Brief Answer:
You are probably having breakthrough bleeding from the OCPs

Detailed Answer:
Hello, and I hope I can help you today.

Endometriosis is a chronic relapsing lifelong problem and it is good that you've been able to have your symptoms controlled up to this point on continuous birth control pills. However, anyone was been on birth control pills for very long period of time eventually will develop thinning of the lining of your uterus which can result in unpredictable bleeding called breakthrough bleeding. Breakthrough bleeding is usually very dark as the tissue that is being expelled has been in the uterus for very long time and can be black in color.

The reason why you feel so awful is because the severity of the cramps that you are getting in your uterus are causing many other side effects due to the endometriosis which likely still exists in your pelvis. You are just getting a menstrual period and endometriosis flare after a very long time. In your case, because of your endometriosis, it is not unusual that nausea, dizziness, headaches or other side effects would be much more severe in your case when you menstruate. This is why you went on the continuous oral contraceptives in the first place, to control these menstrual symptoms.

The reason why this is not a symptom of a ruptured ovarian cyst is that your ovary is located inside your abdomen so bleeding from it cannot come out. This is why surgery can be required if there is too much bleeding at the time of an ovarian cyst rupture. There is no reason to suspect because you are having vaginal bleeding that you would be having intra-abdominal bleeding as well.

I would try to take a strong nonsteroidal anti-inflammatory pain reliever as you can either ibuprofen or naproxen. You can take up to 800 mg of ibuprofen ivory eight hours or up to 500 mg every 12 hours of naproxen. These medications are more commonly known as Advil and Alleve.

It would be extremely unlikely at this point given the fact that you are on continuous oral contraceptives that you would have any cyst at all remaining in your pelvis. The symptoms a ruptured ovarian cyst include severe lower abdominal pain associated with nausea and diarrhea, abdominal bloating and additionally, pain in the right shoulder. It is not normally associated with vaginal bleeding.

You should call your GYN for advice if this continues, because you may need your current pill formulation to be changed.

I hope you're able to get yourself some effective pain medication, and that your pain gets better. I do suggest that you follow-up as urgently as you can with your gynecologist. If you have begun to breakthrough bleed on this pill formulation it might be beneficial to change the brand that you use.

I hope I was able to adequately answer your question today, and that my advice was helpful. If you need anything further, please do not hesitate to contact me.

Best wishes,

Dr. Brown

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Brief Answer:
An abnormal Pap smear has nothing to do with your other conditions

Detailed Answer:
Hello again,

I'm glad I was able to reassure you that your current symptoms are not cause for alarm or need to go to the emergency department.

I also want to let you know that an abnormal Pap smear only has to do with screening for pre-cancerous cells on the cervix, and that risk is not affected by any of the other gynecologic problems you may have other than if you are still bleeding at the time of your appointment, your doctor may not be able to perform the colposcopy procedure.

If this is your first abnormal Pap smear, it is unlikely that this will be anything serious.

I hope that you feel better than all the results of your evaluation by your GYN come out okay.

Take care,

Dr. Brown

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