A 48-year-old female presents with severe secondary dysmenorrhea and menorrhagia. What is the most likely diagnosis?

The most likely diagnosis in this case is uterine leiomyomata, commonly known as uterine fibroids. This condition is characterized by the presence of benign tumors in the uterus that can lead to various symptoms, including severe dysmenorrhea (painful menstruation) and menorrhagia (heavy menstrual bleeding).

Uterine leiomyomata can disrupt the normal uterine architecture and interfere with normal menstruation. They are especially prevalent in women in their reproductive years and can vary in size and location within the uterus, contributing to symptoms of pelvic pain and heavy bleeding during menses.

While other conditions like endometriosis, endometritis, and endometrial hyperplasia can also cause dysmenorrhea and menorrhagia, their symptom profiles and pathophysiology differ. Endometriosis typically involves an abnormal growth of endometrial-like tissue outside the uterus, which can cause pelvic pain, particularly during menstruation, but does not typically lead to heavy menstrual bleeding. Endometritis refers to inflammation of the endometrial lining, often associated with infection, and is less likely to present as isolated menorrhagia in this context. Endometrial hyperplasia, which is an overgrowth of the endometr