**Core Concept**
In perimenopausal women experiencing bleeding per vaginam (PV) due to multiple fibroids, the primary goal is to alleviate symptoms while minimizing the risk of future complications. This involves considering the patient's age, menopausal status, and the extent of uterine involvement.

**Why the Correct Answer is Right**
The treatment of choice in this scenario is a Total Abdominal Hysterectomy (TAH), which involves the surgical removal of the entire uterus. This approach is favored in perimenopausal women with multiple fibroids causing bleeding PV because it eliminates the risk of future fibroid growth and associated symptoms. Additionally, TAH can be performed with a bilateral salpingo-oophorectomy (BSO) if the ovaries are also involved or if the patient desires, but it is not always necessary. The decision to perform a BSO should be individualized based on the patient's menopausal status, ovarian function, and personal preferences.

**Why Each Wrong Option is Incorrect**
**Option A:** While TAH with BSO is a valid surgical option, it is not the most appropriate choice for all perimenopausal women with bleeding PV due to multiple fibroids. This option may be considered in patients with ovarian pathology or those who have completed menopause, but it is not the default approach.

**Option C:** Vaginal hysterectomy is a viable option for patients with smaller uteri and minimal fibroid involvement. However, in cases of significant fibroid burden or uterine enlargement, a vaginal approach may be challenging and may not provide the best cosmetic outcome.

**Option D:** Enucleation of fibroids is primarily used for the treatment of solitary fibroids. In cases of multiple fibroids, this approach may not be feasible or effective in addressing all the fibroids, and may lead to incomplete removal of the fibroids.

**Clinical Pearl / High-Yield Fact**
In the management of perimenopausal women with bleeding PV due to multiple fibroids, it is essential to consider the patient's menopausal status, age, and the extent of uterine involvement. A thorough preoperative evaluation and discussion with the patient regarding the risks and benefits of each surgical option are critical in making an informed decision.

**✓ Correct Answer: B. TAH**