[30F] Experiencing irregular periods, abdominal pain, and shoulder blade pain

Patient Description

A 30-year-old female reports having missed periods since January 3rd, with occasional light pink spotting that lasts a few hours. This is a deviation from her usual pattern of menstrual irregularities, which typically involve heavier and prolonged bleeding. She is experiencing severe cramps and pain that she describes as being focused around the ovaries. The patient has been feeling nauseous for a couple of weeks, with the severity of the nausea worsening with increased pain and physical activity. She also reports pressure and tightness in her shoulder blades, which she compares to the pressure experienced during her C-section; this pain fluctuates in intensity. Despite multiple negative pregnancy tests, the patient has had unprotected sex twice in the past month and a half and has a history of a C-section with tubal ligation. She has been diagnosed with diabetes since May 2023 and is taking multiple medications including Elavil, metformin, abilify, paxil, trileptal, mini press, Atarax, and daily vitamins. She has no known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible explanations for your symptoms include:

  • Polycystic Ovary Syndrome (PCOS): This is a common hormonal disorder among women of reproductive age. Symptoms can include irregular periods, heavy bleeding, excess androgen which can result in excess facial and body hair, severe acne, or male-pattern baldness, and polycystic ovaries. PCOS can also cause pelvic pain.

    • Treatment typically involves lifestyle modifications like a healthy diet and regular exercise. Medications may also be prescribed to manage individual symptoms.
  • Endometriosis: This is a disorder where tissue similar to the tissue that forms the lining of your uterus grows outside of your uterine cavity. Symptoms can include painful periods, pain with intercourse, pain with bowel movements or urination, excessive bleeding, and infertility. Some women also experience other symptoms such as fatigue, diarrhea, constipation, bloating, or nausea, especially during menstrual periods.

    • Treatment typically involves pain medication, hormonal therapy, or surgery.
  • Ovarian Cysts: These are fluid-filled sacs or pockets in an ovary or on its surface. Many women have ovarian cysts at some time. Most ovarian cysts present little or no discomfort and are harmless. However, cysts can cause severe symptoms such as pelvic pain, fullness or heaviness in your abdomen, and bloating.

    • Treatment can range from watchful waiting to surgical removal, depending on the size and type of cyst.
  • Ectopic Pregnancy: This is a pregnancy that occurs outside the uterus, typically in one of the fallopian tubes. Although you've had a tubal ligation and negative pregnancy tests, there's still a very small chance of becoming pregnant. Symptoms can include missed periods, abdominal or pelvic pain, light vaginal bleeding, and shoulder pain.

    • This is a medical emergency and requires immediate treatment, typically through medication or surgery.

What you can do

Given the severity of your symptoms, it's important to seek medical attention as soon as possible. Your doctor can provide a formal assessment and order relevant tests if necessary.

What you should look out for

Reasons to seek immediate medical attention:

  • Severe abdominal pain
  • Heavy vaginal bleeding
  • Dizziness or fainting
  • Severe nausea and vomiting

Please remember that while I strive to provide accurate information, I'm not a doctor and this advice should not replace a consultation with a healthcare professional.

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9 mo ago


People Also Ask


What are the common symptoms of Polycystic Ovary Syndrome (PCOS)?

Common symptoms of PCOS include irregular periods, heavy bleeding, excess androgen which can result in excess facial and body hair, severe acne, or male-pattern baldness, and polycystic ovaries. It can also cause pelvic pain.


How is endometriosis typically treated?

Endometriosis is typically treated with pain medication, hormonal therapy, or surgery, depending on the severity of the symptoms and the patient's individual needs.


What are the signs that an ovarian cyst might require medical attention?

Signs that an ovarian cyst might require medical attention include severe pelvic pain, fullness or heaviness in the abdomen, and bloating. If these symptoms occur, it's important to consult a healthcare provider.


Can you still get pregnant after a tubal ligation?

While tubal ligation is a highly effective form of permanent birth control, there is still a very small chance of becoming pregnant. This is known as a tubal ligation failure, and if pregnancy occurs, it may be an ectopic pregnancy, which requires immediate medical attention.


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