An ultrasound diagnosis of "adenomyosis" will explain periods with more pain and bleeding, as the infiltrating endometrial cells prevent the extensive uterine contractions which lead to excessive bleeding. Thickened endometrial lining , if over 1 cm in width should be biopsied, but at age "31" is unlikely to be overt malignancy. Oral bcp can reduce cramping and bleeding.
Answered 4/1/2021
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