[30F] Experiencing nausea and recent menstrual irregularities

Patient Description

A 30-year-old female reports experiencing sudden onset of nausea for the past three days, which worsens with standing or walking and is not relieved by any measures. The patient believes she had implantation bleeding on August 8th, followed by a period from August 17th to 20th, which was three days late. Two pregnancy tests taken before the period were negative. The patient vomited today after eating and has been feeling lightheaded for several days. She has gained about 7 lbs in the last month. The patient has a history of Crohn's disease diagnosed over 7 years ago and celiac disease diagnosed 2 years ago. She had her gallbladder removed 10 years ago. The patient is allergic to Levaquin and is not currently taking any medications. She recently traveled by plane but did not consume any new or unusual foods or drinks. No unusual fatigue, vaginal bleeding, or significant changes in bowel habits beyond what is typical for her Crohn's disease.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

Pregnancy or Miscarriage

  • Pregnancy: Despite the negative pregnancy tests and your period, it's still possible that you could be pregnant. Sometimes, hormone levels are not high enough to be detected by a home pregnancy test early on. Nausea, especially if it worsens with standing or walking, can be an early sign of pregnancy.
  • Miscarriage: If you were pregnant and experienced what you thought was implantation bleeding followed by a period, it's also possible that you could have had an early miscarriage. This can sometimes be accompanied by nausea and other symptoms.

Gastrointestinal Issues

  • Crohn's Disease: Given your history of Crohn's disease, it's possible that your nausea and stomach aches could be related to a flare-up. Crohn's disease can cause a variety of gastrointestinal symptoms, including nausea, vomiting, and changes in bowel habits.
  • Celiac Disease: Similarly, your celiac disease could be contributing to your symptoms, especially if you've accidentally ingested gluten.

Other Considerations

  • Travel-Related Illness: Although you didn't consume any new or unusual foods, travel can sometimes expose you to new pathogens that can cause gastrointestinal symptoms.
  • Stress and Fatigue: Being a full-time student and employee with a young child at home can be very stressful and tiring, which can sometimes manifest as physical symptoms like nausea.

What you can do

Pregnancy or Miscarriage

  • Take Another Pregnancy Test: As soon as you are able, take another home pregnancy test to check if you might be pregnant. If it's positive, schedule an appointment with your healthcare provider for confirmation and further guidance.
  • Consult a Doctor: If you suspect a miscarriage, it's important to consult a healthcare provider to ensure that you receive appropriate care and to rule out any complications.

Gastrointestinal Issues

  • Monitor Your Diet: Ensure that you are strictly avoiding gluten to prevent celiac disease flare-ups. Keep a food diary to track any foods that might be triggering your symptoms.
  • Manage Crohn's Disease: Follow your healthcare provider's recommendations for managing Crohn's disease. This might include dietary changes, medications, or other treatments.
  • Stay Hydrated: Drink plenty of fluids to stay hydrated, especially if you are experiencing vomiting.

General Tips

  • Rest and Relaxation: Try to get as much rest as possible and manage stress through relaxation techniques such as deep breathing, meditation, or gentle exercise.
  • Seek Medical Advice: Given the complexity of your symptoms and your medical history, it's important to consult a healthcare provider for a thorough evaluation and appropriate treatment.

What you should look out for

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

  • Severe Abdominal Pain: If you experience severe or worsening abdominal pain, seek medical attention immediately.
  • Persistent Vomiting: If you are unable to keep fluids down or if vomiting persists, seek medical care to prevent dehydration.
  • Unusual Vaginal Bleeding: If you experience any unusual vaginal bleeding or spotting, consult a healthcare provider.
  • Severe Fatigue or Weakness: If you feel unusually tired or weak, seek medical advice.

Remember, while I can provide information and suggestions, I am not a doctor. It's important to consult with a healthcare professional to receive a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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3 mo ago


People Also Ask


Can you still be pregnant if you have a period and negative pregnancy tests?

Yes, it is possible to be pregnant even if you have a period and negative pregnancy tests. Sometimes, hormone levels are not high enough to be detected by a home pregnancy test early on. If you suspect pregnancy, it's advisable to take another test or consult a healthcare provider.


How can Crohn's disease affect nausea and vomiting?

Crohn's disease can cause a variety of gastrointestinal symptoms, including nausea and vomiting. These symptoms can occur during a flare-up when the disease is more active, leading to inflammation in the digestive tract.


What are the symptoms of a celiac disease flare-up?

A celiac disease flare-up can cause symptoms such as diarrhea, abdominal pain, bloating, fatigue, and nausea. These symptoms occur when gluten is ingested, even in small amounts, by someone with celiac disease.


What should you do if you suspect a miscarriage?

If you suspect a miscarriage, it's important to consult a healthcare provider for an evaluation. They can provide appropriate care, rule out complications, and offer guidance on next steps. It's crucial to seek medical attention if you experience severe symptoms like heavy bleeding or severe pain.

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