Question

Presenting to the gynecology office for the evaluation of persistent vaginal bleeding, a 39-year-old female reports that her current bleeding episode has lasted for four consecutive weeks. Prior to the onset of this bleeding, she had not menstruated for six months. She has a known medical history of polycystic ovary syndrome (PCOS), diagnosed when she was 22, and obesity. Additionally, she reports a two-year history of episodic, severe unilateral headaches that are reliably preceded by flashing visual zig-zags; she uses over-the-counter ibuprofen for relief. She recently entered a new relationship and specifically requests a daily birth control pill to prevent pregnancy and to help regulate her cycle. Her body mass index is $37 \text{ kg/m}^2$. Vital signs are within normal limits. A urine beta-hCG test performed in the clinic today is negative. Pelvic examination demonstrates a normal-sized, non-tender uterus and no adnexal masses. Which of the following is the most appropriate next step in the management of this patient?