Chronic Menstrual Discomfort
Greetings, I'm reaching out for expertise and guidance concerning my girlfriend's health issues. For the last two weeks, she's been experiencing on-and-off abdominal discomfort, which started in her right lower quadrant (RLQ) and has now also affected the left lower quadrant (LLQ). Here are some details: she is 25 years old, 5 feet 3 inches tall, and weighs 210 pounds. Her medical background includes polycystic ovary syndrome (PCOS), as well as a recent IUD removal due to displacement, a previous spontaneous IUD expulsion, heavy menstrual bleeding, attention-deficit/hyperactivity disorder (ADHD), and anxiety. Her family medical history lists PCOS and endometriosis. She's taking Drospirenone 4mg, which began on March 7, along with Vyvanse 10mg, Iron, B12, a multivitamin, and Vitamin C. Socially, she consumes alcohol a handful of times annually and uses marijuana occasionally (including both smoking and edibles) but stopped recently on January 12. After being diagnosed with PCOS in 2022, my girlfriend has faced two instances of IUD expulsion, and traditional oral contraceptives have been ineffective in controlling her heavy menstrual bleeding. At present, her daytime bleeding is somewhat under control but tends to flare up during the night. It's so severe that she can bleed through a "super jumbo" tampon and period underwear within 60 minutes. For further context, during the previous expulsion in January 2025, she bled through both a "super jumbo" tampon and Depend briefs during the night. Other indicators of her significant bleeding issues involve spending hours on the toilet as she experiences continuous blood flow and passing clots approximately the size of 6 cm. Thus far, she consulted her general practitioner who expressed concerns that her issues might stem from her PCOS, given the presence of numerous follicles in her right ovary. Blood tests, a urine sample, and an ultrasound appointment have been scheduled for mid-January. Her blood work returned normal, confirming she is not pregnant, nor did they find indications of a urinary tract infection (UTI). The doctor who performed the IUD insertion in February 2025 has also been consulted; the device was removed on March 7 as it was, in the doctor's words, "on its way out." As a follow-up, she was prescribed Drospirenone to help with menstruation and discussed a potential prescription for tranexamic acid (TXA). She has a follow-up appointment to explore the option of a birth control implant at the end of December. Since the removal of her IUD, she continues to encounter intermittent severe menstrual bleeding, nausea that comes and goes, as well as constant discomfort in her lower back and abdominal regions. We plan to return to her GP on Monday when the clinic reopens. I am seeking insights and advice regarding what could be causing these symptoms. Is this solely linked to her PCOS? I'm also interested in ways to support her effectively and advocate for her health if necessary. Our current objectives include discussing a referral to an OBGYN and the follow-up for the birth control implant, as it seems IUDs aren't providing relief. Should we consider consulting an endocrinologist? Both of us have reservations about TXA due to potential clotting risks, particularly as my mother experienced a pulmonary embolic shower and spent time in the ICU this past summer, with her situation believed to be linked to hormone replacement therapy (HRT) related to menopause. As both my girlfriend and I work in healthcare, we are finding it challenging to navigate this situation. Any advice you could share would be greatly appreciated.
Answers (1)
12/13/2025, 10:01:17 AM
OpenHealth AI
Main Points: Your girlfriend is experiencing severe menstrual discomfort and heavy bleeding, likely compounded by her PCOS and recent IUD issues. It's commendable that you're seeking support for her. Here are tailored insights and actionable next steps.
Explanation: The symptoms described, including severe abdominal discomfort, heavy menstrual bleeding, and back pain, can be related to her polycystic ovary syndrome (PCOS), as well as potential influences from the removal of her IUD. PCOS can lead to hormonal imbalances, which might cause irregular menstruation and heavy bleeding. Additionally, the removal of the IUD can also disrupt the menstrual cycle initially, resulting in increased symptoms, especially as she had complications with previous IUDs.
With her family history of endometriosis and ongoing severe menstrual symptoms, it’s prudent to consider that endometriosis could also be a factor. The blood tests being conducted are essential in ruling out other conditions and helping understand her hormonal levels.
Next Steps:
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Advocate for a Comprehensive Evaluation:
- During the upcoming GP appointment, discuss the possibility of a referral to an OBGYN. This specialist can offer more targeted treatments for her menstrual issues and a thorough evaluation that may include endometriosis screening.
- Express your concerns about her heavy bleeding and the associated symptoms in detail. Sharing specific incidents (like bleeding through a super jumbo tampon within 60 minutes) can illustrate the severity clearly.
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Discuss Treatment Options:
- Bring up the effectiveness and potential side effects of Drospirenone and the concerns surrounding tranexamic acid (TXA). Address your feelings regarding clotting risks, emphasizing a preference for therapies with lower risks.
- Inquire about alternative birth control methods beyond IUDs, such as hormonal implants or different oral contraceptives that may better suit her condition.
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Manage Discomfort and Symptoms at Home:
- Encourage her to maintain a symptom diary until her appointment, noting the intensity of her bleeding, episodes of nausea, and any other relevant symptoms. This can facilitate a more informed discussion with her healthcare provider.
- Suggest she stay hydrated and consider gentle heat (like a heating pad) to alleviate abdominal and back pain if it's safe and comfortable for her.
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Mental Health Support:
- Given the stress of her ongoing health issues, ensure that both of you are taking care of your mental health. You might consider integrating stress-reduction techniques, such as mindfulness or relaxation exercises, especially since both of you are in healthcare and may be facing compounded stress.
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Keep Communication Open:
- Continue discussing her feelings and experiences with her, providing reassurance that exploring all treatment options is essential. Feeling supported during this time can make a difference in how she manages her condition.
Your proactive approach in advocating for her health is valuable, and you're right to explore all avenues that may help alleviate her symptoms. Best wishes to both of you in the upcoming discussions with her GP.
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