The evaluation of heavy menstrual bleeding begins with a history and physical examination.

Physical findings in a woman with heavy menstrual periods may include:

• An enlarged uterus
• An enlarged ovary
• Cervical tenderness
• Signs of anemia:
• Pallor
• Rapid heart rate
• Rapid breathing
• Low blood pressure

Testing may be required to make the diagnosis of heavy menstrual periods.

Tests that may be used to evaluate heavy menstrual periods include:

• Pelvic ultrasound
• Serum pregnancy test
• Complete blood count
• Serum iron level and total iron binding capacity (TIBC)
• Serum vitamin B12
• Serum folate level
• Thyroid profile
• Serum progesterone level
• Serum estrogen level
• Coagulation profile
• PAP smear
• Urinalysis
• Uterine biopsy

Less commonly used tests that may be used to evaluate heavy menstrual periods include:

• Laparoscopy
• Hysteroscopy:
• Examination of the inside the uterus with an endoscope
• Dilation and curettage
• CT scanning of the pelvis