Soru

An evaluation is requested for a 47-year-old female patient who desires reliable contraception. She reports a 9-month history of erratic, heavy menstrual cycles. Menses occur unpredictably every 3 to 6 weeks, lasting up to 12 days, and are accompanied by the passage of large clots. The patient's medical history includes chronic hypertension and tobacco use disorder, smoking approximately 20 cigarettes per day. Current medications include lisinopril. Vital signs show a blood pressure of 144/92 mmHg, pulse of 82/min, and a body mass index of $35\text{ kg/m}^2$. Pelvic examination demonstrates a parous, normal-appearing cervix and a globally enlarged, non-tender uterus. A urine pregnancy test is negative. Laboratory studies indicate a hemoglobin level of 9.8 g/dL. Pelvic ultrasonography reveals a heterogeneous endometrial echo complex measuring $16\text{ mm}$ in thickness with cystic changes. The patient is interested in starting a contraceptive method that will also alleviate her heavy bleeding. Which of the following is the most appropriate next step in the care of this patient?