I am a 30 year old woman, G0P0, with a 10 week history of continuous light to moderate menstrual bleeding with passage of clots (LMP began March 1 2015). Medication includes spironolactone for adult acne and supplemental calcium and vitamin D. I do not smoke or use recreational drugs, drink 1-2 alcoholic beverages weekly, and consume 2-3 cups of coffee daily. I had a Paragard inserted in June 2011 and replaced with a Mirena in late March 2015 in an attempt to arrest the bleeding, which did not stop. Pregnancy test performed at 1 month follow-up was negative, as were tests for STIs and bacterial vaginosis. Abdominal and transvaginal ultrasounds revealed a properly placed IUD, normal-sized uterus and endometrium, small but morphologically normal right ovary, and a 5 cm simple cyst on enlarged left ovary. My physician does not believe this is responsible for the metrorrhagia. What could be responsible for my never-ending bleeding?