### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hi, I woke up yesterday with a very intense lower abdominal pain... I usually had this type of pain in my first 24hour period...I don t have my perriod right now... My OBG gave me a med called levonorgestrel and ethinyl tab( I m finishing my forth week), not to have my period so often, until we figure what is causing my pain. She sent me to ultrasound... I just got a letter saying that the results showed abnormality, and I need further medical fallow up for an Endometrial biopsy and a new Ultrasound. Why am I in pain if I don t have my period? should I go to the ER? I have Blue cross HMO plan, so I m resposible for 20% of hospital cost, and i just don t have the money to pay that kind of bills. My doctor office is clossed, and she has no emergency contact number where I should reach her... What should I do? I can t walk, and I m laying down with a heating pad on my abdomen, because the pain is so bad. Thanks for any advice, Annamaria

### output:

Hi Annamaria. Thanks for your query. I can understand the pains and the financial burdens due to medicare one goes through. But sometimes the Emergency needs to be tackled irrespective of the other factors you mentioned. The cause of the pains in the lower abdomen so severe that you can not walk makes me think of a serious problem as you have also got a letter indicating a biopsy and repeat ultrasonography. The most probable reason can be a twisted ovarian cyst or a fibrous or salpingitis, You can certainly visit the ER so that at least an ultrasonography will be done and maybe you are examined internally by the Doctor to get a probable diagnosis. Till then, you can take painkillers.