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A 15½-year-old girl came to the office with complaints of the recent onset of painful menstrual periods. She experienced her first menstrual period at the age of 13 years and except for an occasional mildly uncomfortable menstrual period, had not experienced significant pain until recently. She reported regular monthly menses, although she did not write down the dates. She described additional symptoms that also had not been present previously, including headache, loose stools, and breast tenderness. She has tried several over-the-counter medications, including acetaminophen, without significant relief. She has missed 3 days of school in the last 6 weeks because of these complaints. She is otherwise healthy, having no major illnesses, no history of surgeries, and no other genitourinary complaints. There is no family history of endometriosis; severe dysmenorrhea; menorrhagia; irregular periods; infertility; uterine fibroids; or breast, ovarian, colon, or uterine...

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