A 42-year old woman is referred by her GP for with a complaint of painful menses. The patient explained that her periods have always been heavy and painful. But in last 2-3 years have almost become unbearable. Her menses arrive every 24 days and last for 7-9 days. Day 2 to day 6 are very heavy. The pain arrives 36 hours before the menses and is constant, dull, and severe. GP has prescribed paracetamol and mefenamic acid in combination for pain. The woman has had 3 normal vaginal deliveries.
No history of intermenstrual or postcoital discharge. Currently on citalopram for depression. Physical Exam: Abdomen is soft, vague tenderness in the suprapubic area. Cervix appears normal. Bimanual palpation presents uterus soft, bulky and of 10 weeks size. Tender on palpation, no cervical excitation, adnexal tenderness, or adnexal mass. What can be the diagnosis? What tests should be performed…
