A 40-year-old nulligravid woman with developmental disabilities presents to the office with her mother. She is being followed for a long-standing history of heavy menstrual bleeding and pelvic pain. She had previously been treated with depot medroxyprogesterone acetate but had persistent light bleeding that presented hygiene issues. Her past medical history is significant for hypertension and constipation. She has never had abdominal or pelvic surgery. She has never been sexually active. She is not employed. She lives with her mother who is her caregiver.