Your patient is a 36-year-old woman who is alert and complaining of abdominal pain. She states that she is having her period and that this pain is "much different than the cramps I usually get." She describes the pain as achy throughout her pelvis and lower abdomen. She says that this has occurred the past three menstrual cycles and that she has experienced dyspareunia and spotting over the same period. She is G2P2 and has no other significant gynecologic history. Physical examination reveals pain with palpation over her entire abdomen; her skin is warm and dry. Vital signs are: heart rate 84, blood pressure 124/76 mmHg, respiration 12, SpO₂ = 99%. Which of the following is the most likely diagnosis for this patient?

Question

Quizplus · Accepted Answer

The patient's symptoms (pelvic pain, dyspareunia, spotting) are suggestive of endometriosis. Uterine fibroids may cause pelvic pain and abnormal bleeding but dyspareunia is not commonly associated with fibroids. Primary dysmenorrhea typically presents with crampy lower abdominal pain, not pain throughout the pelvis, and it is not usually accompanied by dyspareunia or spotting. Polycystic ovary disease may present with irregular periods, but it is not typically associated with pelvic pain or dyspareunia.

Your Patient Is a 36-Year-Old Woman Who Is Alert and Complaining