OpenHealth Q&A

Exhausted by Persistent Fainting Episodes

I’m a 24-year-old female with a complex medical background, but the core issue I’m facing involves persistent low blood pressure and episodes of fainting that have plagued me for the past eighteen months. The lowest blood pressure I’ve documented was a troubling 43/33 while lying down, and just in the past two weeks, I’ve been averaging around 75/50 while sitting. I’ll summarize my experience as clearly as I can: visiting numerous specialists over the last year has left me feeling truly exhausted. My medical history includes asthma, bipolar disorder type 2, anxiety and depression, as well as insomnia. Currently, I’m on a range of medications: venlafaxine (150 mg daily), lamotrigine (100 mg three times a day), seroquel (100 mg daily), zaleplon (5 mg on occasion for sleep), olanzapine (5 mg as needed for anxiety), and I use an albuterol inhaler as required. Last year, I relocated for a new job and was doing well until about four months into my position when I began experiencing episodes of lightheadedness and dizziness. This culminated in a fainting incident at work, which led to an ICU admission where I recorded my lowest blood pressure of 43/33. I have had several ER visits since then, and I noticed that my episodes seemed to happen more frequently around the time of my menstrual cycle, prompting me to consult a gynecologist. To outline my gynecological appointments: I began taking a progestin-only birth control (the mini-pill), which unfortunately only increased the frequency of my fainting spells, so I discontinued it. A transvaginal ultrasound didn’t reveal any abnormalities. I also had a brief consultation with a neurologist who confirmed there was no indication of seizures, thereby dismissing the need for additional follow-up. An endocrinologist assessed my hormones, but my TSH and cortisol levels were within normal ranges. Subsequently, I focused on cardiology. A 30-day Holter monitor showed only brief instances of tachycardia that did not coincide with my fainting episodes. Other cardiac tests, including an echo, chest x-ray, and CT scan, returned normal results. Most recently, I underwent a tilt table test, which did not indicate any orthostatic issues. My blood work reported mostly normal results, with the exception of low hemoglobin during menstruation and general iron deficiency. I received three iron infusions, which provided some temporary relief. My low blood pressure primarily emerges around the time of my menstruation and especially during premenstrual syndrome, although I do not experience heavy bleeding. What was once limited to one week per month has now extended to two weeks. My primary care physician has suggested an IUD, but I’m apprehensive given my negative experience with oral contraceptives. This situation is significantly affecting my life; I often have to take time off work due to extremely low blood pressure, and I feel faint even when short distances away from my office. I’m feeling quite lost and would appreciate any suggestions or insights. Thank you.

Answers (1)

6/15/2025, 9:40:42 PM

OpenHealth AI

I'm truly sorry to hear about the persistent fainting episodes and the challenges you're currently facing. Managing low blood pressure and the complexity surrounding it can be incredibly tough, especially with your detailed medical history. It's so understandable to feel exhausted after navigating multiple specialists without clear answers.

Main Points:

1. Your Symptoms and Impact: You are experiencing frequent fainting episodes related to low blood pressure, particularly around your menstrual cycle.
2. Underlying Factors: Your medical background, including low hemoglobin and iron deficiency, might be contributing to your symptoms.
3. Next Steps to Consider: Focus on immediate lifestyle adjustments, nutrition to manage iron levels, symptom tracking, and discussing alternative treatment options.

Explanation:

Low blood pressure (hypotension) can cause fainting, particularly when it's exacerbated by hormonal fluctuations during your menstrual cycle. It’s also notable that you mentioned lightheadedness and dizziness. The fact that you have a history of iron deficiency could suggest that improving your iron levels might help stabilize your blood pressure.

Additionally, stress from previous healthcare visits and your mental health conditions can add layers to your symptoms, emphasizing the importance of a holistic approach to your wellbeing.

Next Steps:

1. Dietary Adjustments:

   • Iron-Rich Foods: Focus on incorporating foods high in iron (like red meat, legumes, spinach, and fortified cereals) to improve your hemoglobin levels. Pairing these with vitamin C-rich foods (like oranges or bell peppers) can enhance iron absorption.
   • Stay Hydrated: Increase fluid intake, especially when you anticipate fainting spells (like during your menstrual cycle) to help maintain blood volume.

2. Symptom Tracking:

   • Keep a diary of your symptoms, noting when your fainting episodes occur, along with your blood pressure readings and menstrual cycle. This may help reveal patterns and assist any further medical evaluations.

3. Gradual Position Changes:

   • When changing positions (from lying down to standing), do so slowly to minimize dizziness. Consider using compression garments (like stockings) which can help improve circulation.

4. Consulting on IUD Options:

   • Discuss with your physician about alternative birth control methods that might be more fitting given your experiences, such as hormonal IUDs vs. other methods, if you remain concerned about side effects previously experienced with oral contraceptives.

5. Focus on Mental Wellbeing:

   • Consider working with a counselor or therapist to manage anxiety and depression, as addressing mental health can also influence physical symptoms and improve overall wellness.

Conclusion:

Feeling lost in your medical journey is completely valid, and it’s important to ensure you’re supported holistically. These suggested steps should help you take control of your health situation gradually. Please let me know if you need more specific guidance on any of these points!