A 40-year-old female, gravida 1, para 1, presents to the office with complaints of heavier, longer menstrual cycles and intermenstrual spotting. Her cycles were previously every 28 days, lasting 4 days, and using 3–4 pads per day. Now, her cycles are lasting 9–10 days, and she is soaking 8–9 pads on her heaviest day. She has spotting 2–3 days every week. She reports mild cramping but denies urinary or bowel complaints, dizziness, or weakness. She has had one prior normal pregnancy with spontaneous vaginal delivery, and she has been trying unsuccessfully to conceive for the past year. She has no significant past medical or surgical history, she is taking only prenatal vitamins, and she has no known drug allergies.