<s>[INST] Hi I am 33 years old and have been on the Depo Provera shot for almost two years and periods had stopped. I started to have some light spotting occasionally and then all of a sudden had a gush of blood with clots of blood larger than a quarter. I have done this twice now in two week and it only does it for one day. I have had cervical dysplasia years ago and had it removed. We have a history of breast cancer and endometriosis on my Mom s side. I have also been having lower back pain and occasional sharp intense pain in my side. ( although I do have issues with my back so I am unsure if they are related. I am about 5 6 and 156 lbs. I am also on Lamictal and Viibryd for Bipolar 2 and anxiety and daily multivitamin. Should I be concerned and see my doctor or could this be considered just breakthrough bleeding? [/INST] Welcome to Chat Doctor forum.  In the first year of the usage of the shot of the demo proverb the bleeding is common, but after two years of the usage, the typical bleeding means it may be considered, I advise you to consult a gynecologist for diagnosis and to exclude the pathology. If no pathology is diagnosed you can continue the shots.  Anxiety and depression are the side effects so keep an eye on the signs.  The discharge and the backache may be due to infection and should be excluded.  Wishing for a quick and complete recovery. </s>