<s>[INST] I am a 31 year old female. I am currently taking nortrel 28 birth control and spironolactone, both for PCOS. I am not over weight, I am very active and I eat a healthy diet.Recently I started having right side lower abdominal pain. It was quite bothersome for several hours, for three consecutive days. I also noticed that my mood swings increased ten fold.  I started my period and everything subsided for a day or two.  I woke up in the middle of night and the stomach pain was back and I had blood in my stool twice this morning. Any idea what could be going on? [/INST] Hi, For persistent pain located to the right Iliad fossa, the possibilities include ovarian enlargement mostly due to cysts, constipation and bloating, chronic appendicular inflammation, premenstrual pain due to engorgement, and pelvic infection. Mood swings are usually due to the hormonal surges prior to the onset of menstruation. Blood in stool can be due to local causes if it is fresh. These include mostly fissures and hemorrhoids. Bleeding higher up alters the color of the blood to black or greenish black. Passage of hard stool can erode the mucosa and can lead to bleeding. Infections also can lead to fresh bleeding associated with diarrhea. Hope this helps. </s>