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An_249036 posted:
need some answer. my period came 4 days later witch never happen. then on the 5th day started a light bleeding or even may call it spotting.. not sure if i am pregnant. i have a lower back pain.. not to much cramp comes and goes what do you think.. should i take a hpt?
Jane Harrison Hohner, RN, RNP responded:
Dear An:Absolutely,if you have any possible risk of pregnancy, that is the first condition to be assessed. Even reliable contraceptive methods such as birth control pills, and tubal ligations can fail. So it is important to get a pregnancy test done first.

If the pregnancy test is negative then the next most common cause of erratic bleeding is a missed or late ovulation. In a normal cycle, estrogen is produced all month.Causes for not ovulating are multifold: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with parents or boyfriends/girlfriends, exams), increased body weight, anorexia, rotating shifts at work, etc.

In your specific case the lower back pain MIGHT be explained by a kidney infection, muscles in the back, or more remotely pain from the uterus/ovaries referred to the back where there is a common nerve pathway.

If the pregnancy test is negative and you continue to have erratic bleeding or back pain you should get checked out.

Jane Harrison Hohner, RN, RNP responded:
Dear An: After re-reading your post I realized that I should have added the following. If you are currently using some type of hormonal birth control (eg pills/patch, ring, Mirena IUD,implant), and the pregnancy test is negative then the most likely reason is breakthrough bleeding due to the hormones in the birth control. In this instance, if the breakthrough bleeding persists for three cycles--or if the lower back pain continues--see your GYN or clinic.


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