Gyne Consult

Thank you for referring Emily, a female, whom I saw in clinic on 2026-01-14 for gynecologic consultation after she was referred for prolonged bleeding and cramps on Depo shot.

History of Current Concern:
Emily presents with a history of prolonged uterine bleeding and dysmenorrhea while receiving depot medroxyprogesterone acetate injections. She reports that beginning January 1st, she experienced continuous vaginal bleeding lasting approximately one month. Following her injection at the beginning of January, she describes intermittent spotting and severe lower abdominal cramping. Emily has been using depot medroxyprogesterone acetate since 2021. A pelvic ultrasonography performed in March demonstrated a normal endometrial lining measuring six millimeters.

Gynecologic History:
- Dysmenorrhea: yes.
- Heavy or abnormal menstrual bleeding: yes.
- Intermenstrual bleeding: yes.
- Bladder function: normal
- Bowel function: normal

Sexual History:

Cervical Cytology:
- Has had a cervical cytology
- Does not deny history of abnormal cervical cytology

Obstetrical History:
- Past pregnancy? Yes

Medical History:
- Endometriosis
- Rheumatoid arthritis

Surgical History:
- Two laparoscopic procedures for endometriosis within the past two years

Medications:
1. Methadone

Allergies:
- Penicillin

Family History:

Social/Lifestyle History:
- Cigarettes: Yes
- Alcohol: No

Imaging:
- Pelvic ultrasound performed in March demonstrated a normal endometrial lining measuring six millimeters

Physical Exam:
- A uterine lining biopsy was performed. The endometrial lining appeared very thin, likely due to the effects of depot medroxyprogesterone acetate.

Impression and Plan:
- Emily is a female with:
  1. Delayed or excess hemor fol (induced) term of pregnancy (O04.6)