A 25 year old infeile lady is having menorrhagia. On examination an abdominal mass is palpable which is immobile. On PV examination- uterus and appendages are fixed. The most appropriate first line treatment in this case is

There can be 2 main diagnosis, Endometriosis and Tuberculosis. Menorrhagia is common with early tubercular endometritis but in this question there is history of an abdominal mass and hence it s likely a chronic presentation Endometriosis is a condition of estrogen access and is frequently associated with menorrhagia A laparoscopy is the best tool to diagnose endometriosis and also to take biopsies to confirm/rule out Tuberculosis