[22F] Experiencing urinary urgency and menstrual irregularities

Patient Description

A 22-year-old female reports a constant sensation of needing to urinate for about a week, without accompanying pain, blood, or increased frequency. She has had irregular periods for the past six months, with onset a week early or late. Additionally, she has experienced significant bleeding after intercourse on a couple of occasions. She also notes episodes of clear, watery vaginal discharge and minor cramping. She has been sexually active with the same partner for six months, consistently using protection. The patient has been on the same birth control since age 18 and denies any allergies or sensitivities to latex. Her current medications include Sertraline 250mg at bedtime, Bupropion 200mg in the morning and afternoon, Metformin 500mg once daily, and Propanolol as needed for anxiety. She has a history of anxiety and depression but no other chronic illnesses or pre-existing conditions.

Arora's Assessment

What might be happening

Based on the information you've provided, here are a few possibilities:

Urinary Tract Infection (UTI): Although you don't have the typical symptoms such as pain or burning during urination, some people with UTIs only experience urinary urgency. UTIs are usually caused by bacteria and can be diagnosed with a urine test.
- Treatment typically involves antibiotics prescribed by a doctor.
Overactive Bladder Syndrome: This is a condition where the bladder can't hold urine normally, leading to urinary urgency, frequent urination, and sometimes incontinence. It can be caused by many factors, including nerve problems, medications, and alcohol or caffeine.
- Treatment can involve lifestyle changes, pelvic floor exercises, medications, or procedures.
Interstitial Cystitis: This is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe.
- Treatment typically involves medications, physical therapy, or procedures.
Hormonal Imbalance: Irregular periods and spotting after sex can be due to hormonal imbalances, which can be caused by many factors including stress, significant weight loss or gain, or polycystic ovary syndrome (PCOS).
- Treatment typically involves lifestyle changes, hormonal medications, or treating the underlying cause.
Cervical or Endometrial Polyps: These are small, benign growths on the cervix or inside the uterus. They can cause irregular periods and bleeding after sex.
- Treatment typically involves removal of the polyps.
Sexually Transmitted Infections (STIs): Some STIs can cause urinary urgency and irregular periods. However, you've mentioned using protection consistently, which reduces this risk.
- Treatment typically involves antibiotics or antiviral medications.

Please note that these are possibilities based on the symptoms you've described, and not a definitive diagnosis. It's important to consult with a healthcare professional for an accurate diagnosis and treatment.

What you can do

Schedule an appointment with a healthcare provider: They can perform a physical examination and order tests to help determine the cause of your symptoms.
Keep a symptom diary: Note down when you have urinary urgency, any triggers you notice, and any other symptoms. This can help your healthcare provider diagnose your condition.
Stay hydrated: Drinking plenty of water can help flush bacteria out of your urinary system, which can help prevent UTIs.
Avoid bladder irritants: Caffeine, alcohol, and spicy foods can irritate your bladder and worsen urinary urgency.
Practice good sexual hygiene: Urinate before and after sex, and make sure both you and your partner are clean. This can help prevent UTIs.