[33F] With missed period, abdominal pain, and increased urination

Patient Description

A 33-year-old female presents with a constellation of symptoms including a headache, stomach ache primarily after eating or drinking, increased frequency of urination, and a missed menstrual period. The patient reports that her last menstrual period started on May 4, 2024, and ended on May 9, 2024. She has taken pregnancy tests, which have returned negative. Additional symptoms include nausea associated with the stomach ache, bloating, and increased fatigue. There have been no changes in appetite or weight, and no alterations in bowel movements such as diarrhea or constipation. The patient denies any pain or burning during urination. She has no history of gastrointestinal issues, hormonal imbalances, or urinary tract infections. The patient has a history of smoking marijuana but denies the use of alcohol or other recreational drugs. Her diet has remained consistent, and she has not traveled or been exposed to new environments recently. The patient is currently taking Venlafaxine 187mg and Bupropion 100mg daily as prescribed. She also occasionally takes Advil Dual Action. Her medical history includes migraine headaches diagnosed in 2005 and a cholecystectomy performed in May 2017. She has allergies to Norco, Vicodin, Tramadol, and Tylenol 3, which trigger her migraines. There is a family history of diabetes and colon cancer in her father.

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Arora's Assessment

What might be happening

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

Missed Period, Increased Urination, and Abdominal Pain

  • Hormonal Imbalance: Conditions like polycystic ovary syndrome (PCOS) or thyroid disorders can cause missed periods, abdominal pain, and changes in urination. Hormonal imbalances can also lead to fatigue and headaches.
  • Urinary Tract Infection (UTI): Although you haven't experienced pain during urination, increased frequency can sometimes be a sign of a UTI, which can also cause abdominal discomfort.
  • Gastrointestinal Issues: Conditions like irritable bowel syndrome (IBS) or gastritis can cause abdominal pain, especially after eating or drinking, and may also lead to bloating and nausea.

Headaches and Fatigue

  • Migraine: Given your history of migraines, it's possible that your headaches are related to this condition. Migraines can also cause nausea and fatigue.
  • Medication Side Effects: Both Venlafaxine and Bupropion can have side effects that include headaches, nausea, and fatigue.

Unifying Diagnoses

  • Hormonal Imbalance: This could explain the missed period, fatigue, headaches, and possibly even the abdominal pain and increased urination.
  • Gastrointestinal Issues: Conditions like IBS or gastritis could explain the abdominal pain, bloating, and nausea, and might also contribute to fatigue.

What you can do

Missed Period and Increased Urination

  • See a Doctor: It's important to consult with a healthcare provider to rule out conditions like hormonal imbalances or UTIs. They may recommend blood tests or a pelvic ultrasound.
  • Stay Hydrated: Drink plenty of water, but avoid caffeine and alcohol, which can irritate the bladder.

Abdominal Pain and Nausea

  • Dietary Changes: Try eating smaller, more frequent meals and avoid foods that trigger your symptoms. Keeping a food diary can help identify triggers.
  • Over-the-Counter Medications: Antacids or anti-nausea medications may provide some relief. However, consult your doctor before taking any new medications.

Headaches and Fatigue

  • Migraine Management: Continue to manage your migraines with prescribed medications and lifestyle changes. Avoid known triggers and ensure you get enough rest.
  • Monitor Medication Side Effects: Keep track of any side effects from Venlafaxine and Bupropion and discuss them with your doctor. They may adjust your dosage or switch medications if necessary.

General Tips

  • Track Symptoms: Use MDandMe to journal your symptoms, track progress, and get insights. This can be helpful for your healthcare provider to understand your condition better.
  • Healthy Lifestyle: Maintain a balanced diet, exercise regularly, and get adequate sleep to support overall health.

What you should look out for

Given the range of your symptoms, it's important to seek medical care to rule out any serious conditions. Reasons to seek care more urgently include:

  • Severe Abdominal Pain: If the pain becomes severe or is accompanied by fever, vomiting, or blood in your stool, seek immediate medical attention.
  • Severe Headaches: If your headaches become more severe or are accompanied by vision changes, confusion, or difficulty speaking, seek immediate medical attention.
  • Persistent Symptoms: If your symptoms persist or worsen despite trying the above measures, consult your healthcare provider.

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

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5 mo ago


People Also Ask


Can hormonal imbalances cause missed periods and increased urination?

Yes, hormonal imbalances such as those caused by conditions like polycystic ovary syndrome (PCOS) or thyroid disorders can lead to missed periods and changes in urination patterns. These imbalances can also cause other symptoms like fatigue and headaches.


What are the possible side effects of Venlafaxine and Bupropion?

Venlafaxine and Bupropion can have side effects including headaches, nausea, fatigue, dry mouth, dizziness, and insomnia. It's important to monitor these side effects and discuss them with your doctor, who may adjust your dosage or switch medications if necessary.


How can migraines be managed effectively?

Migraines can be managed through a combination of medication, lifestyle changes, and avoiding known triggers. Medications may include pain relievers, triptans, or preventive medications. Lifestyle changes such as maintaining a regular sleep schedule, staying hydrated, and managing stress can also help.


What dietary changes can help with abdominal pain and nausea?

To help with abdominal pain and nausea, try eating smaller, more frequent meals and avoid foods that trigger your symptoms. Keeping a food diary can help identify these triggers. Additionally, avoiding spicy, fatty, or acidic foods and staying hydrated can be beneficial.

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