[27F] Experiencing fatigue, nausea, and abdominal pain with irregular periods

Patient Description

A 27-year-old female reports experiencing constant fatigue for the past two months, which occurs daily and lasts for about six hours. This fatigue affects her daily routine and overall energy levels, making her feel sleepy and nauseous throughout the day. Her sleep schedule is irregular. She has been experiencing nausea for at least three months, which is somewhat alleviated by drinking water but can be worsened by certain foods. The patient also reports lower abdominal pain and pressure, which is her most bothersome symptom, along with pelvic pain. She has noticed changes in her bowel movements, experiencing both constipation and diarrhea, but no blood in her stool. Her appetite has decreased. Her last menstrual period was in April, and she had unprotected sexual intercourse in May. Her periods have been irregular, and she has not experienced any vaginal bleeding or spotting since April. She took a pregnancy test with diluted urine, which was negative. She has not been diagnosed with any hormonal imbalances or conditions such as polycystic ovary syndrome (PCOS), nor has she been evaluated for them. She does not use alcohol, tobacco, or recreational drugs and is not currently taking any medications.

Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

1. Pregnancy

Rationale: Given that your last period was in April and you had unprotected sex in May, pregnancy is a possibility despite the negative test with diluted urine. Symptoms like nausea, fatigue, increased appetite, and abdominal pain can be associated with early pregnancy.
Typical Testing: A repeat pregnancy test with the first-morning urine or a blood test for hCG levels would be more accurate.

2. Hormonal Imbalance

Rationale: Irregular periods, fatigue, nausea, and changes in appetite can be signs of hormonal imbalances such as polycystic ovary syndrome (PCOS) or thyroid issues.
Typical Testing: Blood tests to check hormone levels, including thyroid function tests and reproductive hormones, can help diagnose these conditions.

3. Gastrointestinal Issues

Rationale: The combination of nausea, changes in bowel movements, and abdominal pain could indicate gastrointestinal issues such as irritable bowel syndrome (IBS) or a gastrointestinal infection.
Typical Testing: Stool tests, blood tests, and possibly imaging studies like an abdominal ultrasound or CT scan can help identify the cause.

4. Pelvic Inflammatory Disease (PID)

Rationale: Pelvic pain and lower abdominal pressure, especially with a history of unprotected sex, could indicate an infection in the reproductive organs.
Typical Testing: A pelvic exam, cervical cultures, and possibly an ultrasound can help diagnose PID.

What you can do

Pregnancy

Immediate Action: Take another pregnancy test using the first-morning urine or visit a healthcare provider for a blood test.
At Home: Monitor your symptoms and keep track of any changes in your menstrual cycle.

Hormonal Imbalance

Immediate Action: Schedule an appointment with your healthcare provider to discuss your symptoms and get appropriate blood tests.
At Home: Maintain a balanced diet, get regular exercise, and manage stress as these can help regulate your hormones.

Gastrointestinal Issues

Immediate Action: Consult a healthcare provider to discuss your symptoms and get appropriate tests.
At Home: Keep a food diary to identify any triggers, stay hydrated, and eat a balanced diet rich in fiber.

Pelvic Inflammatory Disease (PID)

Immediate Action: Seek medical attention to get a proper diagnosis and treatment, as untreated PID can lead to serious complications.
At Home: Avoid sexual intercourse until you have been evaluated by a healthcare provider.

What you should look out for

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

Severe or worsening abdominal pain
Vomiting that prevents you from keeping fluids down
Fainting or severe dizziness
Unexplained weight loss
Fever or chills

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.