Soru

A 39-year-old woman, G0, comes to the clinic due to a three-week history of continuous, heavy vaginal bleeding. She states that she has soaked through a thick maxi pad every 3 hours for the past week. The patient has a history of irregular menstrual cycles, with periods occurring unpredictably every 2 to 6 months since menarche. Medical history is notable for hypertension, for which she takes amlodipine. She does not use tobacco or alcohol. Her blood pressure is $138/88 \text{ mm Hg}$, pulse is $88/\text{min}$, and BMI is $38 \text{ kg/m}^2$. Physical examination reveals dark, velvety patches of skin on the posterior neck and axillae. Pelvic examination shows active bleeding from the cervical os; the uterus is normal in size and non-tender. A urine pregnancy test is negative. Complete blood count shows a hemoglobin of $10.4 \text{ g/dL}$ and a platelet count of $250,000/\text{mm}^3$. Thyroid-stimulating hormone level is within normal limits. Which of the following is the most appropriate next step in management?