A 48-year-old woman presents with severe dysmenorrhea and menorrhagia. Which condition is the most likely diagnosis based on physical examination findings?

In this scenario, the most likely diagnosis for a 48-year-old woman presenting with severe dysmenorrhea and menorrhagia is uterine leiomyomata, commonly known as fibroids. Uterine leiomyomata are benign tumors of the smooth muscle of the uterus that can cause significant menstrual abnormalities, including heavy menstrual bleeding (menorrhagia) and pain (dysmenorrhea).

One of the hallmark features of fibroids is their potential to distort the uterine cavity and alter menstrual flow, leading to heavier periods. The physical examination may reveal an enlarged, irregular uterus, which is characteristic of fibroids. As women approach perimenopause, the prevalence of fibroids and their associated symptoms can increase, making this an especially pertinent diagnosis for a 48-year-old woman.

While endometriosis, endometritis, and endometrial hyperplasia can also present with dysmenorrhea and abnormal bleeding, they have different clinical features and underlying pathophysiology. In endometriosis, for instance, it is the presence of endometrial-like tissue outside the uterus that typically leads to dysmenorrhea, and the physical exam usually does not reveal an enlarged uterus. Endometritis often comes with