[27F] With severe nausea and menstrual cycle issues

Patient Description

A 27-year-old female presents with severe nausea, cramps in the lower abdomen, back, and inner thighs, particularly around the time of ovulation and extending into her menstrual cycle. The nausea starts gradually and becomes severe for about four days, and is constant without specific triggers. Laying very still and avoiding physical activity helps to ease the nausea. She also experiences diarrhea, constant bloating, and has gained about 20-25 pounds in the last 2-3 months. She no longer feels hungry and instead gets nauseous when she needs to eat. Additionally, she has experienced sharp pains in her lower abdomen or pelvis, different from menstrual cramps. She has not been diagnosed with any gastrointestinal conditions or hormonal imbalances, and has a family history of gallbladder issues. An ultrasound done for bad cramps came back unremarkable. Her last vitamin D level was 14.30 ng/mL, and her thyroid level was 1.96 mclU/mL, both checked about a year ago. She has made no significant changes to her diet, consumes very limited alcohol, and uses nicotine pouches daily without noticing any changes in her symptoms. She occasionally feels pain in the upper right side of her abdomen but not significantly or specifically after eating fatty foods. She is open to discussing the possibility of getting a gallbladder ultrasound or other diagnostic tests with her healthcare provider. She is currently taking oral birth control to help alleviate cramps and acne, but it has not been effective recently. She occasionally takes Tylenol but not very often.

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 discomfort:

1. Premenstrual Syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD)

Rationale: PMS and PMDD can cause severe nausea, cramps, bloating, and changes in bowel habits. PMDD is a more severe form of PMS and can significantly impact daily life.
Typical Treatments: Lifestyle changes, dietary adjustments, stress management, and medications such as NSAIDs for pain, hormonal treatments, or antidepressants.

2. Endometriosis

Rationale: Endometriosis can cause severe menstrual cramps, pelvic pain, nausea, and gastrointestinal symptoms like diarrhea. It often worsens during menstruation.
Typical Treatments: Hormonal therapies, pain management, and in some cases, surgical intervention.

3. Irritable Bowel Syndrome (IBS)

Rationale: IBS can cause chronic diarrhea, bloating, and abdominal pain. Symptoms can be exacerbated by hormonal changes during the menstrual cycle.
Typical Treatments: Dietary changes, stress management, medications to manage symptoms, and sometimes probiotics.

4. Gallbladder Issues

Rationale: Given your family history and occasional upper right abdominal pain, gallbladder issues could be contributing to your symptoms.
Typical Treatments: Dietary changes, medications, and in some cases, surgical removal of the gallbladder.

5. Hormonal Imbalances

Rationale: Hormonal imbalances can cause a variety of symptoms, including nausea, weight gain, and changes in appetite. Your history of low vitamin D and the ineffectiveness of your current birth control could be contributing factors.
Typical Treatments: Hormonal therapies, lifestyle changes, and addressing any underlying deficiencies.

What you can do

Severe Nausea and Cramps

See a healthcare provider: It's important to discuss your symptoms with a healthcare provider to rule out serious conditions like endometriosis or hormonal imbalances.
Dietary adjustments: Eating small, frequent meals and avoiding foods that trigger nausea can help. Ginger tea or ginger supplements may also alleviate nausea.
Hydration: Stay well-hydrated, especially if you experience diarrhea.
Over-the-counter medications: Anti-nausea medications like meclizine or dimenhydrinate can be helpful, but consult your doctor before starting any new medication.

Diarrhea and Bloating

Dietary changes: Consider a low-FODMAP diet, which can help manage IBS symptoms. Avoid foods that are high in fat, as they can exacerbate gallbladder issues.
Probiotics: These can help balance your gut flora and reduce bloating and diarrhea.
Hydration: Ensure you are drinking plenty of fluids to stay hydrated.

Weight Gain and Appetite Changes

Consult your doctor: Discuss your weight gain and appetite changes with your healthcare provider to rule out hormonal imbalances or other underlying conditions.
Healthy eating: Focus on a balanced diet rich in fruits, vegetables, lean proteins, and whole grains.

Pelvic Pain

Pain management: Over-the-counter pain relievers like ibuprofen can help manage pain. Heat pads can also provide relief.
Medical evaluation: A thorough evaluation by a healthcare provider is essential to rule out conditions like endometriosis.

What you should look out for

Given the complexity and severity of your symptoms, it's important to seek medical care. Reasons to seek care more urgently include:

Severe or worsening pain: Especially if it becomes unbearable or is accompanied by fever.
Persistent vomiting: If nausea leads to vomiting and you cannot keep fluids down.
Significant weight loss: Unexplained weight loss can be a sign of a more serious condition.
Changes in bowel habits: If diarrhea becomes severe or is accompanied by blood.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare provider 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.