A 55-year-old gravida 3, para 3, perimenopausal female presents with complaints of pelvic pressure, abnormal uterine bleeding, and urinary frequency. Her evaluation reveals uterine fibroids. A trial of hormonal treatment with iron supplementation failed to resolve her symptoms and the patient desires definitive treatment. A hysterectomy is planned. Her medical history is significant for chronic obstructive pulmonary disease (COPD) and a 25 pack-year history of cigarette smoking. Her surgical history included cholecystectomy and bilateral tubal ligation. Her medications include a long-acting muscarinic antagonist inhaler, norethindrone 5 mg daily, and oral iron supplement. She has no shortness of breath at rest, but reports a chronic cough and difficulty walking up more than one flight of stairs. She has no chest pain with activity and no family history of cardiovascular disease.