You didn't specify her age, nor did you mention how many years ago she had her last period (before this bleeding episode).
She has fibroids and Uterus is about 4 times the normal size. Cervical biopsy is plus minus report. You didn't share pap smear report.
Hysterectomy is the best alternative because otherwise she will have to undergo so many tests every 6 months.
Over all, conservative treatment will be more cumbersome and expensive. It will also involve lot of tension for the patient, their family and for the doctor.
Next Steps
So you should get ROMA done and if favourable report, go ahead for hysterectomy.