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When to seek medical advice: Missed or absent periods take a home pregnancy test first, then see your GP if negative Heavy bleeding that impacts your quality of life, causes anaemia symptoms (fatigue, shortness of breath), or requires frequent pad/tampon changes (every 1-2 hours) Any bleeding after menopause (urgent 2-week referral) Persistent bleeding between periods or after intercourse Severe pelvic pain accompanying menstrual changes Symptoms of haemodynamic instability (dizziness, fainting) with bleeding (seek urgent care) Your GP may recommend investigations such as hormone profiles, pelvic ultrasound, or thyroid function tests if menstrual changes are concerning or persistent
Kume et al
[26] Jastreboff, A
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