Frequent Periods: Seeking Guidance on Symptoms
Profile: 26-year-old female, diagnosed with chronic migraines and ADHD, currently on a daily regimen of isotretinoin (20mg), and taking Primolut N (Norethisterone) at a dosage of 5mg three times a day, in addition to a Nexplanon implant which was inserted a year ago. In mid-January, I began experiencing a menstrual cycle that recurs every seven days, a significant change after 14 years of consistent monthly periods. The flow has been heavier than usual and is a striking bright red. Additionally, I've been suffering from persistent lower back pain that doesn’t alleviate despite taking ibuprofen or acetaminophen, alongside severe cramps that primarily affect my left side, though I do occasionally feel discomfort on the right. While the cramps can be somewhat eased with ibuprofen, they inevitably return. Furthermore, I’ve been dealing with ongoing nausea post meals and frequent bloating in my lower abdomen. After several cycles of these troublesome symptoms, I consulted a general practitioner. Unfortunately, my concerns were dismissed; the doctor prescribed 5mg of Norethisterone to be taken three times daily for ten days, suggesting that it would help to “slow down” the bleeding, while offering a refill option for up to three cycles. Following my initial treatment course, I paused the Norethisterone for two days, during which I experienced even more intense cramps, increased nausea, and resumed bleeding. I restarted the medication and, although the bleeding ceased once more, the intensity of the back pain and cramps has escalated, becoming nearly constant. This ongoing ordeal is taking a toll on my mental well-being, leaving me feeling persistently unwell. I also needed an iron infusion ten months ago after lab results indicated a dangerously low ferritin level of 4, which raises my concern about possibly low iron levels again. I’ve scheduled a follow-up appointment with the clinic I visited last, but that won't occur until the middle of next week. Given that my previous appointment felt dismissive, I am unsure if there are specific tests or further steps I should inquire about during my upcoming visit.
Answers (1)
3/20/2025, 5:01:09 PM
OpenHealth AI
It sounds like you are experiencing a complex set of symptoms with your menstrual cycle, including frequent periods, significant pain, nausea, and a history of low iron levels. It's understandable to feel overwhelmed, especially since these symptoms have been persistent and are affecting your well-being. Let's break down your situation and focus on what you can do next.
Main Points:
- Frequent and Heavy Periods: Your changing menstrual cycle is concerning, especially with the heaviness and color of the blood.
- Persistent Pain and Nausea: The continuing discomfort, especially if it's worsening, is something to take seriously.
- Previous Low Iron Levels: This adds an important dimension to your concerns, as iron status can be impacted by heavy menstrual bleeding.
Explanation:
Changing menstrual patterns can be caused by various factors, including hormonal imbalances, side effects from medications, or even underlying conditions like endometriosis or fibroids. Given your use of medications like the Nexplanon implant and Norethisterone, hormonal fluctuations may play a significant role. Heavy bleeding and pain, especially with your history of low iron, should not be overlooked.
Next Steps:
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Keep a Symptom Diary: Document the timing and characteristics of your bleeding, pain levels, and any other symptoms such as nausea and bloating. This can provide valuable information for your healthcare provider at your follow-up appointment.
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Request Specific Tests: During your visit, ask about:
- Blood Tests: Specifically, request a complete blood count (CBC) to check your hemoglobin levels, as well as serum ferritin to assess your iron stores.
- Hormonal Evaluation: Discuss if a hormonal assessment could help determine if your symptoms could be related to an imbalance.
- Ultrasound: This may help identify any structural abnormalities like fibroids or cysts in your reproductive system.
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Discuss Medication Options: Explain the persistent symptoms you experienced on Norethisterone and that a temporary relief is not enough. Ask whether there are alternative treatments that could provide more consistent relief or different management strategies for your symptoms.
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Exploring Lifestyle Adjustments: While you wait for your follow-up, consider:
- Dietary Changes: Focus on iron-rich foods (like red meat, leafy greens, and legumes) and those rich in vitamin C to help with iron absorption.
- Hydration and Activity: Staying hydrated and engaging in gentle activity, like walking or stretching, may help reduce discomfort.
It's important to prioritize your health and well-being, and voicing your concerns actively can help ensure you're taken seriously. Be proactive during your follow-up appointment and emphasize how these symptoms are affecting your quality of life. You're advocating for yourself, which is critical in navigating these challenges.
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