[21F] With severe lower abdominal pain and dizziness

Patient Description

A 21-year-old female presents with severe, sharp, and achy lower abdominal pain that has been occurring off and on for the last two weeks. The pain lasts around one to two hours, with brief 30-minute intervals of relief, and is severe enough to wake her up at night. The patient has tried ibuprofen, Pamprin, and Advil without relief. She also experiences dizziness, which has become more frequent since the onset of the abdominal pain, and occasional nausea due to the intensity of the pain. The dizziness is described as a spinning sensation accompanied by darkening of vision. The patient has a history of ovarian cysts and fibroids, which have caused significant pain in the past, but she notes that this current pain is worse than her usual cramps. She also had an ectopic pregnancy earlier this year. There are no changes in bowel habits, fever, chills, unusual vaginal discharge, or severe nausea and vomiting. She reports a slight increase in urination frequency and some bloating, making it uncomfortable to wear tight clothing. The patient smokes tobacco and has a family history of strokes and cancer.

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Arora's Assessment

What might be happening

It sounds like you are experiencing a complex set of symptoms that could be related to multiple underlying issues. Here are some possibilities:

Lower Abdominal Pain

  • Ovarian Cysts or Fibroids: Given your history of ovarian cysts and fibroids, it's possible that these could be causing your severe lower abdominal pain. These conditions can sometimes cause sharp, achy pain and may worsen over time.
  • Pelvic Inflammatory Disease (PID): This is an infection of the female reproductive organs and can cause severe lower abdominal pain, especially if left untreated.
  • Gastrointestinal Issues: Conditions like irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) can also cause severe abdominal pain.

Dizziness and Lightheadedness

  • Orthostatic Hypotension: This condition causes a sudden drop in blood pressure when you stand up, leading to dizziness and lightheadedness. It can be more frequent when you're in pain or stressed.
  • Anemia: Low levels of red blood cells can cause dizziness and lightheadedness, especially when standing up.

Unifying Diagnoses

  • Endometriosis: This condition can cause severe abdominal pain, especially around your menstrual cycle, and can also lead to dizziness and nausea.
  • Hormonal Imbalances: Conditions like polycystic ovary syndrome (PCOS) can cause a range of symptoms, including abdominal pain, dizziness, and changes in menstrual cycles.

What you can do

Severe Abdominal Pain

  • See a Doctor: Given the severity and duration of your pain, it's crucial to consult a healthcare provider as soon as possible. They may recommend imaging tests like an ultrasound or CT scan to get a clearer picture of what's going on.
  • Pain Management: Over-the-counter pain relievers haven't been effective for you, so your doctor may prescribe stronger medications or suggest other treatments like hormonal therapy.
  • Heat Therapy: Applying a heating pad to your lower abdomen may help alleviate some of the pain.

Dizziness and Lightheadedness

  • Hydration: Make sure you're drinking plenty of fluids, as dehydration can worsen dizziness.
  • Slow Movements: When standing up, do so slowly to give your body time to adjust.
  • Consult a Doctor: Your doctor may want to check your blood pressure and possibly run some blood tests to rule out anemia or other conditions.

General Tips

  • Symptom Journal: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider. This can help in diagnosing and managing your condition.
  • Rest: Ensure you get plenty of rest and avoid activities that exacerbate your symptoms.
  • Diet: Eat small, frequent meals to avoid bloating and discomfort.

What you should look out for

Given the severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Severe or worsening pain
  • Fainting or severe dizziness
  • Unusual vaginal bleeding or discharge
  • Fever or chills

Remember, while I can provide information and suggestions, it's essential to consult a healthcare professional for a formal diagnosis and treatment plan.

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2 mo ago

People Also Ask

What could be causing severe lower abdominal pain in women with a history of ovarian cysts and fibroids?

Severe lower abdominal pain in women with a history of ovarian cysts and fibroids could be due to the cysts or fibroids themselves, which can cause sharp, achy pain. Other possibilities include pelvic inflammatory disease (PID) or gastrointestinal issues like IBS or IBD.

How can dizziness and lightheadedness be related to abdominal pain?

Dizziness and lightheadedness can be related to abdominal pain due to conditions like orthostatic hypotension, where blood pressure drops suddenly, or anemia, which can cause dizziness, especially when standing. Pain and stress can exacerbate these symptoms.

What are some potential treatments for severe abdominal pain that doesn't respond to over-the-counter medications?

For severe abdominal pain that doesn't respond to over-the-counter medications, a doctor may prescribe stronger pain relievers, suggest hormonal therapy, or recommend imaging tests to better understand the cause. Heat therapy, like using a heating pad, may also provide relief.

When should someone with severe abdominal pain and dizziness seek urgent medical care?

Urgent medical care should be sought if the abdominal pain is severe or worsening, if there is fainting or severe dizziness, unusual vaginal bleeding or discharge, or if there are signs of infection like fever or chills.

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