45F: Persistent bleeding and flank pain despite Deviry treatment - #10619

The patient is a 45-year-old female weighing approximately 56 kg, presenting with a history of severe menstrual cycle irregularity and overbleeding. Her cycles have shortened to only 20 to 25 days instead of a full month, characterized by heavy blood loss leading to extreme dizziness, low blood pressure, and iron deficiency requiring tablet supplementation. This month, she experienced five days of continuous light bleeding, followed by two days of very heavy flow, then a 2 to 3-day cessation, before heavy bleeding restarted abruptly, causing severe dizziness and a heavy physical sensation. To stabilize this, she was prescribed Tranostat 500 mg and Mefpas 500 mg for three days, which stopped the heavy flow. Simultaneously, she began Deviry 10 mg tablets with a tapering schedule: 3 times a day for 7 days, followed by 2 times a day for 7 days, and finally 1 time a day for 7 days. She started these medications on an evening 7 days ago and will complete her 7th day (and 21st total dose) of the TID (3 times daily) phase this afternoon. Despite the heavy bleeding stopping after three days, she continues to experience persistent spotting of blood, which occurs specifically when she feels pain in her abdomen or the flank side of her abdomen. We seek a diagnostic investigation into this pain-linked spotting and confirmation on whether the twice-daily Deviry schedule should officially begin tomorrow morning.