[34F] Experiencing severe lower abdominal pain and heavy menstrual bleeding

Patient Description

A 34-year-old female is experiencing severe, sharp pain in the lower abdomen that worsens with movement, rated as 7/10 in intensity and escalating to 10/10 upon movement. This pain onset occurred immediately after intercourse. Additionally, she reports a history of heavy menstrual bleeding outside of her regular periods for approximately one year, with the bleeding being so severe that it requires changing a tampon and pad more frequently than every 2-3 hours, and has led to blood on her seat after just 10 minutes. The patient has also experienced passage of large clots, dizziness, lightheadedness, fainting spells, and blood in her urine. A couple of years ago, she had internal bleeding in her stomach, suspected to be from an ovarian cyst rupture. Approximately 14 years ago, she was diagnosed with cancer cells and HPV during her second pregnancy but has not followed up on these conditions for the past 12 years. The patient is not currently on any medications and has no known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Endometriosis: This is a condition where tissue similar to the lining of the uterus is found outside the uterus. It can cause severe abdominal pain, especially during or after intercourse, and heavy menstrual bleeding.

    • Treatment typically involves hormonal therapies and pain management. In severe cases, surgery may be needed.

  • Pelvic Inflammatory Disease (PID): This is an infection of the female reproductive organs. It can cause pain in the lower abdomen and heavy menstrual bleeding. It's usually caused by sexually transmitted bacteria.

    • Treatment typically involves antibiotics.

  • Uterine Fibroids: These are noncancerous growths of the uterus that can cause heavy menstrual bleeding and pelvic pain.

    • Treatment can range from medication to manage symptoms to surgical removal of the fibroids.

  • Cervical or Uterine Cancer: Given your history of HPV and the presence of cancer cells 14 years ago, it's important to consider the possibility of cervical or uterine cancer. These can cause heavy menstrual bleeding and pelvic pain.

    • Treatment typically involves surgery, radiation, and/or chemotherapy.

Please note that these are possibilities and not a definitive diagnosis. It's important to see a healthcare provider for a formal diagnosis.

What you can do

  1. Schedule an appointment with a healthcare provider as soon as possible. They can conduct a physical examination and order necessary tests to determine the cause of your symptoms.
  2. Over-the-counter pain relievers like ibuprofen can help manage your pain in the meantime. However, these should not be used as a long-term solution.
  3. Keep track of your symptoms, including when they occur, their severity, and any potential triggers. This information can be helpful to your healthcare provider.

What you should look out for

Seek immediate medical attention if:

  • Your pain becomes unbearable or significantly worsens
  • You experience heavy bleeding that soaks through one or more pads or tampons every hour for several hours
  • You have signs of shock, such as cold and sweaty skin, irregular heart rate, or rapid breathing
  • You have severe dizziness or fainting spells

Remember, I'm an AI and not a doctor. It's important to consult with a healthcare provider for a formal diagnosis and treatment.

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8 mo ago

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People Also Ask

What are the common symptoms of endometriosis?

Common symptoms of endometriosis include severe menstrual cramps, chronic pelvic pain, pain during or after intercourse, heavy menstrual bleeding, and infertility. Some women may also experience fatigue, diarrhea, constipation, bloating, and nausea, especially during menstrual periods.

How is Pelvic Inflammatory Disease (PID) diagnosed and treated?

Pelvic Inflammatory Disease (PID) is typically diagnosed through a pelvic exam, analysis of vaginal discharge and cervical cultures, and sometimes ultrasound or other imaging tests. Treatment usually involves a course of antibiotics to clear the infection. It's important to complete the full course of antibiotics even if symptoms improve, and sexual partners may also need treatment to prevent reinfection.

What are the potential complications of untreated uterine fibroids?

Untreated uterine fibroids can lead to complications such as severe anemia due to heavy bleeding, chronic pelvic pain, and pressure symptoms affecting the bladder and bowel. In some cases, fibroids can affect fertility or complicate pregnancy. Regular monitoring and treatment can help manage these risks.

How does HPV relate to cervical cancer, and what are the signs to watch for?

HPV is a major risk factor for cervical cancer, as certain strains of the virus can cause changes in cervical cells that may lead to cancer over time. Signs of cervical cancer can include abnormal vaginal bleeding (such as bleeding after intercourse or between periods), unusual vaginal discharge, and pelvic pain. Regular screening through Pap smears and HPV tests can help detect precancerous changes early.

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