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

### input:
I have been having quite bad lower back pain, in the pelvis region for close to 3 weeks now.. I have had constant spotting between periods and they have been very irregular. I have had the contraceptive implant put in about 10 months ago.. I have previously had cin2 but had lettz procedure to remove it and several smears which have come back black although i am overdue one now. I had severe spd in both my pregnancies so im wondering could the pain be related to this. Or my biggest fear is they are cancer symptoms. I am an otherwise healthy 34 year old female. Your opinion would be appreciated. Thank you.

### output:

Hello and welcome to Chat Doctor. Thank you for your query. I have gone through your query, and would like to start of by speaking about your SPD (symphysis pubis dysfunction). The only reason why most women are diagnosed with SPD during pregnancy is because the pelvis is directly involved with birth. But SPD can present in women who are not pregnant as well, this is mainly because SPD involves a misalignment of the pelvis, due to which it can put pressure on surrounding structures, especially the spinal cord, which is very sensitive and can easily result in pain (even severe at times). I highly doubt this could be related to cancer. But for your satisfaction, why don't you go ahead with an ultrasound of the pelvis and abdomen and a transvaginal ultrasound (TVS), which will help in superficial suspicion of any such abnormalities. You can also follow this up with an x-ray of the lumbar spine and pelvis, which will ensure that the position of your pelvis is what is causing your presentation. Do not worry, I can understand your anxiety, but once SPD is confirmed as the cause, wearing lumbar and pelvic support belts will surely help you, along with some help from a physiotherapist. Wishing you a symptom-free life. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: http://doctor.ChatDoctor .com/doctors/ Chat Doctor.  I would gladly help you. Best wishes.