[20F] With missed periods and fatigue

Patient Description

A 20-year-old female reports missing her period for the past two months, with intermittent spotting that was brown with clotting. She also experiences persistent fatigue, even after 8 hours of sleep. The patient has started a new job while attending school, which may contribute to stress, although she does not feel particularly stressed. She consumes a lot of coffee to maintain energy levels and feels better after eating, though the fatigue returns. Her menstrual cycles were previously irregular but became regular over the past year, making the recent missed periods unusual. She has taken three negative pregnancy tests. There have been no significant changes in weight, diet, or caffeine intake, and no recent travel. The patient has no pre-existing medical conditions, allergies, or current medications.

Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

Hormonal Imbalance: Stress, changes in weight, or lifestyle changes can affect your hormone levels, potentially leading to missed periods. Even if you don't feel stressed, the demands of balancing work and school might be impacting your body.
- Treatment typically involves lifestyle modifications, such as stress management, diet, and exercise. In some cases, hormonal therapy may be recommended by a healthcare provider.
Polycystic Ovary Syndrome (PCOS): This is a common condition that can cause irregular menstrual cycles, fatigue, and other symptoms. It is often associated with hormonal imbalances.
- Treatment may include lifestyle changes, medications to regulate your menstrual cycle, and managing symptoms like fatigue.
Nutritional Deficiencies: Fatigue and menstrual irregularities can sometimes be linked to deficiencies in nutrients such as iron, vitamin D, or B vitamins, especially if your diet is not well-balanced.
- Treatment involves dietary adjustments and possibly supplements, as recommended by a healthcare provider.
Thyroid Issues: An underactive thyroid (hypothyroidism) can cause fatigue and menstrual irregularities.
- Treatment typically involves thyroid hormone replacement therapy.

What you can do

While it's important to consult a healthcare provider for a formal diagnosis, here are some steps you can take in the meantime:

Maintain a Balanced Diet: Ensure you're eating a variety of foods to get all necessary nutrients. Consider reducing caffeine intake gradually to see if it affects your fatigue levels.
Manage Stress: Incorporate stress-reducing activities into your routine, such as exercise, meditation, or hobbies you enjoy.
Track Your Symptoms: Use MDandMe to journal your symptoms, track your menstrual cycle, and note any changes in your energy levels. This information can be helpful for your healthcare provider.
Get Adequate Rest: Try to maintain a consistent sleep schedule and create a relaxing bedtime routine to improve sleep quality.