[33F] With delayed period, lower right abdominal pain, and occasional nausea

Patient Description

A 33-year-old female presents with a delayed period of 45 days, despite a negative pregnancy test. She has no new sexual partners and has used protection. This is the first time she has experienced such a delay. There have been no significant changes in her lifestyle, stress levels, or weight recently. Her last menstrual period was on May 22nd, 2024. She reports lower right abdominal pain described as squeezing and sharp, occasional nausea, and constipation. She has not experienced any fever, changes in appetite, or changes in urinary habits. She has no history of ovarian cysts, endometriosis, or other gynecological conditions, and no family history of these conditions or gastrointestinal issues. She has not traveled recently and is not currently taking any medications other than 600mg ibuprofen as needed.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  1. Ovarian Cysts:

    • Rationale: Ovarian cysts can cause delayed periods, lower abdominal pain, and occasional nausea. They are fluid-filled sacs that can form on the ovaries and sometimes cause sharp or squeezing pain.
    • Typical Treatments/Testing: An ultrasound is often used to diagnose ovarian cysts. Treatment may include watchful waiting, hormonal contraceptives, or surgery if the cysts are large or causing significant symptoms.
  2. Gastrointestinal Issues:

    • Rationale: Constipation and lower abdominal pain can be related to gastrointestinal issues such as irritable bowel syndrome (IBS) or other digestive disorders. These conditions can sometimes affect menstrual cycles.
    • Typical Treatments/Testing: Diagnosis may involve a physical exam, blood tests, and imaging studies. Treatment often includes dietary changes, increased fiber intake, and sometimes medications to manage symptoms.
  3. Hormonal Imbalance:

    • Rationale: Hormonal imbalances can lead to delayed periods and other symptoms like abdominal pain and nausea. Conditions like polycystic ovary syndrome (PCOS) or thyroid disorders can disrupt menstrual cycles.
    • Typical Treatments/Testing: Blood tests to check hormone levels, and possibly an ultrasound. Treatment may involve lifestyle changes, medications to regulate hormones, or other interventions depending on the underlying cause.

What you can do

For Delayed Period and Lower Abdominal Pain:

  • See a Doctor: It's important to consult with a healthcare provider to determine the underlying cause of your delayed period and abdominal pain. They may recommend an ultrasound or blood tests.
  • Pain Management: Continue taking ibuprofen as needed for pain relief, but do not exceed the recommended dose. Applying a heating pad to your lower abdomen may also help alleviate pain.
  • Track Symptoms: Use MDandMe to journal your symptoms, track your menstrual cycle, and note any changes or patterns. This information can be helpful for your healthcare provider.

For Constipation:

  • Dietary Changes: Increase your intake of fiber-rich foods such as fruits, vegetables, and whole grains. Drink plenty of water to stay hydrated.
  • Physical Activity: Regular exercise can help improve bowel movements. Aim for at least 30 minutes of moderate exercise most days of the week.
  • Over-the-Counter Remedies: Consider using over-the-counter laxatives or stool softeners if dietary changes are not effective. Consult with a pharmacist or healthcare provider for recommendations.

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 care if you experience any of the following:

  • Severe or worsening abdominal pain
  • Heavy or unusual vaginal bleeding
  • Persistent nausea or vomiting
  • Fever or signs of infection
  • Sudden or severe changes in bowel habits

Remember, it's important to consult with a healthcare provider to receive a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to continue the conversation.

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6 mo ago

People Also Ask


What could cause a delayed period besides pregnancy?

A delayed period can be caused by factors such as stress, significant weight changes, hormonal imbalances, thyroid disorders, or conditions like polycystic ovary syndrome (PCOS). It's important to consult a healthcare provider for a proper diagnosis.


How can ovarian cysts affect menstrual cycles and cause pain?

Ovarian cysts are fluid-filled sacs that can form on the ovaries. They can cause delayed periods, lower abdominal pain, and nausea. Diagnosis typically involves an ultrasound, and treatment may include watchful waiting, hormonal contraceptives, or surgery if necessary.


What are some common gastrointestinal issues that might affect menstrual cycles?

Gastrointestinal issues like irritable bowel syndrome (IBS) or other digestive disorders can cause symptoms such as constipation and abdominal pain, which may indirectly affect menstrual cycles. Diagnosis may involve physical exams and imaging studies, with treatment focusing on dietary changes and symptom management.


How can hormonal imbalances impact menstrual cycles and what are common treatments?

Hormonal imbalances can disrupt menstrual cycles, leading to delayed periods and symptoms like abdominal pain and nausea. Conditions like PCOS or thyroid disorders are common causes. Treatment often involves lifestyle changes, medications to regulate hormones, and addressing the underlying condition.


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