A 38-year-old woman presents to the outpatient clinic with a 4-month history of progressive fatigue, generalized weakness, and decreased exercise tolerance. She reports experiencing shortness of breath when climbing stairs, which is unusual for her. Over the past few weeks, she has developed a craving for chewing ice. Her medical history is unremarkable, and she has had two uncomplicated pregnancies. She notes that her menstrual periods have become increasingly heavy over the past year, lasting 8 days and requiring frequent pad changes due to the passage of large clots. She takes occasional ibuprofen for menstrual cramps. She is a non-smoker and consumes alcohol occasionally.

She appears pale but is in no acute distress. She is afebrile. Her blood pressure is 110/70 mmHg with a heart rate of 98 bpm and a respiratory rate of 16/min.