Lower Abdominal Pain, Discharge, and Anemia in Women

Lower abdominal discomfort - discharge - anemia

Before my pregnancy in 2016, I experienced discharge almost continuously, usually lasting 2-3 days, and I would only see a doctor if the amount was significant or if there was itching.
Around three months into my pregnancy, the discharge did not stop for two months, and I tried different medications prescribed by various doctors.
When I was selecting an obstetrician for delivery, my doctor informed me that medications during pregnancy were ineffective and that it would resolve after childbirth.
Indeed, it improved after delivery, but 1-2 months later, the discharge started again, mostly mild.
When it became severe, I would see a doctor and receive medication.
Recently, I have been experiencing lower abdominal discomfort before my menstrual period, and the discharge has increased over the past few days.

Before I turned 20, an emergency physician diagnosed me with hereditary Mediterranean anemia.
I had fainted twice due to anemia before middle school, and the only time I fainted was after several nights of insufficient sleep.
I typically recover quickly from sudden anemia, even if severe, as long as I sit with my head down and sweat it out for about 10 minutes.
However, this week, I have been experiencing continuous symptoms of anemia, leading to dizziness.
Today, I felt faint to the point where my vision turned white, but I did not break out in a cold sweat.
Unlike before, my face is not pale but rather flushed.

I would like to ask the doctor if I should first get checked by a hematologist before going to see a gynecologist, or if I should go to a general gynecology clinic or a hospital.
Would it be better to have both specialties examine me? Thank you, doctor, for taking the time to respond.

Zhang, 30~39 year old female. Ask Date: 2020/04/20

Dr. Cai Yonglong reply Obstetrics and Gynecology

Please first visit the obstetrics and gynecology outpatient clinic for an examination.
Severe anemia leading to fainting has been noted, and ultrasound and blood tests have been arranged.
If there is an increase in discharge, a bacterial culture can be performed.
If a referral to oncology is necessary, the obstetrics and gynecology outpatient physician will provide recommendations.
Please go to the obstetrics and gynecology outpatient clinic.

Reply Date: 2020/04/20

More Info

Understanding lower abdominal pain, discharge, and anemia in women involves a multifaceted approach, as these symptoms can stem from various underlying conditions. Given your history of increased discharge, abdominal discomfort, and hereditary thalassemia, it is crucial to consider several factors that may contribute to your current symptoms.

Firstly, the increased discharge you are experiencing could be related to hormonal changes, particularly if you are nearing your menstrual cycle. Hormonal fluctuations can lead to variations in vaginal discharge, which may become more pronounced during ovulation or just before menstruation. If the discharge is accompanied by a foul odor, itching, or unusual color, it may indicate an infection, such as bacterial vaginosis or a yeast infection, which would require medical evaluation and treatment.

The lower abdominal pain you describe could be due to several reasons. Conditions such as dysmenorrhea (painful menstruation), ovulation pain (mittelschmerz), or even pelvic inflammatory disease (PID) should be considered. Given your history of hereditary thalassemia, it is also essential to rule out any complications related to anemia, such as iron deficiency, which can exacerbate fatigue and dizziness.

Regarding your anemia, it is concerning that you have experienced episodes of fainting and dizziness. These symptoms can be indicative of significant anemia, which may require further investigation. Thalassemia can lead to chronic anemia, and if you are experiencing worsening symptoms, it is advisable to seek medical attention promptly. A hematologist would be well-equipped to assess your blood counts and determine if any specific treatment is necessary, such as iron supplementation or other therapies.

As for where to seek care, it may be beneficial to start with a gynecologist who can evaluate your reproductive health and address any gynecological concerns, including the discharge and abdominal pain. If they suspect that your anemia is related to a hematological issue, they can refer you to a hematologist for further evaluation. Alternatively, if your symptoms are severe or you feel unwell, visiting an emergency department may be warranted.

In summary, your symptoms of lower abdominal pain, increased discharge, and anemia warrant a thorough evaluation. It is essential to address each symptom in the context of your overall health, particularly considering your history of hereditary thalassemia. Seeking care from a gynecologist initially, with the possibility of referral to a hematologist, would be a prudent approach to ensure that all aspects of your health are addressed comprehensively.

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