[25F] Experiencing abdominal pain, unexpected bleeding, and shortness of breath

Patient Description

A 25-year-old female presents with persistent abdominal pain for 2-3 weeks, rated as 7 out of 10 in severity. She reports unexpected bleeding that began heavy and dark red, now light pink, not related to her menstrual cycle. Additionally, she experiences a dull, persistent pain under her shoulder blade and shortness of breath. She has a family history of ovarian cancer and ovarian cysts, as her mother underwent a complete hysterectomy due to these conditions. The patient has asthma, managed with an Abudoral inhaler, and was diagnosed with mental illnesses at age 12. She is allergic to penicillin. No recent travel or other medications reported.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations:

  1. Gastrointestinal Bleeding: The combination of dark, almost black stools and abdominal pain could suggest gastrointestinal bleeding. This can occur due to various reasons, such as ulcers or gastritis. The dark color of the stool may indicate that the bleeding is occurring in the upper gastrointestinal tract. It's important to seek medical attention to determine the cause and receive appropriate treatment.

  2. Gynecological Issues: The unexpected bleeding, especially after intercourse, could be related to a gynecological issue such as cervical polyps, infections, or other conditions. Given your family history of ovarian cancer, it's crucial to have this evaluated by a healthcare professional.

  3. Musculoskeletal or Referred Pain: The dull pain under your shoulder blade could be musculoskeletal in nature or referred pain from another area, such as the abdomen. This should be assessed to determine the underlying cause.

  4. Asthma and Shortness of Breath: Your shortness of breath could be related to your asthma, especially if it's not well-controlled. It's important to ensure that your asthma management plan is up to date.

What you can do

Gastrointestinal Concerns:

  • Seek medical attention promptly to evaluate the cause of the dark stools and abdominal pain. This may involve tests such as blood work, imaging, or endoscopy.
  • In the meantime, avoid non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, as they can exacerbate gastrointestinal bleeding.

Gynecological Concerns:

  • Schedule an appointment with a gynecologist to discuss the unexpected bleeding and any other related symptoms. They may perform a pelvic exam or other diagnostic tests.

Pain Management:

  • For the dull pain under your shoulder blade, consider gentle stretching exercises and applying heat or cold packs to the area for relief.
  • If the pain persists or worsens, consult a healthcare provider for further evaluation.

Asthma Management:

  • Ensure you are using your inhaler as prescribed and have an updated asthma action plan. If your shortness of breath is worsening, consult your healthcare provider.

General Health:

  • Keep a journal of your symptoms using MDandMe to track any changes and share this information with your healthcare provider.
  • Maintain a balanced diet and stay hydrated, especially if your appetite is reduced.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Severe abdominal pain or a sudden increase in pain intensity
  • Significant or persistent bleeding
  • Shortness of breath that worsens or does not improve with your inhaler
  • Dizziness, fainting, or signs of anemia (such as extreme fatigue or paleness)

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

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People Also Ask


What could cause unexpected bleeding not related to the menstrual cycle?

Unexpected bleeding not related to the menstrual cycle could be due to gynecological issues such as cervical polyps, infections, or other conditions. It's important to consult a gynecologist for a proper evaluation, especially with a family history of ovarian cancer.


How can gastrointestinal bleeding be identified and treated?

Gastrointestinal bleeding can be identified by symptoms such as dark, tarry stools and abdominal pain. Treatment involves seeking medical attention for tests like blood work, imaging, or endoscopy to determine the cause. Avoid NSAIDs as they can worsen bleeding.


What are potential causes of dull pain under the shoulder blade?

Dull pain under the shoulder blade could be musculoskeletal or referred pain from another area, such as the abdomen. Gentle stretching, heat or cold packs, and consulting a healthcare provider if the pain persists can help manage it.


How should asthma be managed if shortness of breath persists?

Asthma should be managed by using the inhaler as prescribed and having an updated asthma action plan. If shortness of breath persists, it's important to consult a healthcare provider to ensure the asthma management plan is effective.


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