Thanks for writing to us with your health concern.
I do not see any need for you to consult your doctor right away, because you have been having the pain for about 6 years now.
Also, regarding the erratic menstrual pattern, it could be for the following reasons -
1 . You are 47, hence might be undergoing the perimenopausal transitional phase, during this period, as menopause approaches, for a few years, the periods get irregular and scanty, and then menopause sets in.
2. While being on the progesterone only contraceptive, the bleeding is always scanty and light, hence what you have described for the past 2 - 3 cycles is considered normal while on the pill.
Hence, please do not worry about the spotting.
Also, regarding the pelvic pain, you seem to be having it off and on. It could be one of a number of reasons.
The first could be occasional pelvic infection which causes this pain, also it could be periodic pelvic congestion which some women experience every month ( this is more likely since the progesterone contraceptive seems to be helping it )
A bowel infection or chronic appendicitis also could cause this. ( more likely since
Right now I would suggest the following course of action -
1. A repeat pelvic transvaginal ultrasound ( to rule out any pathology in the uterus and ovaries )
2. A repeat Pap smear
If these two are normal, you can wait for your next annual exam and continue taking the progesterone contraceptive, as it would help with the pelvic pain too , and would also regulate your cycles ( though you must expect scant to no bleeding while on this type of pill ).
Also, please have your blood sugars tested, Hemoglobin checked, thyroid levels checked, and calcium and Vitamin D levels measured.
Thyroid disorders, anemia, calcium or vitamin D deficiency also often cause chronic pelvic pain.
If all these tests ( the pelvic ultrasound and blood tests ) are normal, you should consult an Orthopedic surgeon to rule out any cause in the bones and muscles for the pain.
All the best.
Please feel free to ask any further follow up questions.