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What gets checked, and why iron is in the first set of tests

What to expect, so that a list of tests does not read as a list of things they suspect.

Lesson 4 of 5

11 min Text

What this lesson says

  • A careful history comes first and does most of the work
  • A full blood count looks for anaemia, which is common and treatable
  • Thyroid function is often checked because it is easy to test and easy to miss
  • A pelvic ultrasound looks at the structure of the womb and ovaries
  • An examination needs your agreement, and a chaperone can be asked for

This is general education. It is not advice about your own situation, and it does not replace seeing a clinician.

Written lesson.
  1. 1. The first and most useful investigation is the conversation. How long, how much, when it changed, what else has changed, what you take, what you are using for contraception, whether pregnancy is possible, and whether anybody in the family bleeds easily. Most of what narrows the list comes out of that.
  2. 2. A full blood count is almost always done, and it is done for you rather than about the diagnosis: it shows whether months of heavy bleeding have left you anaemic. That matters because anaemia is the part of heavy bleeding that is making you feel unwell day to day, it is common in India across every age group, and it is treatable in its own right while the cause of the bleeding is being worked out. Iron studies, such as ferritin, are sometimes added.
  3. 3. Thyroid function is often checked. It is a cheap test, an under-active thyroid can produce heavy periods, and the treatment is entirely different from anything gynaecological — so it is ruled in or out early rather than late.
  4. 4. A pelvic ultrasound looks at the shape and structure of the womb and ovaries and is how fibroids, adenomyosis and polyps are usually first seen. It can be done over the abdomen with a full bladder, or internally, which gives a clearer picture; the internal one needs your agreement like any other examination, and you can ask what it will show before deciding.
  5. 5. An examination may be offered and it needs your consent. You can ask what it is for, ask for a chaperone, ask for privacy to undress, ask for it to be done at a later visit, and ask for it to stop once it has started. If something in your history makes it frightening, saying so without explaining it is enough, and it changes how the examination is done.
  6. 6. Depending on your age and what the scan shows, a sample of the lining of the womb may be suggested. It is a common, quick procedure done to look at the lining directly. Ask what it is being done to rule in or out, how long the result takes, and who will explain it to you.

All lessons in this course

  1. 1 What ordinary looks like, and how wide the range is 10 min
  2. 2 What counts as heavy, when nobody can measure it 10 min
  3. 3 What is usually behind heavy or painful bleeding 12 min
  4. 4 What gets checked, and why iron is in the first set of tests 11 min Reading now
  5. 5 What treatment is aimed at, and questions for your clinician 10 min

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