A 42-year-old woman, gravida 2, para 2, last menstrual period three weeks ago, presents for surgical consultation secondary to heavy menstrual bleeding. She reports persistent, regular monthly bleeding with passage of clots. She was admitted to the hospital for a blood transfusion secondary to anemia, dizziness, and fatigue. She was discharged on a progestational agent and reports initial improvement in her bleeding and symptoms. The heavy vaginal bleeding has recurred and is now associated with constant pelvic pain and cramping. She is sexually active with her husband. She is requesting a hysterectomy. She has no relevant past medical or surgical history. She is currently taking medroxyprogesterone (Provera) 20 mg PO three times daily and has no known drug allergies.