You are Angie O’Plasty, a 35-year-old lady. You live with your husband, Arthur. You have been suffering from painful periods your whole life, but these have recently become much worse. You have been trying for a baby for the last two years but so far haven’t been able to conceive a child.

HPC: You have had painful periods for as long as you can remember, but during your teenage years you chose to put up with this as you thought it was normal. In the last six months, your periods have become much more painful than before, rendering you virtually unable to do anything. You choose to lie in bed all day rather than facing going out as the pain is crippling.

The pain starts just a few days before your period begins, and becomes much worse over the course of the period, settling down as it finishes. The pain occurs in your lower tummy but you can’t pinpoint a particular area that is worse. It is a severe cramping pain that comes in waves. It sometimes goes to your back and to the tops of your legs. In between periods you have a dull ache felt in your lower abdomen on most days; this is tolerable but very uncomfortable.

You also get pain during sex that feels like it’s coming from right inside your pelvis. You haven’t noticed any pain on going to the toilet to pass urine or to open your bowels and you’ve noticed no changes in your urine or stools. You haven’t been going to the toilet more frequently and you haven’t had to rush to the toilet.

You’ve noticed a bit of bleeding between periods over the last few months, but there is no bleeding after sex. You’ve always had heavy periods, so you can’t tell if this has changed.

You feel really tired all the time. You spend a lot of time in bed, and although you are usually a very sociable person, you are seeing your friends less and less as you’d prefer to stay at home instead. You and Arthur have been keen to start a family for a while now. Despite trying every trick in the book for two years, you haven’t been able to conceive a child. Arthur has had tests in the last few months that have shown his side of things is normal.

ICE: The main thing worrying you is your inability to conceive. Most of your friends have now had babies of their own and you feel like you’re losing out and falling behind your friends, unable to share in their joy because of your own jealousy. This has been made worse by the fact that Arthur’s tests came back normal and so you feel guilty as you feel like you are the problem, and you’re holding Arthur back from having a child.

You are very anxious about the worsening pain. You think that there is something inside your tummy that is causing the pain and also making you infertile. You’ve never really thought about the problems you’ve had with periods until now, and you are convinced that there is a link between the period pain and the inability to conceive.

You have become anxious about going to work as being surrounded by children makes you upset.

If you feel able to open up to the doctor, you can tell them that you have been googling your symptoms on the internet and you are worried that this could be cancer, and that you’re going to die and leave Arthur without not only a child, but a wife also. You haven’t discussed your appointment today with Arthur.

You really want answers to your problems, and someone to listen to, as you’ve isolated yourself from your friends and distanced yourself from Arthur.

Past Obstetric/Gynae History: Your last menstrual period finished 4 days ago. You started your periods quite early at age 9. They were irregular to begin with and became regular by age 12 but even then your cycles were only 22 days long. Your periods have always been heavy and painful, and when you were 22 you began taking the combined oral contraceptive pill aiming to alleviate the pain. This worked for some time and you did not have any issues, but the pains began to start again when you came off the pill at age 32 to try and conceive.

Your last smear was two years ago, and it was normal. You have never had an abnormal smear and you’ve always attended your appointments. You have never been pregnant.

PMH: None significant

DH: Paracetamol No allergies

FH: Your mother suffered from painful periods and you also had an episode of her coughing up blood

SH: You live with your husband Arthur in a beautiful detached house in the countryside. You work as a school teacher in a primary school where you teach Year 1 (5-6 year olds). You would never touch a cigarette. You haven’t drank in 2 years as you’re worried it may affect your chances of conceiving.