At 9am, Spouse was seen in the ER today and was given an ultrasound. She presented extreme abdominal pain in her lower right quadrant, increased vaginal bleeding, and clammy skin. Ultrasound results showed a small (5mm) cyst on her ovary. No pain meds prescribed. The ER made her an appointment with a gynecologist at 1:30 this afternoon. After a pelvic exam, he deemed everything normal, reported no vaginal bleeding, and sent her home with a follow-up in October. She is now bent over in pain and reports heavy vaginal bleeding. What could be causing this?