A 48-year-old G2P2 woman presents to your clinic after having 4 months of irregular heavy menses. She says her last menstrual period (LMP) was 10 days ago and lasted 8 days. Two months before that, she had a period that lasted 3 days.

She reports no previous history of abnormal bleeding. She doesn’t take any medication and her physical exam, including a pelvic examination, is normal. A recent complete blood count (CBC) was normal. Her only sexual partner, her husband, had a vasectomy 10 years ago, and she is not pregnant. Her last Pap smear, 2 years earlier, was normal.