What could be causing my symptoms of irritation, anger, stomach pain, headaches, and a disturbed menstrual cycle?

Understanding Your Symptoms: Hormonal and Gastrointestinal Connection

Your constellation of symptoms—irritability, anger, stomach pain, headaches, and irregular menstrual cycles—most likely represents premenstrual syndrome (PMS) or premenstrually-related symptoms, potentially overlapping with menstrual migraine and hormonally-triggered gastrointestinal disturbances.

Primary Diagnostic Considerations

Hormonal Fluctuations and Mood Changes

• Estrogen withdrawal during the menstrual cycle directly triggers both emotional and physical symptoms, including irritability, anger, and pain 1.
• The week before menstruation is a well-documented trigger for symptom exacerbation, with emotional symptoms (depression, anxiety) commonly occurring alongside physical complaints 1.
• Your 3-month history of irregular cycles suggests hormonal dysregulation, which can amplify these premenstrual symptoms and make them less predictable 1.

Gastrointestinal Symptoms During Menses

• Abdominal pain and gastrointestinal disturbances are extremely common perimenstrually, occurring in 73% of healthy women 2.
• Specifically, abdominal pain affects 58% of women premenstrually and 55% during menses, making it one of the most prevalent symptoms 2.
• The presence of emotional symptoms (irritability, anger) significantly increases the likelihood of experiencing multiple gastrointestinal symptoms, both before and during menstruation 2.
• This connection reflects shared underlying processes involving brain-gut-hormone pathways 2.

Headache Pattern

• Menstrual migraine occurs within 2 days before and 3 days after menstruation onset, triggered by estrogen withdrawal 3, 4.
• Your headaches occurring alongside other premenstrual symptoms strongly suggest a hormonal trigger 5.
• The intensity of pain correlates with the intensity of mood symptoms (depression, anxiety), creating a reinforcing cycle 6.

Critical Evaluation Steps

Document Your Symptom Pattern

• Keep a detailed symptom diary for 2-3 menstrual cycles, tracking the exact timing of irritability, anger, stomach pain, and headaches relative to your menstrual bleeding 1, 5.
• Note whether symptoms resolve within a few days after menstruation begins—this pattern confirms premenstrual syndrome 5.
• Record any triggers such as stress, sleep deprivation, or dietary factors 7.

Rule Out Alternative Diagnoses

• If abdominal pain is severe (visual analog scale >5) or accompanied by ascites/intestinal edema, consider other gynecologic causes including ovarian cysts, endometriosis, or pelvic inflammatory disease 1.
• Evaluate for irritable bowel syndrome if gastrointestinal symptoms persist throughout the entire month, not just perimenstrually 1.
• Screen for thyroid dysfunction, as primary hypothyroidism can cause menstrual irregularities and mood changes 8.
• Consider recent viral illness history, as post-viral syndromes can cause menstrual alterations, fatigue, headache, and body pain 1.

Assess for Medication Triggers

• Review all current medications, as opioids and dopamine antagonists commonly cause nausea and can disrupt menstrual cycles 7, 8.
• If you use cannabis regularly, consider cannabinoid hyperemesis syndrome, which causes cyclic nausea, vomiting, and abdominal pain 7.

Treatment Algorithm

First-Line Interventions

• For headaches: Start with NSAIDs (ibuprofen, naproxen) taken at the first sign of headache, as these are effective for both menstrual migraine and general pain 3, 5.
• Consider short-term perimenstrual prophylaxis with NSAIDs starting 2 days before expected menstruation if headaches are predictable 5.
• For gastrointestinal symptoms: NSAIDs also reduce abdominal pain and cramping when taken early in the symptom cycle 5.

Hormonal Management (If First-Line Fails)

• Continuous combined hormonal contraceptives (avoiding placebo pills) prevent estrogen withdrawal and eliminate the hormonal trigger for your symptoms 1, 3.
• Alternatively, use only 2 placebo days instead of 7 to minimize estrogen fluctuation 3.
• Critical caveat: If you experience migraine WITH aura (visual disturbances, numbness, speech changes), combined hormonal contraceptives are contraindicated due to stroke risk 3.
• Progestin-only methods (pills, IUD) are safe alternatives that don't carry estrogen-related risks 1.

Adjunctive Therapies

• Magnesium supplementation has evidence for reducing both premenstrual symptoms and menstrual migraine 5.
• Cognitive-behavioral techniques and stress management reduce pain perception and improve coping, particularly when emotional symptoms are prominent 1, 6.

Red Flags Requiring Urgent Evaluation

• Severe abdominal pain (>5/10 on pain scale) with fever suggests pelvic infection requiring immediate antibiotics 1.
• Sudden onset of worst headache of your life requires emergency evaluation to exclude intracranial pathology 1.
• Heavy menstrual bleeding soaking through protection hourly, or bleeding lasting >7 days, needs gynecologic assessment 1.
• Progressive worsening of symptoms despite treatment warrants imaging (pelvic ultrasound) to exclude structural abnormalities 1.

Common Pitfalls to Avoid

• Don't dismiss the mind-body connection: emotional symptoms and physical pain share neurobiological pathways and must be addressed together 6, 2.
• Avoid waiting for symptoms to become unbearable before starting treatment—early intervention with NSAIDs is more effective 5.
• Don't assume irregular cycles are "normal"—3 months of irregularity warrants evaluation for thyroid disease, polycystic ovarian syndrome, or other endocrine disorders 1, 8.