[31F] With pelvic pain, fatigue, and bloating

Question

What may this be? My PCP says we will discuss "next steps" at my next appointment?

Patient Description

A 31-year-old female presents with sharp, stabbing pain in the lower right pelvic area, accompanied by constant dull pelvic pain. She also reports feeling fatigued, getting full quickly, and experiencing abdominal bloating. The fatigue has been ongoing for a few weeks, with physical activity exacerbating the condition, necessitating frequent naps lasting 2-4 hours. Despite these symptoms, there have been no changes in sleep patterns, diet, or weight. The patient denies nausea, vomiting, changes in bowel habits, and pain during urination but does experience pain during intercourse. Recent imaging tests showed a code of ORADS-1, and a Pap smear in December was normal. Medical history includes a ruptured cyst and abnormal growth of cells on the cervix. Current medications include Cymbalta (25mg daily), Buspar (5mg daily), high blood pressure medicine (10mg daily), B12 (daily), Vitamin D (daily), migraine medicine (25mg daily), and Depo (once every 3 months).

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Arora's Assessment

What might be happening

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

1. Ovarian Cyst or Endometriosis

  • Rationale: Given your history of a ruptured cyst and the location and nature of your pelvic pain, another ovarian cyst or endometriosis could be causing your symptoms. Endometriosis can cause chronic pelvic pain, fatigue, and pain during intercourse.
  • Typical Treatments/Testing: An ultrasound or MRI can help diagnose these conditions. Treatment may include pain management, hormonal therapy, or surgery in severe cases.

2. Gastrointestinal Issues

  • Rationale: The bloating and feeling full quickly could be related to gastrointestinal issues such as irritable bowel syndrome (IBS) or a gastrointestinal infection.
  • Typical Treatments/Testing: A gastroenterologist may recommend dietary changes, medications, or further testing like a colonoscopy or endoscopy.

3. Chronic Fatigue Syndrome (CFS)

  • Rationale: Your profound fatigue that doesn't improve with sleep and worsens with physical activity could be indicative of Chronic Fatigue Syndrome.
  • Typical Treatments/Testing: Diagnosis is often based on ruling out other conditions. Treatment focuses on symptom management, including medications, lifestyle changes, and cognitive behavioral therapy.

Unifying Diagnosis

  • Pelvic Inflammatory Disease (PID): Although you don't have a fever or abnormal discharge, PID can sometimes present with pelvic pain, fatigue, and frequent urination. Given your history of abnormal cervical cell growth, this is worth considering.
  • Hormonal Imbalance: Your symptoms could also be related to a hormonal imbalance, possibly exacerbated by your current medications.

What you can do

Pelvic Pain

  • See a Doctor: Given the severity and duration of your pelvic pain, it's important to consult a healthcare provider for a thorough evaluation. They may recommend imaging tests or refer you to a specialist.
  • Pain Management: Over-the-counter pain relievers like ibuprofen can help manage pain. Applying heat to the affected area may also provide relief.

Fatigue

  • Consult a Healthcare Provider: Your fatigue could be related to several underlying conditions, so it's crucial to get a proper diagnosis.
  • Lifestyle Changes: Ensure you are getting adequate rest, maintaining a balanced diet, and engaging in light physical activity as tolerated.
  • Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider.

Bloating and Feeling Full Quickly

  • Dietary Adjustments: Eating smaller, more frequent meals and avoiding foods that cause bloating can help.
  • Hydration: Ensure you are drinking enough water throughout the day.
  • Consult a Gastroenterologist: If symptoms persist, a specialist can help identify any underlying gastrointestinal issues.

What you should look out for

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

  • Severe or Sudden Worsening of Pain: This could indicate a more serious underlying condition.
  • Fever or Signs of Infection: Such as abnormal vaginal discharge or chills.
  • Unexplained Weight Loss: This could be a sign of a more serious condition.
  • Severe Fatigue: That prevents you from performing daily activities.

Remember, while I can provide guidance, it's essential to consult with a healthcare professional for a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.

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4 mo ago


People Also Ask


What are the common symptoms of an ovarian cyst or endometriosis?

Common symptoms of an ovarian cyst or endometriosis include pelvic pain, pain during intercourse, fatigue, and sometimes irregular menstrual cycles. Endometriosis can also cause heavy periods and infertility.


How can gastrointestinal issues like IBS cause bloating and feeling full quickly?

Gastrointestinal issues like IBS can cause bloating and a feeling of fullness due to irregular bowel movements, gas, and sensitivity to certain foods. These symptoms can be managed with dietary changes and medications.


What is Chronic Fatigue Syndrome and how is it diagnosed?

Chronic Fatigue Syndrome is characterized by extreme fatigue that doesn't improve with rest and worsens with physical or mental activity. Diagnosis is often made by ruling out other conditions and considering symptoms like sleep disturbances, muscle pain, and memory issues.


What are the potential side effects of taking multiple medications like Cymbalta, Buspar, and Depo?

Potential side effects of taking multiple medications can include interactions that may exacerbate symptoms like fatigue, dizziness, or gastrointestinal issues. It's important to discuss all medications with a healthcare provider to manage and monitor for any adverse effects.

1 Comments


Arora (Bot)#24147

4 mo ago

Based on your symptoms and history, there are a few possible conditions that might be causing your symptoms. These include ovarian cysts or endometriosis, gastrointestinal issues like irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS). Additionally, conditions like pelvic inflammatory disease (PID) and hormonal imbalances are also considerations. Your primary care provider (PCP) will likely discuss further diagnostic tests such as ultrasounds, MRIs, or referrals to specialists like a gastroenterologist. They may also talk about treatment options, which could include pain management, hormonal therapy, or lifestyle changes. It's important to have a thorough discussion with your PCP to determine the best course of action based on your specific symptoms and medical history.

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