[36F] With irregular menstrual cycle, abdominal discomfort, and negative pregnancy tests

Patient Description

A 36-year-old female reports changes in her menstrual cycle and abdominal symptoms. Her last full cycle ended approximately two months ago, followed by light spotting two weeks later. She experienced bloating, light heartburn, clear discharge, lower back pain, and pressure in her lower abdomen. Recently, she started bleeding with clots. Normally, her cycles are heavy, but this time it was different. She is sexually active, anemic, and has never been pregnant or had any miscarriages. She took three pregnancy tests, all of which were negative. She describes her stomach as growing, despite no weight gain in her face. Over the past three months, her menstrual cycle has been irregular, with heavy bleeding ending sooner than usual and spotting occurring two weeks after her cycle ended. She has experienced slight nausea, abdominal pain, constipation, and one instance of diarrhea. Her appetite has changed, with increased hunger in the morning but a loss of appetite after eating once a day. She has also experienced heartburn and fatigue when she started spotting, but the fatigue has since improved. Her medical history includes anemia diagnosed in 2006 and gastrointestinal problems diagnosed last year. A pelvic exam last year revealed small ovarian cysts. She has no history of surgeries, recent travel, or exposure to new environments or substances. She has a family history of diabetes but no other significant family medical history. She is not currently taking any medications or supplements and has no known allergies.

Arora's Assessment

What might be happening

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

1. Hormonal Imbalance

Rationale: Irregular menstrual cycles, spotting, and changes in bleeding patterns can often be due to hormonal imbalances. This can be influenced by stress, changes in weight, or other factors.
Typical Treatments/Testing: Blood tests to check hormone levels, including thyroid function tests, and possibly a pelvic ultrasound.

2. Ovarian Cysts

Rationale: You mentioned having small ovarian cysts in the past. Ovarian cysts can cause irregular bleeding, abdominal pain, and bloating.
Typical Treatments/Testing: Follow-up pelvic ultrasound to check the status of the cysts, and possibly hormonal treatments to regulate your cycle.

3. Pregnancy-Related Issues

Rationale: Despite negative home pregnancy tests, there is still a possibility of early pregnancy complications such as an ectopic pregnancy or very early miscarriage.
Typical Treatments/Testing: Blood test for hCG levels and an ultrasound to confirm or rule out pregnancy.

4. Gastrointestinal Issues

Rationale: Your history of gastrointestinal problems could be contributing to your bloating, abdominal pain, and changes in bowel movements.
Typical Treatments/Testing: Consultation with a gastroenterologist, possible imaging studies, and dietary modifications.

5. Anemia

Rationale: Your history of anemia could be exacerbated by heavy menstrual bleeding, leading to fatigue and other symptoms.
Typical Treatments/Testing: Blood tests to check hemoglobin levels and iron studies, and possibly iron supplements or dietary changes.

What you can do

Hormonal Imbalance and Ovarian Cysts

Consult a Gynecologist: Seek a consultation with a gynecologist who can perform a thorough examination and order appropriate tests.
Track Symptoms: Keep a detailed record of your symptoms, including the timing and nature of bleeding, pain, and other symptoms. This can help your healthcare provider make a more accurate diagnosis.
Lifestyle Modifications: Maintain a healthy diet, manage stress, and ensure regular physical activity.

Pregnancy-Related Issues

Seek Medical Attention: Given the possibility of pregnancy-related issues, it's important to consult a healthcare provider for a blood test and ultrasound.
Monitor Symptoms: Keep track of any changes in your symptoms, such as increased pain or bleeding.

Gastrointestinal Issues

Consult a Gastroenterologist: Follow up with a gastroenterologist to address your gastrointestinal symptoms and get appropriate testing and treatment.
Dietary Modifications: Consider dietary changes that may help alleviate your symptoms, such as increasing fiber intake for constipation.

Anemia

Manage Anemia: Ensure you are managing your anemia with appropriate iron supplements or dietary changes. Consult your healthcare provider for specific recommendations.
Monitor Symptoms: Keep track of any symptoms related to anemia, such as fatigue or weakness.

General Tips

Stay Hydrated: Drink plenty of water to help with bloating and overall health.
Rest: Ensure you are getting enough rest, especially if you are feeling fatigued.
Use MDandMe: Use the MDandMe app to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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 even more urgently include:

Severe Abdominal Pain: If you experience severe or worsening abdominal pain, seek immediate medical attention.
Heavy Bleeding: If you have heavy bleeding that soaks through a pad or tampon in an hour, seek medical care.
Fainting or Dizziness: If you experience fainting or severe dizziness, seek medical attention.
Signs of Infection: If you have a fever, chills, or unusual discharge, seek medical care.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. If you have any more questions or need further clarification, feel free to ask!