FCOG-1193

FCOG-1193

A 40-year-old nulligravid woman comes to the office due to persistent abnormal uterine bleeding. Patient’s menstrual periods previously occurred monthly, which lasts of 4 days with moderate bleeding and light cramping. However, for the past 8 months, she has had intermenstrual spotting and bleeding which have occurred at varying intervals and last for 3-7 days. 
Patient had started combination oral contraceptives 4 months ago, which has not improved the bleeding pattern. 

On examination her temperature is 37.2 C (99 F), blood pressure is 126/76 mm Hg, pulse is 86/min and BMI is 29 kg/m2. 
Speculum examination shows dark red blood in the posterior vaginal vault but no cervical or vaginal lesions. Remainder of the pelvic examination was normal. 
Her laboratory results are as follows:
– Hemoglobin: 12.2 g/dL
– Prolactin: 5 ng/mL
– TSH: 1.8 µU/mL
– Urine pregnancy test is negative. 
Pelvic ultrasound shows an anteverted uterus without any adnexal masses. 

Which of the following is considered the best next step in management of this patient?