She has no other history of serious illness and takes no medications. She used an oral contraceptive from the age of 17 years to 40 years, but she discontinued use after she was diagnosed with deep venous thrombosis of the right lower extremity. Use of acetaminophen and ibuprofen has provided minimal relief. During the past year, menstrual periods have occurred at 21- to 28-day intervals and lasted 10 to 12 days with increasingly severe pain. Previously, menses occurred at regular 28-day intervals and lasted 3 days with minimal cramping. A 42-year-old nulligravid woman comes to the office because of a 1-year history of increasingly irregular vaginal bleeding and menstrual cramps.
