A 34-year-old gravida 2, para 2 woman presents to the gynecology clinic for increasingly heavy menstrual bleeding over the past year. Periods occur every 28–29 days and are predictable. Bleeding lasts for seven days with the heaviest bleeding occurring on days 2 and 3. On those days, she uses super tampons and maxi pads, changing them every 2 hours, and at night is using night-time pads. She has to leave long meetings at work to change protection and has menstrual accidents. She passes large clots and describes “gushing” type bleeding when on the toilet. She has tried non-steroidal anti-inflammatory drugs and tranexamic acid for bleeding with only slight improvement in heaviness; oral contraceptive pills have not worked in the past and she is not using them now. She has no relevant past medical or surgical history and denies any drug allergy.