A 42-year-old woman with a known uterine fibroid (8 cm intramural) presents with severe menorrhagia, anemia (Hb 7.2 g/dL), and heavy vaginal bleeding for the past 3 months unresponsive to oral iron supplementation. She is not a surgical candidate due to comorbidities (severe diabetes, hypertension). What is the most appropriate next step in management?