosis: This condition occurs when tissue similar to the lining of the uterus grows outside of your uterus. Symptoms can include painful periods, pain with intercourse, pain with bowel movements or urination, excessive bleeding, bloating, and fatigue.
- Treatment typically involves medication to manage pain and hormonal therapy to slow the growth of the endometrial tissue. In more severe cases, surgery may be recommended.
Polycystic Ovary Syndrome (PCOS): This is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.
- Treatment of PCOS often focuses on managing individual concerns, such as infertility, hirsutism, acne or obesity.
Irritable Bowel Syndrome (IBS): This is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both.
- Treatment is aimed at relieving symptoms and can include changes in diet, lifestyle and stress management.

Please note that these are just possibilities and not a definitive diagnosis. It's important to consult with a healthcare provider for an accurate diagnosis.

What you can do

Schedule an appointment with your healthcare provider: They can conduct a physical exam and possibly order tests to determine the cause of your symptoms.
Keep a symptom diary: This can help you and your healthcare provider identify patterns that might indicate a specific condition.
Maintain a healthy lifestyle: Regular exercise, a healthy diet, and adequate sleep can help manage your symptoms and improve your overall health.