Intense Lower Abdominal Pain and Missed Cycle: Seeking Advice (F/35)
Hello everyone, I hope you can excuse any grammatical errors, as English is not my first language. I am a 35-year-old woman who has undergone treatment for endometriosis (surgery done two years ago), along with a diagnosis of myomatosis and a gastric bypass in 2017. I have been using monthly Depo-Provera (Novafem) for over seven years without a break. Generally, I experience light yet consistent withdrawal bleeding every month, about every 30 to 35 days, and I am not attempting to conceive at this time. My most recent menstrual period began on May 22 and continued for a week. As of today, July 17, I am now at day 56 of my cycle without any bleeding. Lately, I have been experiencing increasingly bothersome PMS-like symptoms, especially this week, including: - Tenderness in my breasts - Heightened emotional sensitivity - An unexpected flare-up of hormonal acne - Bloating and gas in my digestive tract - Discharge that ranges from clear to milky white, which is usual for me and doesn’t have an unpleasant odor. Earlier today, I suddenly began to feel intense pain in my lower abdomen, deep in my pelvis. The discomfort was so severe that I was doubled over and unable to speak. There hasn’t been any fever, vomiting, or diarrhea, making me doubt it’s appendicitis. I took some naproxen and prednisone, which I had previously been prescribed during another flare. Thankfully, the pain subsided within 30 minutes. Additional information: - I took a pregnancy test yesterday, and it was negative. - No known issues with PCOS. - I have a history of anxiety and have been diagnosed with bipolar II, which I have managed with stable medication for over ten years. - There have been no signs of infection, such as fever, chills, or unusual vaginal discharge. - I am not experiencing pain while urinating. I am trying to understand what could be happening: - Is this related to uterine activity or a possible 'trapped period' from the Novafem? - Could my endometriosis have resurfaced even after surgery? - Or could this simply be a case of hormone dysregulation? I would greatly appreciate any insights or similar experiences anyone might want to share. I plan to arrange for an ultrasound if symptoms persist, but for now, I just want to feel less isolated and more grounded. Under what circumstances should I consider going to the emergency room? I hope it's not necessary, as I can't afford it and would prefer to seek help only in a life-threatening situation. Thank you very much for your assistance!
Answers (1)
7/19/2025, 12:31:17 AM
OpenHealth AI
It sounds like you're experiencing a combination of concerning symptoms, and I appreciate you sharing such detailed information. Your situation involves a missed cycle, abdominal pain, and various hormonal symptoms, especially considering your history with endometriosis and other medical conditions. Here’s a concise breakdown of what might be happening and actionable steps you can take.
Key Points:
- Missed Cycle and Hormonal Symptoms: You have been using Depo-Provera for a long time, which can cause irregular bleeding and hormonal fluctuations.
- Acute Lower Abdominal Pain: Sudden, severe pain could be related to ovarian function, endometriosis, or gastrointestinal issues, considering your history.
- When to Seek Immediate Care: Understanding the signs that necessitate emergency care is vital for your peace of mind.
Explanation:
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Menstrual Cycle Irregularities: The missed cycle could be due to the effects of Depo-Provera, as some women experience prolonged amenorrhea (no periods) after extended use. However, with your history of endometriosis, it's also possible you might be experiencing an issue related to your condition.
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Abdominal Pain: Endometriosis can resurface or continue causing pain even after surgery. The intensity of your pain could suggest several things, including a possible ovarian cyst or endometrial lesions. The absence of other symptoms like fever or unusual discharge is reassuring, but the sudden intensity of the pain is concerning.
Next Steps:
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Monitor Symptoms: Keep a detailed diary of your symptoms over the next week, noting the intensity and frequency of the pain, any changes in discharge, and other physical cues. This documentation can assist when discussing your case with a healthcare provider.
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Hydration and Diet: Focus on maintaining hydration and consider gentle, fiber-rich foods to help with bloating and digestive issues. Avoid trigger foods that might exacerbate gas.
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Emergency Signs: Seek emergency care if:
- You experience severe, unmanageable pain that returns or worsens.
- There are signs of internal bleeding (such as severe dizziness or fainting).
- You develop a persistent fever, vomiting, or significant changes in your discharge.
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Consider Professional Evaluation: If symptoms persist or worsen, schedule an ultrasound as you mentioned. Discuss your symptoms and medical history with the healthcare provider, especially given your concerns about endometriosis.
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Emotional Well-Being: It's important to address your emotional health, especially with a history of anxiety or bipolar disorder. Consider reaching out to a mental health professional for support during this challenging time.
You are doing the right thing by seeking advice and staying proactive about your health. I hope you find some comfort in knowing these steps may help clarify what's going on and improve your situation. Please keep me updated or ask if you have further questions!
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