[29F] Experiencing prolonged and heavy vaginal bleeding with sharp pain

Patient Description

A 29-year-old female has been experiencing vaginal bleeding on and off for the past 3 weeks out of 5 weeks. The bleeding episodes can be heavy, sometimes soaking through her underwear. She reports that this kind of heavy bleeding has not happened to her before. She is not experiencing pain or cramps most of the time, but occasionally she gets a sharp pain on her right side, described as similar to a charlie horse, and also experiences lower back pain on the right side, which comes and goes. The pain is sharp and can be quite severe, rated 7-8 out of 10. The bleeding episodes come on suddenly and last about 2 days to a week before stopping. She hasn't noticed any patterns or triggers for the bleeding. Her menstrual cycle has been pretty constant for the past 15 years, and she hasn't noticed any recent changes or stressors that might affect her hormonal balance. She hasn't started or stopped any medications recently, including birth control, and hasn't experienced any significant weight changes. She has noticed changes in her vaginal discharge, including an odor and a gooey substance. She has not experienced fever, chills, pain or burning during urination, pelvic pain or pressure, or unusual fatigue or weakness. Her last normal period was in May, and her periods usually last 7 days. Last month, she had her period twice, and this month she's had it once already. She hasn't used any substances such as tobacco, alcohol, or recreational drugs recently. She has had a C-section but no other surgeries or medical conditions related to her reproductive system. She does not have a family history of reproductive health issues. She is currently taking TUMS, 10 mg twice a day, and no other medications, supplements, or herbal remedies.

Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

1. Abnormal Uterine Bleeding (AUB)

Rationale: Abnormal uterine bleeding can present as heavy or prolonged menstrual bleeding, bleeding between periods, or bleeding after sex. It can be caused by hormonal imbalances, uterine fibroids, polyps, or other underlying conditions.
Typical Treatments/Testing: Your doctor may perform a pelvic exam, ultrasound, or blood tests to determine the cause. Treatment may include hormonal therapies, medications to reduce bleeding, or surgical options if necessary.

2. Infection

Rationale: The presence of an odor and unusual discharge suggests a possible infection, such as bacterial vaginosis or a sexually transmitted infection (STI).
Typical Treatments/Testing: Your doctor may take a sample of the discharge for testing. Treatment typically involves antibiotics or antifungal medications, depending on the type of infection.

Unifying Diagnoses

Hormonal Imbalance: This could explain both the abnormal bleeding and the changes in your menstrual cycle. Hormonal imbalances can be caused by stress, weight changes, or underlying conditions like polycystic ovary syndrome (PCOS).
Uterine Fibroids or Polyps: These non-cancerous growths can cause heavy bleeding, irregular periods, and pelvic pain. An ultrasound can help diagnose these conditions.

What you can do

Abnormal Uterine Bleeding (AUB)

Seek Medical Attention: Given the severity and duration of your bleeding, it's important to see a healthcare provider as soon as possible. They can perform the necessary tests to determine the cause and recommend appropriate treatment.
Track Your Symptoms: Use MDandMe to journal your symptoms, track your bleeding patterns, and note any other changes. This information can be valuable for your healthcare provider.

Infection

Consult a Doctor: If you suspect an infection, it's important to get tested and treated promptly. Untreated infections can lead to more serious complications.
Maintain Hygiene: Keep the vaginal area clean and dry. Avoid using scented products that can irritate the area.

General Tips

Stay Hydrated: Drink plenty of water to stay hydrated, especially if you are experiencing significant blood loss.
Rest: Ensure you get enough rest to help your body recover.
Monitor for Severe Symptoms: Keep an eye out for any signs of severe anemia (such as extreme fatigue, dizziness, or shortness of breath) or signs of infection (such as fever or severe pain).

What you should look out for

Given the severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

Heavy Bleeding: If you are soaking through a pad or tampon every hour for several hours.
Severe Pain: If you experience severe or worsening pain in your abdomen or pelvis.
Signs of Infection: If you develop a fever, chills, or severe pain.
Signs of Anemia: If you feel extremely fatigued, dizzy, or short of breath.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.

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