Questionnaire/history: Nature of the bleeding? Impact on the quality of life? Details of normal menstrual cycle? - Length of the cycle? - Number of days of menstruation and any variation of this patterns? Related symptoms (eg persistent intermenstrual bleeding, pelvic pain, and/or pressure symptoms - suggesting uterine cavity abnormality, histological abnormality, adenomyosis or fibroids)? Sexual history? - Contraceptive use? - Contraceptive plans? - Future plans for a family? - Possibility of pregnancy/ectopic pregnancy? Cervical screening history? Past medical history (eg endometriosis)? Family history (eg coagulation disorder)? Current medication? Previous treatment for menorrhagia? Drug allergies? Examination: Examination offered if other related symptoms? Goitre (hypothyroidism)? Bruises or petechiae (coagulation disorder)? Acne, hirsutism (polycystic ovary syndrome)? Abdominal examination? Bimanual pelvic examination (including a speculum examination of the cervix) (except in young girls who are not sexually active) (to exclude an underlying cause, such as ascites, fibroids or gynaecological cancer and if the LNG-IUS is being considered)? Investigations: Full blood cell count (to rule out iron deficiency anaemia (which is a strong indicator of excessive menstrual bleeding)? Thyroid function test if features of hypothyroidism? Tests for coagulation disorders (eg Willebrand disease) if heavy menstrual bleeding since menarche and personal or family history of a coagulation disorder? Vaginal or cervical swab if an infection is suspected? Pelvic ultrasound if possible larger fibroids (eg uterus is palpable abdominally, pelvic mass or examination inconclusive or difficult (eg if obesity)? Transvaginal ultrasound if suspected adenomyosis (eg if significant dysmenorrhoea or a bulky, tender uterus)? Management Reference(s): NICE CKS: Menorrhagia Information for patient/carer(s): NHS Health A to Z: Heavy periods