instruction: hello doctor I have some symptoms for the past one and a half weeks that mic the symptoms when I found I was pregnant with my daughter I was supposed to have my period tomorrow last week I started with light spotting and it happened on and off for a day maybe less then within two days I started bleeding I thought it just started early but I have been on occasional bleeding lighter to heavier for two days I have had cramping back pain headache and today I had a lot of blood clots and tissue coming out with it along with right groin pain for a couple of days I have never experienced these symptoms and they are intense I am scared this is the start of a miscarriage but any test I have taken has been negative I am on the patch for almost a year and have not experienced anything like this and I have a weird feeling now
output: hello first to confirm a pregnancy you should perform a pregnancy test two weeks after having sexual intercourse so perform a urinary pregnancy test or hug human chorionic gonadotropin test to exclude or to confirm a pregnancy and after that perform an ultrasound to evaluate the uterine cavity on the other hand maybe your menses have come earlier and has a different pattern compared with other menstrual bleeding as you use the patch for one year there are low chance of pregnancy always if you have used it correctly