Female 53 yrs, 2 yrs post menopausal gravida=4 . recent nausea, positive urine and serum hcg test, itching palms and soles of feet, normal CMP . increasing twinge type feeling in rt flank. Ultrasound revealed two small uterine fibroids and follicle lt ovary. Hypothyroid. Only meds are levothyroxine20 and 25 mg sertraline. Hx of LGSIL ( colpo performed but no LEEP) and High Risk HPV but recent normal pap