[22F] With prolonged menstrual bleeding, hip pain, and nausea
Patient Description
A 22-year-old female has been experiencing several concerning symptoms. She reports hip pain located on either side of her lower back for the past three months, described as aching and exacerbated by standing and lifting. The pain can last all day but sometimes improves with rest. There is no swelling, redness, or warmth around the area, and no history of injuries or accidents. Birth control has not been effective in managing this pain, and no imaging tests have been conducted.
She also reports nausea for the past couple of days, with no relief from any treatments.
The patient is most concerned about prolonged menstrual bleeding for the past three months, which varies in intensity from heavy to spotting, with the presence of clots. There is no dizziness or lightheadedness, but she has noticed a strong vaginal odor. Birth control started two weeks ago has not stopped the bleeding. She has a history of irregular periods and previous cysts, although the last ultrasound was clear.
Additionally, she experiences vaginal pain rated 4 out of 10 in severity and general exhaustion. She has not experienced significant weight changes, fever, chills, or unusual vaginal discharge aside from the strong odor. She has no known allergies to medications and is currently taking Ozempic at a dosage of 1.0 weekly. She has no chronic conditions or ongoing health issues that require medication.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, there are a few potential diagnoses and conditions that could be contributing to your current health issues. Here are some possibilities:
Prolonged Menstrual Bleeding and Vaginal Pain
- Hormonal Imbalance: Irregular periods and prolonged bleeding can often be due to hormonal imbalances. Birth control is usually prescribed to help regulate these hormones, but it may take some time to see an effect.
- Uterine Fibroids or Polyps: These are non-cancerous growths in the uterus that can cause heavy and prolonged menstrual bleeding, as well as pelvic pain.
- Endometrial Hyperplasia: This is a condition where the lining of the uterus becomes too thick, often due to hormonal imbalances, and can lead to prolonged bleeding.
- Infection: The strong vaginal odor and pain could indicate a vaginal infection, such as bacterial vaginosis or a yeast infection, which can also contribute to irregular bleeding.
Hip and Lower Back Pain
- Musculoskeletal Issues: Given the location and nature of your pain, it could be related to musculoskeletal issues such as muscle strain, ligament sprain, or even early signs of conditions like sciatica or sacroiliac joint dysfunction.
- Referred Pain: Sometimes, pain in the lower back and hips can be referred pain from other areas, such as the pelvic region, especially if there are gynecological issues.
Nausea and Exhaustion
- Side Effects of Medication: Although you haven't experienced side effects from Ozempic or birth control, it's still possible that these medications could contribute to nausea and fatigue.
- Anemia: Prolonged menstrual bleeding can lead to anemia, which can cause symptoms like fatigue and nausea.
What you can do
Prolonged Menstrual Bleeding and Vaginal Pain
- See a Gynecologist: It's crucial to consult a gynecologist to evaluate the cause of your prolonged bleeding and vaginal pain. They may recommend an ultrasound, blood tests, or other diagnostic procedures.
- Monitor Symptoms: Keep track of your bleeding patterns, pain levels, and any other symptoms using the MDandMe journal. This information can be very helpful for your healthcare provider.
- Maintain Hygiene: Ensure good vaginal hygiene to help manage the strong odor and reduce the risk of infections.
Hip and Lower Back Pain
- Consult a Healthcare Provider: Given the duration and nature of your pain, it's important to see a healthcare provider for a thorough evaluation. They may recommend imaging tests like X-rays or MRIs.
- Pain Management: Over-the-counter pain relievers like ibuprofen can help manage the pain. Applying heat or cold packs to the affected area may also provide relief.
- Physical Therapy: Gentle stretching and strengthening exercises can help alleviate musculoskeletal pain. A physical therapist can provide a tailored exercise program.
Nausea and Exhaustion
- Stay Hydrated: Drink plenty of fluids to stay hydrated, especially if you're experiencing nausea and vomiting.
- Small, Frequent Meals: Eating small, frequent meals can help manage nausea. Avoid spicy, fatty, or greasy foods.
- Rest: Ensure you get adequate rest to help manage exhaustion.
What you should look out for
Given the severity and duration of your symptoms, it's important to seek medical care as soon as possible. Here are some specific signs that warrant immediate attention:
- Heavy Bleeding: If you experience very heavy bleeding (soaking through a pad or tampon every hour for several hours), seek medical attention immediately.
- Severe Pain: If your pain becomes severe or is accompanied by other symptoms like fever, chills, or dizziness, seek medical care.
- Signs of Anemia: Watch for signs of anemia, such as extreme fatigue, shortness of breath, or paleness.
Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can use MDandMe to journal your symptoms, track your progress, get insights, and share your medical notes with your provider.
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4 mo ago