instruction: hello doctor I have been extremely stressed lately I started a new job a couple of months ago I am going through a divorce and I have health issues pertaining to a brain surgery I had two years ago I had a normal pap smear last year my periods were normal until three months ago I was late by over a week for the past two months I got my period between 18 24 of last month I stopped and then again bled for a week from est to ith of this month this is the normal time I would have gotten it months ago now again a week later I am bleeding it started with dark brown blood that had tissue like small pieces in it and is now dark red going on day three my periods are always very heavy I always have ovary pain and bad cramps I had a section with my daughter and was told I have scar tissue during an exam I suffer from very painful periods when I sneeze or move or cough or stretch during ovulation and the beginning of my period I have a feeling like my right side is ripping apart why am I bleeding like this it has never happened to me before and I am scared it could be cancer I just had bloodwork I went to the hospital for an unrelated issue this week before the bleeding started and my red and white blood cells and normal abc workup was normal please help I am trying not to stress
output: hell first of all stop worrying we can take care of this stress can also play a vital role in hormonal functions so try to calm and relax yourself first see in general an average length of the menstrual cycle that is considered normal is 28 plus minus days so any deviation either before or after is abnormal coming to your present menstrual history you got early bleeding this time this mostly suggests some hormonal disturbance which needs to be evaluated it could be related to your thyearoid hormone or even a lifestyle related problem called cos polycystic ovarian syndrome but however any structural causes like polyps or fibroid also need to be ruled out for which ultrasound is required along with an examination by your gynecologist based on the past history it appears probably you must have had an entity called endometriosis or scar endometriosis in your cesarean scar this usually happens under the influence of the hormones that occurs in natural menstrual cycles when you are ovulating right now probably you did not ovulate either because of stress or due to the hormonal changes we need to evaluate I am suggesting a few tests that you need to take so that we can have a look into this meanwhile try to work on your lifestyle changes do regular exercises and take adequate dietary precautions avoid fatty or sugary or high carb junk foods all these measures will have beneficial effects on you try to meditate or do yoga for relaxation I would also like to know if you had any recent weight gain or weight loss any excess acne development or excess facial hair growth or scalp hair loss also if you have any headaches or visual changes it would be good if you could share the details of your recent ultrasound reports your scar tissue biopsy report if any done and the details of your previous issue which I am suspecting it to be endometriosis to guide you on the present problem the reports you shared show a good hemoglobin levels so nothing to worry in that ultrasound abdomen and pelvis complete hemogram lipid profile let liver function test rat renal function test 75 glucose tolerance test hba1c serum calcium vitamin b12 levels serum fasting and post prandial insulin levels serum fish follicle stimulating hormone oh leutinizing hormone free testosterone estradiol prolactin levels thyearoid profile to ash anti tpo on second or third day of next menstrual period hormonal imbalance cos polyp fibroid to be ruled out with ultrasound if the flow is heavy with passage of clots you can take tablet tragic 500 my thrice daily after food can avoid if the flow is normal yoga or medication maintain menstrual diary regular exercises at least one hour daily lifestyle and dietary modifications please revert back with the necessary details through chat preferably