[30F] Experiencing delayed menstruation, nausea, and other symptoms

Patient Description

A 30-year-old female presents with a 3-month delay in menstruation, accompanied by nighttime nausea, persistent headaches, dizziness when changing head positions, and itching on the legs and neck described as mosquito bite-like. The patient reports a negative home pregnancy test. She also experiences gastric discomfort throughout the day, significant hair loss, and fatigue. There has been a weight gain of approximately 4 kg over the past few months. The patient's menstrual cycles were previously regular. Medical history includes migraine, mild rheumatoid arthritis, polycystic ovary syndrome (PCOS), and a history of thyroid issues, although TSH levels have been stable for the past two years. The patient occasionally takes Disprin for severe headaches and reports no known allergies or adverse reactions to medications.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations for what you might be experiencing:

  1. Polycystic Ovary Syndrome (PCOS): Given your history of PCOS, the missed periods, weight gain, and hair loss could be related to hormonal imbalances associated with this condition. PCOS can also cause fatigue and changes in appetite.

  2. Thyroid Dysfunction: Although your TSH levels have been stable, thyroid issues can sometimes recur or fluctuate, leading to symptoms like fatigue, weight changes, hair loss, and menstrual irregularities.

  3. Migraine: Your persistent headaches could be related to your history of migraines. Migraines can also cause nausea and dizziness.

  4. Rheumatoid Arthritis: While primarily affecting joints, rheumatoid arthritis can sometimes cause systemic symptoms like fatigue and headaches.

  5. Gastrointestinal Issues: The alternating constipation and diarrhea, along with gastric discomfort, could suggest a gastrointestinal issue such as irritable bowel syndrome (IBS), which can be exacerbated by stress.

  6. Allergic Reaction or Skin Condition: The itching on your legs and neck could be due to an allergic reaction or a dermatological condition.

What you can do

For Missed Periods and Hormonal Symptoms:

  • Consider scheduling an appointment with your healthcare provider to discuss your menstrual irregularities and potential hormonal imbalances. They may recommend blood tests or an ultrasound to assess your PCOS and thyroid function.

For Headaches and Migraines:

  • Keep a headache diary to track triggers, frequency, and severity. This can help your healthcare provider tailor a treatment plan for you.
  • Ensure you are staying hydrated and getting enough rest.

For Itching:

  • Try using a gentle, fragrance-free moisturizer to soothe your skin.
  • Avoid hot showers and harsh soaps that can exacerbate itching.

For Gastrointestinal Symptoms:

  • Maintain a balanced diet rich in fiber to help regulate bowel movements.
  • Consider keeping a food diary to identify any dietary triggers.

For Overall Well-being:

  • Practice stress-reducing activities such as yoga, meditation, or deep breathing exercises.
  • Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

What you should look out for

While your symptoms are concerning, they do not appear to be immediately life-threatening. However, you should seek medical attention if you experience:

  • Severe or worsening headaches
  • Fainting or severe dizziness
  • Unexplained weight loss
  • New or worsening joint pain

Remember, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. If you have any more questions or need further assistance, feel free to reach out.

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29 d ago


People Also Ask


Can PCOS cause missed periods and weight gain?

Yes, PCOS can cause missed periods and weight gain due to hormonal imbalances. It often leads to irregular menstrual cycles and can affect metabolism, contributing to weight gain.


How can thyroid dysfunction affect menstrual cycles and hair loss?

Thyroid dysfunction can lead to hormonal imbalances that affect menstrual cycles, causing irregularities or missed periods. It can also lead to hair loss due to changes in the body's metabolism and nutrient absorption.


What are common triggers for migraines that could be causing my headaches?

Common triggers for migraines include stress, certain foods (like chocolate, cheese, and processed meats), dehydration, lack of sleep, and hormonal changes. Keeping a headache diary can help identify specific triggers.


What might be causing the itching on my legs and neck?

The itching on your legs and neck could be due to an allergic reaction, a dermatological condition, or even dry skin. It's important to avoid irritants and use gentle skincare products. If the itching persists, consult a healthcare provider for further evaluation.


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