[23F] With delayed menstruation, emotional changes, and gastrointestinal symptoms

Patient Description

A 23-year-old female has been experiencing heightened emotional sensitivity for the past few days, initially attributed to an impending menstrual period. However, her period is now four days late. This morning, she had a single episode of vomiting bright yellow acid and continues to feel nauseous. She reports frequent abdominal cramps and pain, which are intermittent but sometimes severe. Additionally, she has noticed changes in her bowel movements, predominantly diarrhea, and has experienced hot flashes followed by chills. She has not observed any blood in her stool or vomit. A pregnancy test taken on the third day of her missed period was negative. The patient has not traveled recently, consumed any unusual or potentially contaminated food, or used substances like alcohol, tobacco, or recreational drugs. She has no pre-existing conditions or chronic illnesses and is not currently taking any medications, over-the-counter drugs, supplements, or topical medications.

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Arora's Assessment

What might be happening

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

  • Gastroenteritis: This is an inflammation of the stomach and intestines, often caused by a viral or bacterial infection. Symptoms can include vomiting, diarrhea, abdominal cramps, and sometimes fever or chills. The bright yellow vomit could be bile, which is common when the stomach is empty.

    • Treatment: Gastroenteritis usually resolves on its own within a few days. Treatment focuses on staying hydrated and resting. In some cases, over-the-counter medications can help manage symptoms.
  • Premenstrual Syndrome (PMS): Emotional changes, abdominal cramps, and gastrointestinal symptoms can be part of PMS, which occurs in the days leading up to your period.

    • Treatment: Over-the-counter pain relievers, such as ibuprofen, can help with cramps. Lifestyle changes, such as regular exercise and a balanced diet, can also alleviate symptoms.
  • Early Pregnancy: Despite a negative pregnancy test, it's still possible to be pregnant, especially if the test was taken early. Symptoms of early pregnancy can include missed periods, nausea, vomiting, and abdominal cramps.

    • Treatment: If you suspect pregnancy, consider retaking a pregnancy test a few days later or consulting a healthcare provider for a more accurate test.
  • Irritable Bowel Syndrome (IBS): IBS is a chronic condition that affects the large intestine and can cause symptoms like diarrhea, abdominal pain, and cramping. Emotional stress can exacerbate IBS symptoms.

    • Treatment: Managing IBS often involves dietary changes, stress management, and sometimes medications prescribed by a doctor.

What you can do

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

  1. Stay Hydrated: Drink plenty of fluids, such as water, clear broths, or oral rehydration solutions, to prevent dehydration, especially if you have diarrhea.
  2. Rest: Give your body time to recover by getting plenty of rest.
  3. Monitor Your Symptoms: Keep track of your symptoms, including their frequency and severity. You can use MDandMe to journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your provider.
  4. Dietary Adjustments: Eat small, bland meals that are easy on your stomach, such as bananas, rice, applesauce, and toast (the BRAT diet). Avoid spicy, fatty, or greasy foods.
  5. Over-the-Counter Medications: Consider using over-the-counter medications like antacids for stomach acid or pain relievers for cramps, but consult a healthcare provider if you're unsure.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or Worsening Symptoms: If your abdominal pain becomes severe or your symptoms worsen, it's important to see a doctor.
  • Dehydration: Signs of dehydration include dry mouth, dark urine, dizziness, and decreased urine output.
  • Persistent Vomiting: If you continue to vomit and cannot keep fluids down, you should seek medical care.
  • Fever: A persistent fever (temperature over 100.4°F) or chills may indicate an infection that requires medical attention.
  • Missed Period: If your period remains absent and you continue to have symptoms, consider retaking a pregnancy test or consulting a healthcare provider.

Remember, while these suggestions can help manage your symptoms, they are not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and appropriate treatment.

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4 mo ago


People Also Ask


What could cause a missed period besides pregnancy?

A missed period can be caused by stress, hormonal imbalances, significant weight changes, excessive exercise, or certain medical conditions like polycystic ovary syndrome (PCOS). It's important to consult a healthcare provider if your period remains absent.


How can I differentiate between gastroenteritis and IBS?

Gastroenteritis typically presents with sudden onset of symptoms like vomiting, diarrhea, and abdominal cramps, often following exposure to contaminated food or water. IBS is a chronic condition with symptoms that can be triggered by stress or certain foods and usually doesn't include vomiting. A healthcare provider can help differentiate between the two.


When should I retake a pregnancy test if the first one was negative?

If the first pregnancy test was negative, it's recommended to wait a few days to a week and retake the test, especially if your period is still absent. For more accurate results, consider testing in the morning when hCG levels are highest.


What are some effective ways to manage nausea and vomiting at home?

To manage nausea and vomiting at home, try eating small, bland meals, staying hydrated with clear fluids, and avoiding strong odors or foods that trigger nausea. Ginger tea or peppermint can also help soothe the stomach. If symptoms persist, consult a healthcare provider.

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