Skip to main content

Heavy periods at forty-five

45 yG3P3Gynaecology

Flooding, clots, a ferritin of 6, and a uterus that feels bigger than it should.

  1. Clinic visit 1Step 1

    History and examination

    Heavy, regular, painful periods for 18 months. No intermenstrual or postcoital bleeding. BMI 31. Pale. Abdomen: a firm mass to the level of the symphysis. Speculum: normal cervix, screening up to date. Bimanual: the uterus is enlarged to about 14 weeks' size, irregular, mobile, mildly tender.

    Which PALM-COEIN categories does the examination point to, and what is the first test?