Diagnosis

Visit your GP if you feel your periods are unusually heavy. They'll investigate the problem and may offer treatments to help.

GP consultation

To try to find out what's causing your heavy periods, your GP will ask about:

• your medical history
• the nature of your bleeding
• any related symptoms you have

They'll alsoask some questions about yourperiods, including:

• how many days your periods usually last
• how much bleeding you have
• how often you have to change your Periods
• whether you experience flooding (heavy bleeding through to your clothes or bedding)
• what impact your heavy periods are having on your everyday life
• whether you bleed between periodsor after sex
• whether you also have pelvic pain

To help determine the cause of your heavy bleeding, you may have a physical examination, particularly if you have pelvic pain or bleeding between periods or after sex.

Your GP may also want to know what type of contraception you're currently using and whether you plan to have a baby in the future. The last time you had a cervical screening test will also be noted.

You'll also be askedabout your family history to rule out inherited conditions thatmay beresponsible, such as Von Willebrand disease , which runsin families andaffects the blood's ability to clot.

Further testing

Depending on your medical history and the results of your physical examination, the cause of your heavy bleeding may need to be investigated further.

For example, if you have pelvic pain and experience bleeding between periods orduring or after sex, you'll need further tests to rule out serious illness, such as womb cancer (a rare cause of heavy menstrual bleeding).

Pelvic examination

If you need to have a pelvic examination, your GP will ask if you'd like a female assistant to be present. A pelvic examination will include:

• a vulval examination an examination of yourgenitals for evidence of external bleeding and signs of infection, such as a vaginal discharge
• a speculum examination a speculum is a medical instrument inserted into your vagina to allow your vagina and cervix to be examined
• bimanual palpation fingers are used to examine the insideof your vagina to identify whether your womb or ovaries are tender or enlarged

Before carrying out a pelvic examination, your GP or gynaecologist will explain the procedure to you and why it's necessary. You should ask about anything you're unsure about. A pelvic examination shouldn't be carried out without your consent (permission).

Biopsy

In some cases of heavy bleeding, a biopsy may be needed to establish a cause. This will be carried out by a specialist and involves removing a small sample of womb lining for closer examination under a microscope.

Blood tests

A full bloodtest is usually carried out for all women with heavy periods. This can detect iron deficiency anaemia , which is often caused by a loss of iron following prolonged heavy periods.

If you have iron deficiency anaemia, you'll usually be prescribed a course of medication. Your GP will be able to advise you about the type of medication most suitable for you and how long you need to take it for.

Ultrasound scan

If the cause of your heavy menstrual bleeding is still unknown after you've had the above tests, you may need an ultrasound scan of your womb. This looks for abnormalities such as fibroids (non-cancerous growths) or polyps (harmless growths). It can also be used to detect some types of cancer.

A transvaginal ultrasound scan is often used. A small probe is inserted into your vagina to get a close-up image of your womb.