Uterine leiomyoma Quiz: Ace Your Exams

A 32-year-old woman presents to the gynecology office for evaluation of heavy menstrual bleeding. Her periods tend to last up to 12 days per month, and she goes through several pads per hour early in her cycle, which is difficult for her to manage at work. She often feels tired, even when not menstruating. She has no dizziness or shortness of breath. She is currently not in a monogamous relationship and is using condoms for contraception. She does not currently want to become pregnant but wants to become pregnant in the future. Temperature is 37.0°C (98.6°F), pulse is 92/min, respiratory rate is 20/min, and blood pressure is 116/72 mmHg. On examination, the patient is awake and alert. Chaperoned pelvic examination is within normal limits. A pelvic ultrasound reveals a 3.4 cm solid, well-defined, submucosal uterine mass. There are no findings concerning malignancy, but it is noted on the ultrasound that the patient has a bicornuate uterus. Laboratory evaluation reveals a hemoglobin of 10.1 g/dL. Which of the following is the most appropriate management?