The Night I Sat on the Bathroom Floor Deciding Whether Stomach Pain Was Worth a Phone Call

Eleven at night, on the bathroom floor

I want to describe the actual problem, because I do not think it is the pain.

The problem is that at eleven at night, with a pain under my ribs that I could not name, I had no way of knowing whether I was being dramatic or whether I was being slow. Those are the only two options available to a woman at that hour, and both of them are embarrassing in different directions.

So I did what I always do, which is nothing, and then I looked it up the next morning, which is when I finally found the thing I should have been told at the start.

The number that calmed me down

Wegovy's label reports abdominal pain in 20% of people taking the 2.4 mg injection.

That is one in five, and on its own it sounds like a lot. The part that matters is sitting in the column next to it: 10% of the people on placebo reported it too¹.

That is the context nobody gives you. Half the abdominal pain in that trial happened to people who were not taking the drug at all. Stomachs hurt. Mine hurt before I started and it will hurt after I stop, and about half the time this happens it has nothing to do with the injection.

Knowing that did not make the pain stop. It made me stop treating every twinge as evidence.

What I did not know, and should have

Here is the thing I found in the label that changed how I think about calling.

Under its warnings, Wegovy lists acute pancreatitis, and the instruction is exactly six words long: discontinue if pancreatitis is suspected¹.

Suspected. Not confirmed, not diagnosed. The drug's own manufacturer says that when this is a possibility, the response is to stop and find out — not to wait until you are certain.

I had been holding myself to a much higher standard than the label does. I was waiting to be sure before I bothered anybody, and the document that comes in the box says the threshold is suspicion.

The gallbladder warning reads the same way: acute gallbladder disease has occurred in clinical trials, and if gallstones are suspected, gallbladder studies and clinical follow-up are indicated¹.

Mine came out years ago, which I used to think meant I could stop reading that paragraph. It does not — I still get the pain, I just cannot get the stones — and it took me an embarrassingly long time to work out that this made my own symptoms harder to interpret rather than easier.

The two things I actually watch now

I am not a doctor and I am not going to hand anyone a checklist that sounds like one. But there are two things that have turned out to matter more than how much it hurts.

Where it is. Ordinary GLP-1 stomach pain, for me, is diffuse and low and moves around. It is crampy, tied to eating, and it does not stay in one place. What I have learned to take seriously is pain that picks a spot and stays there — particularly high up in the middle or under the right ribs, and especially if it goes through to my back.

What it does over time. Ordinary pain fluctuates. It is worse after a meal, better a few hours later, worse in the days after a dose increase and quieter by the end of the week. What worries me is pain that climbs steadily and does not let go, or that wakes me up.

The one that gets missed entirely is dehydration. The label carries a warning about acute kidney injury from volume depletion — and if you are not keeping fluids down, that is a route to something serious that does not feel like a "stomach problem" at all. It just feels like being unable to drink.

The part where I stopped apologizing

The bigger review of gastrointestinal effects of these drugs is honest that a lot of the management advice rests on clinical experience rather than trial evidence², and there is now a full systematic review of gastroparesis with these drugs — a rare but real event, with its own recognizable pattern of vomiting food eaten many hours earlier³.

Which is to say: this is not a settled field, and my prescriber is not being evasive when she hedges. She genuinely does not have a clean answer either.

What I have changed is the phone call. I used to open with an apology and a summary of why it was probably nothing. Now I say where it is, how long it has been there, whether it is getting worse, and whether I am keeping fluids down. It takes forty seconds and it gets me a real answer instead of reassurance.

I have called twice. Once it was nothing. Once she wanted to see me.

I would rather have that ratio than the one I had before, which was zero calls and a lot of nights on the bathroom floor doing arithmetic about whether I was allowed to be worried.