What initial investigations should I perform for a patient presenting with menorrhagia?

Carry out a full blood count test for all women with HMB, in parallel with any HMB treatment offered. ¹

Consider testing for coagulation disorders (for example, von Willebrand's disease) if the woman has had HMB since her periods started and has a personal or family history suggesting a coagulation disorder. ¹

Carry out a physical examination before all investigations or LNG-IUS fittings. ¹

If the woman has suspected submucosal fibroids, polyps, or endometrial pathology, offer outpatient hysteroscopy based on her history and symptoms. ¹

Offer pelvic ultrasound to women with suspected larger fibroids, a palpable abdominal uterus, or a pelvic mass, especially if examination is inconclusive or difficult. ¹

Offer transvaginal ultrasound (preferably) to women with symptoms suggestive of adenomyosis, such as significant dysmenorrhoea or a bulky, tender uterus. ¹

Consider serum ferritin testing only if iron deficiency anaemia is suspected, not routinely. ¹

Do not routinely carry out female hormone testing or thyroid hormone testing unless other signs and symptoms are present. ¹