<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 39-year-old woman, gravida 4, para 4, comes to the physician because of a 5-month history of painful, heavy menses. Menses previously occurred at regular 28-day intervals and lasted 3 days with normal flow. They now last 78 days and the flow is heavy with the passage of clots. Pelvic examination shows a tender, uniformly enlarged, flaccid uterus consistent in size with an 8-week gestation. A urine pregnancy test is negative. Which of the following is the most likely cause of this patients findings?? A: Pedunculated endometrial mass, B: Endometrial tissue within the uterine wall, C: Malignant transformation of endometrial tissue, D: Endometrial tissue within the ovaries, E: Benign tumor of the myometrium,  <response>: This is a patient with abnormal uterine bleeding. The key findings are painful, heavy menses lasting 7-8 days with passage of clots, and pelvic exam showing enlarged uterus. The enlarged uterus that is soft and tender points to adenomyosis as a likely cause. Adenomyosis is the presence of endometrial tissue within the myometrium uterine muscle wall. This can lead to dysmenorrhea and menorrhagia. The other choices are less likely:A Pedunculated masses typically cause irregular bleeding rather than heavy regular bleeding. B Endometriosis refers to endometrial tissue outside the uterus, not within the myometrium.C Malignant transformation would not cause uniform enlargement. D Endometrial tissue in the ovaries would not cause uterine enlargement.E Benign uterine tumors could cause enlargement but not the heavy bleeding.B: Endometrial tissue within the uterine wall 