[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.

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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.

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4 mo ago


People Also Ask


Could my symptoms be related to pregnancy even if my home test was negative?

Yes, it's possible for a home pregnancy test to be negative if taken with diluted urine or too early. A repeat test with first-morning urine or a blood test for hCG levels is more reliable.


What are the common signs of a hormonal imbalance like PCOS or thyroid issues?

Common signs of hormonal imbalances include irregular periods, fatigue, weight changes, acne, hair loss, and mood swings. Blood tests can help diagnose these conditions.


How can I differentiate between gastrointestinal issues and other conditions causing my symptoms?

Gastrointestinal issues often involve symptoms like nausea, changes in bowel habits, and abdominal pain. A healthcare provider can help differentiate these from other conditions through tests like stool analysis and imaging.


What are the risks of untreated Pelvic Inflammatory Disease (PID)?

Untreated PID can lead to serious complications such as chronic pelvic pain, infertility, and ectopic pregnancy. It's important to seek medical evaluation and treatment if PID is suspected.

1 Comments


Patricia#13184

4 mo ago

Seems like you are having secondary amenorrhea (absence of periods despite previously having them). The most common cause is pregnancy so it'll be good to repeat your pregnancy test, but other causes can include hypothyroidism which is consistent with your fatigue.

I would go ask a primary care doc or ob-gyn so they can get you the appropriate testing.

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