A 32-year-old woman reports chronic low back pain that worsens during her period. She also reports pain during intercourse and difficulties getting pregnant. Her physical examination is unremarkable. What are potential causes and next steps?
This woman's chronic back pain, associated with her menstrual cycle and dyspareunia, suggests a possible diagnosis of endometriosis, where tissue similar to the lining of the uterus is found outside the uterus. This condition can cause infertility. She should be referred to a gynecologist for further evaluation, which may include an ultrasound or possibly laparoscopy.