A 28-year-old nulligravid woman presents reporting severe dysmenorrhea, deep dyspareunia, and dyschezia that worsens with menses. She states she has always had painful periods, but they have worsened over the past year. She describes it as sharp, twisting, and feels that something is “stabbing her from the inside out.” She is in a long-term relationship and desires future fertility. She has tried several different combined oral contraceptive pills, which mildly improved her pain. She has also tried non-steroidal anti-inflammatory drugs, medroxyprogesterone acetate, and a gonadotropin-releasing hormone agonist without relief. She states the dyspareunia and constipation have worsened over time. She underwent a diagnostic laparoscopy at age 26 and was told she had stage IV endometriosis. She continues to have debilitating pain that significantly impacts her quality of life. She would like to proceed with fertility-sparing surgical management. She has no other relevant relevant past medical or surgical history. She is currently taking oral contraceptives (ethinyl estradiol/norethindrone) and has no known drug allergies.