[45F] With severe menstrual cramps and intermittent swelling

Patient Description

A 45-year-old female reports experiencing severe menstrual cramps and heavy bleeding with blood clots after a six-month gap without a period. The cramps are very intense, occurring every 20 to 30 minutes, and are rated as 7 or 8 out of 10 in pain severity. The patient has not taken any medication to relieve the pain. Additionally, she experienced moderate to severe swelling in her feet, ankles, and lower legs a couple of weeks ago, which has since subsided. The swelling was tender and painful, especially when standing for too long. The patient also felt bloated for a period of time, but this has improved. There is no unusual vaginal discharge or odor. The patient feels like she gets hot faster and sweats more when hot, but no specific hot flashes or night sweats. There is no history of fibroids, endometriosis, or polycystic ovary syndrome (PCOS). She is not currently taking any medications. The patient has a family history of diabetes, cancer, and high blood pressure. There has been no recent travel to areas with different climates or altitudes, and there are no pre-existing conditions or chronic illnesses.

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Arora's Assessment

What might be happening

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

Menstrual Issues

  • Hormonal Imbalance: The irregularity and severity of your periods, along with the six-month gap, could be due to hormonal imbalances. This can happen as you approach menopause (perimenopause) or due to other hormonal disorders.
  • Uterine Fibroids: These are non-cancerous growths in the uterus that can cause heavy bleeding, severe cramps, and clotting during periods.
  • Endometrial Hyperplasia: This is a condition where the lining of the uterus becomes too thick, often leading to heavy and painful periods.

Swelling in Feet, Ankles, and Lower Legs

  • Venous Insufficiency: This condition occurs when the veins in your legs have trouble sending blood back to your heart, leading to swelling, especially after standing for long periods.
  • Heart or Kidney Issues: Swelling in the lower extremities can sometimes be a sign of heart or kidney problems, especially given your family history of high blood pressure and diabetes.

Bloating

  • Gastrointestinal Issues: Bloating can be caused by various gastrointestinal issues, including irritable bowel syndrome (IBS), food intolerances, or other digestive disorders.
  • Fluid Retention: This can be related to hormonal changes or other underlying health conditions.

What you can do

Menstrual Issues

  • See a Doctor: Given the severity and irregularity of your symptoms, it's important to consult a healthcare provider. They may recommend blood tests to check hormone levels, an ultrasound to look for fibroids, or other diagnostic tests.
  • Pain Management: Over-the-counter pain relievers like ibuprofen (Advil) or naproxen (Aleve) can help manage the pain. Always follow the dosage instructions.
  • Heat Therapy: Applying a heating pad to your lower abdomen can help relieve cramps.

Swelling in Feet, Ankles, and Lower Legs

  • Elevate Your Legs: When you notice swelling, try to elevate your legs above the level of your heart to help reduce the swelling.
  • Compression Stockings: Wearing compression stockings can help improve blood flow and reduce swelling.
  • Stay Active: Regular physical activity can help improve circulation. Avoid standing for long periods without moving.

Bloating

  • Dietary Changes: Avoid foods that are known to cause bloating, such as beans, carbonated drinks, and high-fat foods. Eating smaller, more frequent meals can also help.
  • Hydration: Drink plenty of water to help your digestive system function properly.

What you should look out for

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

  • Severe Pain: If your pain becomes unbearable or is accompanied by fever, dizziness, or fainting.
  • Heavy Bleeding: If you experience heavy bleeding that soaks through a pad or tampon in an hour or less.
  • Shortness of Breath or Chest Pain: These could be signs of a more serious condition and require immediate medical attention.

Remember, while I can provide information and suggestions, it's important to consult a healthcare professional for a formal diagnosis and treatment plan. 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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5 mo ago


People Also Ask


What could cause a six-month gap in menstrual periods followed by heavy bleeding and severe cramps?

A six-month gap in menstrual periods followed by heavy bleeding and severe cramps could be due to hormonal imbalances, which are common as women approach menopause (perimenopause). Other possible causes include uterine fibroids or endometrial hyperplasia, which can lead to heavy and painful periods.


What are some possible reasons for swelling in the feet, ankles, and lower legs?

Swelling in the feet, ankles, and lower legs can be caused by venous insufficiency, where veins have trouble sending blood back to the heart. It can also be a sign of heart or kidney issues, especially if there is a family history of high blood pressure or diabetes.


How can hormonal imbalances affect menstrual cycles and overall health?

Hormonal imbalances can lead to irregular menstrual cycles, heavy bleeding, and severe cramps. They can also cause symptoms like hot flashes, mood swings, and changes in metabolism, affecting overall health.


What lifestyle changes can help manage bloating and swelling?

To manage bloating and swelling, consider dietary changes such as avoiding foods that cause bloating, staying hydrated, and eating smaller, more frequent meals. Elevating the legs, wearing compression stockings, and staying active can help reduce swelling.

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