A 32-year-old woman presents with heavy and prolonged menstrual bleeding for the last six months. Her periods are regular but the flow is excessive, causing her to change sanitary pads every 1-2 hours. She denies any pain, but reports feeling tired and out of breath. What are potential causes and the next steps?
The patient's symptoms of heavy menstrual bleeding (menorrhagia) along with fatigue and shortness of breath suggest the possibility of anemia due to blood loss. Causes of menorrhagia include uterine fibroids, endometrial polyps, adenomyosis, or a bleeding disorder. Initial steps would include a complete blood count (CBC) to check for anemia, a pregnancy test to rule out pregnancy-related complications, and a pelvic ultrasound to evaluate for structural abnormalities. Further management would depend on these findings.