1st August 2023

A 38 year old woman attends a sexual health clinic appointment. She reports a several month history of general lethargy,

A 38 year old woman attends a sexual health clinic appointment. She reports a several month history of general lethargy, alongside dyspareunia, irregular periods, and occasional post-coital bleeding. She has had a single committed sexual relationship for the past 5 years and became sexually active at 19 years old. There is no known history of STIs. She smokes 10 cigarettes a day.

Which of the following pathophysiological processes is likely driving her underlying disease?

Select the SINGLE most appropriate option from the list below. Select ONE option only.