'Too young to feel this tired'
Michelle, a 41-year-old teacher, complains of several months of poor sleep and fatigue.
She also reports experiencing intermittent abdominal bloating since adolescence. She has not been able to identify a specific dietary trigger.
Her bowel habits are regular and she has no history of rectal bleeding. She denies associated constitutional symptoms.
Michelle’s periods are regular, short and light, with no associated dysmenorrhoea.
She uses the combined oral contraceptive pill, has no past medical