[Answered]: P.N

P.N. is a 29-year-old white female who presents to her gynecologist complaining of severelower abdominal cramps that were poorly responsive to OTC ibuprofen or acetaminophen.She has been married for nine years and has two sons, ages 6 and 3 years. She and her hus-band would like to try to have a daughter as soon as possible. Menses began yesterday andthe pain has lasted for about 72 hours. She reports that she had a similar episode of pain justbefore her last menses but that the pain subsided with the end of her period. She also com-plains of sharp, deep pain during sex, mild lower back pain, and pain with urination duringthe past two weeks. The patient denies blood in the stool, pain with defecation, heavy peri-ods, intermenstrual bleeding, diarrhea, and constipation. P.N. began having her periods at13 years of age.Past Medical HistoryWith the exception of typical childhood diseases like measles and chickenpox and one uri-nary tract infection four years ago, P.N. has been relatively healthy. She also had an episodeof rheumatic fever at age 10, but there were no complications. Her mother has a history ofhypertension and cancer. Her father has a history of hypertension, kidney stones, and geni-tal herpes. Before her recent death, her maternal grandmother had a history of leukemia,breast cancer, and endometriosis.Lifestyle HistoryP.N. eats a low-fat diet and tries to watch her weight. She exercises regularly (two 30-minutewalks each day), plays softball, and participates in a women’s bowling league. She does notsmoke or drink alcohol. She is not taking any prescription medications, but occasionallyuses naproxen for headaches. She has had some heartburn lately that is becoming moretroublesome and will see her internal medicine physician about it next we