Review Question - QID 214699

A 43-year-old woman presents to her gynecologist with complaints of several months of heavy menstrual bleeding. She states that in the last several months, she has noticed that her menses have lasted up to 7 days from her normal 5 days, and she has required several more pads every month. She endorses worsening pain with her menses as well. She denies pain with intercourse. She states that she has had no other changes, and she is not pregnant. She is currently not sexually active and has a history of 2 full-term spontaneous vaginal deliveries both over 15 years ago. On exam, her temperature is 98.4°F (36.9°C), blood pressure is 118/68 mmHg, pulse is 68/min, and respirations are 12/min. The patient demonstrates an enlarged uterus that is soft and mobile. There are no palpable masses. A urine chorionic gonadotropin test demonstrates no pregnancy. The patient’s hemoglobin is 10.0 g/dL. Which of the following best describes the pathologic process?