OpenHealth Q&A

Seeking Advice on OBGYN Concerns

A 44-year-old woman from Australia, who has never smoked and drinks occasionally, shares her health concerns. She has experienced two singleton pregnancies and one set of twins, with her most recent pregnancy taking place twelve years prior. Since her late thirties, she has dealt with a range of symptoms including night sweats, cognitive fog, fatigue, and severe menstrual issues. Approximately two years ago, she consulted her general practitioner due to symptoms such as vomiting, nausea, pelvic pain on the right side, and a significantly delayed menstrual cycle (around 45 days). Though aware she was not pregnant, an emergency visit revealed an ovarian cyst after further examinations. Over the next twelve months, she returned to her GP multiple times for various complaints, including urinary tract infections, heart racing, extreme tiredness, night sweats, highly erratic bleeding patterns, heavy menstrual flow with clots, and enduring pain in her back and legs. After experiencing pain during intercourse and severe premenstrual symptoms, her concerns were often minimized, with suggestions to try hormonal birth control or consider perimenopause. However, she was hesitant to start hormonal treatments, recalling her previous experiences with the Mirena IUD, which had led to persistent bleeding, displacement, and pelvic discomfort. Finally, about a year ago, a GP took her symptoms seriously and ordered blood tests, revealing a notably low iron level (9). This led to a pelvic ultrasound, which indicated a bulky uterus, adenomyosis, fibroids, and an ovarian cyst. As a result, she was referred to an OBGYN. The OBGYN proposed trying hormonal birth control as a first step, with hysterectomy as a backup plan if necessary. As part of her treatment, she underwent iron infusions, which temporarily elevated her iron levels but often left her feeling ill, with side effects like nausea and hair loss. After experimenting with Slynd for three months, she experienced persistent spotting, diminished libido, and mental stress. With the expense of treatments in Australia, continuing the medication without improvement seemed impractical. Currently, she has shifted to Primolut, taking two tablets daily for three weeks followed by a week off, yet the results have been limited, with irregular cycles ranging from 10 to 25 days, ongoing heavy bleeding, and severe premenstrual symptoms. Recently, she began bleeding again on Monday, only having had three days of no bleeding before this episode. By Tuesday morning, she experienced significant cramps along with extremely heavy bleeding, necessitating frequent changes of her tampon and pad. Eventually, she passed a large clot, which alleviated some discomfort. As of Thursday, while the bleeding has ceased, she noticed peculiar yellow patches appearing on her hands and arms that resemble a jaundiced appearance, which emerged the day before. She struggles to schedule an appointment with her OBGYN for another three weeks and is preparing for an upcoming trip overseas. She wonders whether the Primolut could be causing her severe bleeding and the yellow discoloration on her skin, and is seeking guidance on how to proceed.

Answers (1)

3/20/2025, 9:40:50 AM

OpenHealth AI

Thank you for sharing your concerns; it sounds like you are facing several challenging symptoms that have impacted your well-being greatly. Here's a summary of your situation and some actionable steps you can take addressing your immediate symptoms and managing your health until you can see your OBGYN.

Main Points:

1. Symptoms of Concern: Persistent heavy bleeding, severe cramps, spots that might resemble jaundice, and the need to manage ongoing fatigue and discomfort.
2. Potential Causes and Treatment Considerations: Ongoing side effects from Primolut and underlying conditions such as adenomyosis and fibroids.
3. Next Steps: Focus on symptom relief, monitor changes, and prioritize hydration.

Explanation:

Your experience of heavy bleeding, passing clots, and unusual skin discoloration might be interconnected with your current medication (Primolut) and your underlying gynecological conditions. The yellow patches on your skin could indicate a variety of issues such as increased bilirubin levels or potentially reaction to medications, but it's essential to monitor this for further evaluation.

Your heavy menstrual symptoms and side effects from hormonal treatments (like Slynd and Primolut) require careful management. Since you’re having a difficult time with scheduling your OBGYN appointment, here are some steps you can take:

Specific Next Steps:

1. Monitor Your Symptoms: Keep a detailed record of your symptoms, including when bleeding starts and stops, the amount of flow, any associated pain, and the appearance of skin discoloration. This will be helpful for the OBGYN.

2. Hydration and Nutrition: Make sure you stay well-hydrated, especially if you're experiencing heavy bleeding. Consider increasing iron-rich foods (red meat, beans, leafy greens) and vitamin C (to enhance iron absorption) to support your levels, given your history of low iron.

3. Pain Management: For cramps, consider using over-the-counter pain relievers like ibuprofen or acetaminophen, as tolerated. Apply heat to the affected areas for additional relief.

4. Consider Temporary Adjustments: If the bleeding becomes unbearable before you can see your OBGYN, try to limit physical activities that may exacerbate it. It might also be worth discussing shorter intervals of Primolut if the current dosage is causing excessive side effects.

5. Seek Immediate Attention if Needed: If the yellow discoloration worsens, other symptoms develop (like fever, severe abdominal pain, or if you feel faint or unusually tired), consider seeking urgent care.

6. Follow-Up on Appointment: Given your upcoming trip, if your symptoms worsen or do not improve, consider calling your OBGYN's office to discuss the possibility of an earlier appointment or reaching out for any telehealth options for a quicker response.

Conclusion:

While waiting to see your healthcare provider, prioritize monitoring and managing your symptoms, especially focusing on hydration and pain relief. Your health and comfort are important as you navigate this period. Should you have any drastic changes or increasing concerns about your symptoms, don't hesitate to seek immediate care.