Question

A 39-year-old nulligravid female presents to the physician reporting eight months of heavy, unpredictable vaginal bleeding. Her menstrual cycles were previously regular, occurring every $28$ to $30$ days and lasting $5$ days. Over the past eight months, bleeding episodes have occurred at irregular intervals ranging from $15$ to $45$ days, with menses lasting up to $10$ days and requiring her to change super-absorbency pads every two hours on heavy days. Medical history is significant for type 2 diabetes mellitus, chronic hypertension, and morbid obesity. Current medications include metformin and lisinopril. Vital signs show a temperature of $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure of $148/92\text{ mm Hg}$, pulse of $82/\text{min}$, and a body mass index (BMI) of $42\text{ kg/m}^2$. Pelvic examination reveals normal external genitalia, a normal-appearing cervix, and a bulky but non-tender uterus. A urine pregnancy test is negative. Laboratory studies show a hemoglobin level of $10.2\text{ g/dL}$. Which of the following is the most appropriate next step in the management of this patient?