Diagnosis of Heavy Periods
The diagnosis of heavy periods involves a combination of patient history, physical examination, laboratory testing, and imaging studies. Because menstrual flow can vary significantly among individuals, and there is no simple way to measure blood loss accurately at home, the diagnosis of heavy periods is often guided by how the symptoms impact daily life. Identifying the underlying cause is essential for tailoring effective treatment and ruling out serious conditions such as fibroids, bleeding disorders, or, in rare cases, reproductive cancers.
The diagnostic process typically begins with a detailed medical history. During the consultation, the healthcare provider will ask about the patient’s menstrual cycle. How often periods occur, how long they last, and how heavy the bleeding is. For example, they often ask how often the patient changes sanitary products, whether they use both tampons and pads, if clots appear and how big they are, and if bleeding affects work, school, or social life. It’s also important to find out if the patient has pain, bleeds between periods, or shows signs of anaemia like tiredness, breathlessness, or dizziness.
A menstrual diary or period tracking app can be a valuable diagnostic tool. Patients may be encouraged to record the frequency, duration, and intensity of their periods for several months. This log provides useful insights into patterns, variability, and triggers, such as stress, exercise, or dietary changes. It also helps distinguish truly heavy periods from prolonged but light bleeding or irregular spotting.
The provider will also review the patient’s medical and family history, including any use of medications (such as anticoagulants), contraceptives, or hormone therapies. A family history of bleeding disorders, fibroids, or gynaecological cancers may raise suspicion of underlying hereditary or structural issues. Any history of recent pregnancy, miscarriage, or procedures like IUD insertion is also relevant.
Diagnosis of Heavy Periods
A physical exam comes next. First, doctors check the abdomen and pelvis to see if the uterus is larger than normal, tender, or has lumps that could be fibroids, ovarian cysts, or adenomyosis. Then, they may use a speculum to look inside the cervix for infections, polyps, or unusual discharge. Finally, if needed, they perform a bimanual exam to feel the uterus and ovaries, checking their shape, size, and position.
Following this, several laboratory tests may be ordered. These typically include:
Full blood count (FBC) to check for anaemia and signs of infection.
Iron studies, including ferritin, to assess iron stores.
Thyroid function tests, since both hypothyroidism and hyperthyroidism can cause menstrual irregularities.
Hormone levels, such as oestrogen, progesterone, FSH, and LH, especially in adolescents or women nearing menopause.
Doctors order blood clotting tests—like prothrombin time and aPTT—or check for von Willebrand disease if they suspect a bleeding problem, especially in teens or people who bruise easily and bleed for a long time.
Depending on findings, additional tests might include:
Pregnancy test, even if pregnancy seems unlikely, to rule out miscarriage or ectopic pregnancy as a cause of abnormal bleeding.
Infection screening, particularly for chlamydia and gonorrhoea, which can lead to pelvic inflammatory disease and abnormal bleeding.
For structural evaluation, imaging plays a crucial role. The first-line imaging tool is usually a pelvic ultrasound. Which is safe, non-invasive, and provides detailed information about the uterus, endometrial lining, and ovaries. It helps identify:
Uterine fibroids or polyps
Ovarian cysts or tumours
Endometrial thickness (important in postmenopausal women)
Adenomyosis (though this is sometimes better seen with MRI)
Diagnosis of Heavy Periods
A transvaginal ultrasound offers even greater detail and is especially useful in women with abnormal bleeding but no obvious external signs. If the ultrasound reveals abnormalities or if symptoms persist despite normal imaging, further evaluation may include:
Saline infusion sonohysterography (SIS) is a test where doctors put sterile fluid into the uterus to get clearer ultrasound pictures of the inside of the uterus..
Hysteroscopy – a direct visual inspection of the uterine cavity using a thin camera inserted through the cervix. This is often done to diagnose and remove polyps or fibroids.
Endometrial biopsy – used particularly in women over 40 or those with risk factors for endometrial cancer (e.g. obesity, diabetes, unopposed oestrogen use). The biopsy helps rule out hyperplasia or malignancy.
In younger women or those approaching menopause, hormone-related causes such as anovulatory cycles are more common. These are cycles where ovulation does not occur, and progesterone is not produced to regulate the endometrial lining. Without progesterone, the lining builds up excessively and then sheds irregularly, causing heavy or prolonged bleeding. Diagnosis in such cases relies heavily on history, exclusion of structural causes, and hormone level assessments.
In cases where no clear structural, hormonal, or systemic cause can be found, the diagnosis may be labelled as dysfunctional uterine bleeding. This is a diagnosis of exclusion and often managed with hormonal therapy or monitoring. Especially if the bleeding is not causing anaemia or impacting quality of life severely.
It’s also important to consider emotional and psychological wellbeing during the diagnostic process. Heavy periods can affect self-esteem, social participation, and mental health, particularly in adolescents who may feel isolated or embarrassed. Open, empathetic dialogue helps ensure patients feel heard and supported. Which is critical for long-term care and adherence to treatment plans.
Diagnosis of Heavy Periods
In summary, the diagnosis of heavy periods involves a thorough assessment of menstrual history, physical findings, blood tests, and imaging studies. The goal is not only to determine the cause but to guide treatment, relieve symptoms, and prevent complications like anaemia or fertility issues. Whether the bleeding is due to fibroids, hormonal imbalance, or an underlying health condition, accurate diagnosis is the first step towards restoring menstrual health and improving quality of life.
