A 35-year-old gravida 3, para 3 presents with complaints of heavy menstrual bleeding. Patient reports her menses have been getting progressively heavier over the last year. She has been on oral contraceptive pills for the last six months, and feels they are not helping. She is experiencing heavy flow requiring her to wear a pad and a tampon together for the first two days of her seven-day cycle. She had a cesarean section for her second child followed by a vaginal birth after cesarean (VBAC) of an 8 lb infant. She has no other surgical history and no medical history and has no known drug allergies. She denies any history of sexually transmitted infections (STIs). Her last cervical cytology six months ago was normal. She is currently taking desogestrol 0.15 mg, 0.03 mg ethinyl estradiol contraceptive pills but she has completed her family and desires definitive therapy. After discussing her treatment options, patient requests a hysterectomy.