Heavy menstrual bleeding

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Heavy menstrual bleeding is a common problem.

Initial assessment should include:

• BMI
• Check FBC (unless tested in last 3 months)
• Test for coagulation ONLY if HMB since menarche or family history suggests clotting disorder
• Thyroid function testing is not required unless additional symptoms are present
• Smear if overdue.

In primary care staring initial treatment prior to physical examination is acceptable if there are no additional symptoms or risk factors (see flowchart). Physical examination should be performed before referral to secondary care to allow triaging of referral.

A transvaginal ultrasound scan is also useful if referring to secondary care.