All right, welcome. This is episode 557 of the Divine Intervention podcast.

Into this podcast, we're going to be continuing the series on the step three, 3-137.

This is part 5. This is questions 41 to 50.

So let's begin question 41.

A 44-year-old woman, who is a known patient, comes to the office for a pap smear.

She says she has felt fine but has noted a significant increase in the amount of bleeding with her menstrual periods.

She says, my periods are still regular, but they now last 10 days instead of 6.

It seems the flow is very heavy for at least 5 of the 10 days.

With periods like this, I am anxious for menopause.

She also reports frequent fatigue and occasional insomnia,

but she attributes these symptoms to having three teenage children.

She has not had dysmenorrhea, dysparonia, or vaginal discharge.

Medical history is unremarkable.

She does not use any medications and says that she does not like to take pills.

Family history is positive for colonic polyps. The patient has been separated from her husband.

For five years.

She is occasionally sexually active and always uses condoms.

Pelvic examination today discloses no abnormalities,

except for an enlarge year's approximately eight weeks gestational size,

which is unchanged from a previous examination.

Ultrasonography two years ago disclosed the myomatous uterus.

Cervical, cytology, and appropriate cultures are obtained, and complete blood count and serum

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