Dr.omayaabout 7 years ago

A 36 years woman presented with severe-syncope like symptoms, she has noticed similar symptoms increasing in severity over a period of 5 y. Specifically the presenting event lasted 2-3min and was consistent with lower extremity weakness as well as vertigo. She revealed she was currently having her menses with particularly heavy flow. Past medical hx : anemia No HTN No DM No thyroid dysfunction or renal disease. Gyne Hx: hx of menorrhagia irregular prolonged heavy menses 28-45 days lasted 7-10 days associated with abdominal, pelvic pain and vertigo. During abdominal palpation lower abdominal with firm masses palpated no tenderness. BP:166/97 Glu : 68 . Your DX , DDx and next step ?