instruction: hello doctor since I came off the pill 14 months ago I have had lots of issues black brown smelly spotting irregular periods severe pain severe fatigue been to the emergency department many times with different issues stomach bleeding severe stomach pains lightheadedness back and neck ache etc I developed a headache about months ago mri showed a pituitary microadenoma have been to endocrinologist but he has ruled out hormonal reasons and sent me away saying another mri will be done in months and have referred me to a fertility specialist I cannot live like this severe stomach issues cannot eat properly diarrhea severe headaches weeks leading up to periods have lost keg within months severe fatigue no energy for anything palpitations any exercise makes me very lightheaded someone please help
output: hi in your description you have mentioned lots of issues that needs to be investigated and sorted out in detail individually microadenoma and hormonal imbalance are two separate issues actually those can cause different symptoms need different investigations precautions and treatments it would be better if you could send me your detailed reports adenoma related issues need to be consulted with endocrinologist on regular basis for rest of the medical issues need to be consult with consultant general physician to sort out for every symptom have some counseling sessions with pshychaitrist to help feel emotionally balanced for irregular periods have transvaginal scan and blood tests on day of periods testosterone progesterone prolactin insulin fish and oh thyearoid function tests high vaginal swab cervical smear collect all laboratory tests and discuss here have combined oral contraceptive pills for cycles to have hormonal support and regulate periods after collection of swab from vagina have injection ceftriaxone 500 my intramuscular once azithromycin go per oral once tablet doxycycline 100 my twice daily and tablet metronidazole 400 my hourly for 14 days have balanced diet weight and mi complete treatment of any health issue you have daily walk exercise and yoga have recreational activities and quit recreational drugs have cold milk at bed time and after waking up before breakfast