A 42-year-old woman, gravida 2, para 2, last menstrual period three weeks ago, presents for surgical consultation secondary to heavy menstrual bleeding. She reports persistent, regular monthly bleeding with passage of clots. She was admitted to the hospital for a blood transfusion secondary to anemia, dizziness, and fatigue. She was discharged on a progestational agent and reports initial improvement in her bleeding and symptoms. The heavy vaginal bleeding has recurred and is now associated with constant pelvic pain and cramping. She is sexually active with her husband. She is requesting a hysterectomy. She has no relevant past medical or surgical history. She is currently taking medroxyprogesterone (Provera) 20 mg PO three times daily and has no known drug allergies.

A 45-year-old woman, gravida 2, para 2, postoperative day 0 following a vaginal hysterectomy for menorrhagia due to uterine fibroids calls for assistance after falling when attempting to ambulate. At the completion of her procedure, her Foley catheter was removed. She attempted to ambulate to the bathroom but experienced a fall onto the bed when she attempted to bear weight on her left leg. She describes numbness of the left thigh. Her surgery was difficult due to the presence of multiple uterine fibroids but had no unusual complications. Estimated blood loss was 315 mL and operative time was 2.5 hours. She has a medical history of diabetes and tobacco abuse and a past surgical history of vaginal hysterectomy. She is currently taking metformin and has no known drug allergies.

A 45-year-old woman, gravida 2, para 2, presents for preoperative consultation for hysterectomy. She has a long-standing history of abnormal uterine bleeding and has failed medical management with combined hormonal contraceptive pills and a levonorgestrel intrauterine device (IUD). She has completed childbearing and desires definitive surgical management with hysterectomy. Her family history is notable for breast cancer in her maternal grandmother. She denies history of abnormal Pap smears. She has no history of sexually transmitted infections. She has two prior spontaneous vaginal deliveries at term. Her medical history is significant for hypertension and she has no past surgical history. She is currently taking lisinopril and she has no known drug allergies.

A 35-year-old gravida 3, para 3 presents with complaints of heavy menstrual bleeding. Patient reports her menses have been getting progressively heavier over the last year. She has been on oral contraceptive pills for the last six months, and feels they are not helping. She is experiencing heavy flow requiring her to wear a pad and a tampon together for the first two days of her seven-day cycle. She had a cesarean section for her second child followed by a vaginal birth after cesarean (VBAC) of an 8 lb infant. She has no other surgical history and no medical history and has no known drug allergies. She denies any history of sexually transmitted infections (STIs). Her last cervical cytology six months ago was normal. She is currently taking desogestrol 0.15 mg, 0.03 mg ethinyl estradiol contraceptive pills but she has completed her family and desires definitive therapy. After discussing her treatment options, patient requests a hysterectomy.