Carry out a full blood count test for all women with HMB, in parallel with any HMB treatment offered. NICE NG88
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. NICE NG88
Carry out a physical examination before all investigations or LNG-IUS fittings. NICE NG88
If the woman has suspected submucosal fibroids, polyps, or endometrial pathology, offer outpatient hysteroscopy based on her history and symptoms. NICE NG88
Offer pelvic ultrasound to women with suspected larger fibroids, a palpable abdominal uterus, or a pelvic mass, especially if examination is inconclusive or difficult. NICE NG88
Offer transvaginal ultrasound (preferably) to women with symptoms suggestive of adenomyosis, such as significant dysmenorrhoea or a bulky, tender uterus. NICE NG88
Consider serum ferritin testing only if iron deficiency anaemia is suspected, not routinely. NICE NG88
Do not routinely carry out female hormone testing or thyroid hormone testing unless other signs and symptoms are present. NICE NG88