Review Question - QID 216363

A 40-year-old woman comes to the office for heavy menstrual bleeding with occasional passage of clots. She notes that she has irregular spotting between periods and dyspareunia. She is nulliparous and began menarche at age 10. Her body mass index (BMI) is 35 kg/m^2. His temperature is 99.0°F (37.2°C), blood pressure is 115/70 mmHg, pulse is 95/min, and respirations are 15/min with an oxygen saturation of 99% on room air. On physical exam, an asymmetrically enlarged, mobile, non-tender uterus with multiple nodular irregularities is noted. Which of the following is the most appropriate next step in management?