All patients with heavy periods regardless of age should have a blood count to look for anemia if they have heavy periods, and if anemia is present they should be treated. Mild to moderate anemia responds well to iron supplements. Blood transfusion is usually reserved for patients with severe anemia, especially in those patients with associated medical issues and those who have severe symptoms of weakness, dizziness, fainting, exhaustion, shortness of breath, or chest pain.
In patients who present with heavy periods as a young teen, blood clotting factors, a CBC, platelet count and PT/PTT and a bleeding time may be warranted. Referral to a hematologist (blood specialist) is warranted if there are any abnormalities in the blood work up.
Blood test for hormonal imbalance may include LH, FSH, TSH, and prolactin. LH and FSH test your sex hormones that stimulate the ovary, TSH tests for thyroid function, and prolactin looks at the posterior pituitary gland. Pelvic ultrasound can evaluate the uterus for fibroids, adenomyosis, and ovarian cysts.
Sonohysterogram is a test done in the office to rule out polyps or fibroids in the lining of the uterus (submucus fibroid). A small spaghetti sized cather is placed in the lining of the uterus and sterile water is injected into the lining of the uterus and the muscular uterine walls separate under the pressure of the sterile water, and a concomitant ultrasound is done looking in the lining of the uterus for polyps or fibriods.
Endometrial biopsy is critical in patients with heavy menses, especially over the age of 40 (or younger with risk factors such as PCO or obesity) to rule out hyperplasia, precancer or cancer of the endometrium (lining of the uterus). It is about 95% as good as doing a D and C.
Hysteroscopy is done in the office or ambulatory care center and is the gold standard for direct evaluation of the lining of the uterus. Polyps and certain submucus fibroids can be removed or resected using operative hysteroscopy. A D and C can be added as an adjunct procedure (a generalized scraping) if no discrete structural problems are found.