A 42-year-old multiparous woman with heavy menstrual bleeding desires in-office endometrial ablation. She has regular but heavy menses that lasts 10 days and occurs every 28 days. Menses are so heavy that she passes large clots and has missed work on occasions. She denies any dysmenorrhea or intermenstrual bleeding. She has had a complete evaluation and no cause of abnormal uterine bleeding was identified. She denies fatigue, shortness of breath, or lightheadedness. She has intolerable side effects with systemic contraceptives and has previously trialed tranexamic acid and a levonorgestrel intrauterine device without success. She would like to avoid hysterectomy and requests in-office endometrial ablation. She has no history of chronic pain, anxiety, or intolerance of office procedures or anesthesia. Her partner has had a vasectomy. She has no medical comorbidities and does not take any daily medications.