[23F] With lymph node pain, irregular bleeding, and dark discharge

Patient Description

A 23-year-old female presents with pain in her lymph nodes, irregular vaginal bleeding, and dark discharge. The irregular bleeding has been occurring almost every day for over a month and is described as random and prolonged. The discharge is dark, sometimes thick, brown in color, involves a lot of shedding, and has a different smell than usual. The patient also reports lower abdominal pain and pain during intercourse. The pain in the lymph nodes started two days ago, is sharp, constant, and rated as a 6 out of 10 in intensity. The patient denies any fever, chills, nausea, or vomiting. She has not had any recent changes in medications, except for her regular Depo birth control shot every three months. There have been no recent new sexual partners or unprotected sexual encounters, no recent travel to areas with known health risks, and no history of sexually transmitted infections (STIs). The patient has no pre-existing conditions or chronic illnesses.

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Arora's Assessment

What might be happening

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

  • Pelvic Inflammatory Disease (PID): PID is an infection of the female reproductive organs. It can cause irregular bleeding, unusual discharge, and lower abdominal pain. Lymph node pain can also occur if the infection spreads. Treatment typically involves antibiotics prescribed by a healthcare provider.

  • Hormonal Imbalance: Irregular bleeding and changes in discharge can sometimes be due to hormonal imbalances, which can be influenced by birth control methods like the Depo shot. Hormonal imbalances can also cause pain and discomfort in the lower abdomen.

  • Cervical or Endometrial Polyps: These are growths on the cervix or the lining of the uterus that can cause irregular bleeding and unusual discharge. They are usually benign but can cause discomfort and require medical evaluation.

  • Sexually Transmitted Infections (STIs): Although you mentioned no history of STIs and no recent new sexual partners, some STIs can remain asymptomatic for a long time and then cause symptoms like irregular bleeding, unusual discharge, and lower abdominal pain. Testing is important to rule this out.

  • Endometriosis: This condition involves the growth of endometrial tissue outside the uterus, which can cause irregular bleeding, pain during intercourse, and lower abdominal pain. Diagnosis often requires imaging studies and sometimes laparoscopy.

What you can do

  1. Consult a Healthcare Provider: It is important to see a doctor for a formal assessment and diagnosis. They may perform a pelvic exam, order blood tests, or recommend imaging studies to determine the cause of your symptoms.

  2. Track Your Symptoms: Use MDandMe to journal your symptoms, track your progress, and share longitudinal medical notes with your provider. This can help in identifying patterns and triggers.

  3. Maintain Good Hygiene: Keep the genital area clean and dry. Avoid using scented products that can irritate the area.

  4. Stay Hydrated and Eat a Balanced Diet: Proper hydration and nutrition can help support your overall health and potentially alleviate some symptoms.

  5. Avoid Sexual Activity: Until you have been evaluated by a healthcare provider, it may be best to avoid sexual activity to prevent further irritation or potential spread of infection.

What you should look out for

Seek medical attention more urgently if you experience:

  • Severe Abdominal Pain: If the pain becomes intense or unbearable.
  • Fever or Chills: These could indicate an infection that requires prompt treatment.
  • Heavy Bleeding: If you experience heavy bleeding that soaks through pads or tampons quickly.
  • Foul-Smelling Discharge: This could be a sign of an infection that needs immediate attention.
  • Difficulty Urinating or Pain During Urination: This could indicate a urinary tract infection or other issues that need to be addressed.

Remember, while I can provide information and suggestions, I am not a doctor. It is crucial to seek care from real health professionals to receive a formal diagnosis and appropriate treatment.

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4 mo ago


People Also Ask


What are the common symptoms of Pelvic Inflammatory Disease (PID)?

Common symptoms of PID include lower abdominal pain, unusual vaginal discharge, irregular menstrual bleeding, pain during intercourse, and sometimes fever or chills. It is important to seek medical attention for proper diagnosis and treatment.


Can hormonal birth control like the Depo shot cause irregular bleeding?

Yes, hormonal birth control methods like the Depo shot can cause side effects such as irregular bleeding or spotting, especially in the first few months of use. If the bleeding is persistent or concerning, it is advisable to consult a healthcare provider.


What are cervical or endometrial polyps and how are they treated?

Cervical or endometrial polyps are growths on the cervix or the lining of the uterus. They are usually benign but can cause symptoms like irregular bleeding and unusual discharge. Treatment may involve removal through a simple procedure, especially if they cause symptoms or are suspected to be problematic.


How can endometriosis be diagnosed and managed?

Endometriosis is diagnosed through imaging studies like ultrasound or MRI, and sometimes requires a laparoscopy for confirmation. Management includes pain relief, hormonal therapies, and in some cases, surgery to remove endometrial tissue.

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