A 34-year-old woman presents with heavy menses during the past 2 years. Her menstrual periods occur monthly and last 4 to 5 days. She has heavy bleeding with clots and cramping discomfort on the first 2 days. For several days before her periods she experiences mood irritability and breast tenderness. She is otherwise healthy. She takes an iron supplement and no other medications. There is no family history of cancer.
She would prefer not to take any estrogen-containing treatments and would prefer to avoid invasive procedures. Her blood pressure is 105/60 mm Hg, and her physical examination findings are normal. Her hemoglobin level is 11.4 g/dL (to convert to g/L, multiply by 10), with a mean corpuscular volume of 80 fL (to convert to μm 3 , divide by 1). Her serum creatinine level is 0.7 mg/dL (to convert to μmol/L, multiply by 88.4). Her thyrotropin level is normal. How would you…
