Samira is a 26-year-old female with a history of intense dysmenorrhea. She experienced menarche at age 11. Her menstrual cycles average 25 days in length. She has a BMI of 18. Her menstrual cycle pain...

Samira is a 26-year-old female with a history of intense dysmenorrhea. She experienced menarche at age 11. Her menstrual cycles average 25 days in length. She has a BMI of 18. Her menstrual cycle pain had decreased over the last 3 years while she was consistently taking birth control pills. However, she is now planning her first pregnancy and has been off birth control for 6 months. She has yet to conceive, even though she and her partner have been carefully timing intercourse and monitoring Samira’s fertility window each month. Her dysmenorrhea has returned, and she has developed menometrorrhagia, along with other cyclical symptoms like diarrhea, bloating, and craving salty foods.