The answer

There is actually quite a bit that can be done about heavy menstrual bleeding. Jamila can expect to be taken seriously by her GP, who should ask questions about the nature of the bleeding, any related symptoms such as bleeding in between periods and pelvic pain, as well as the impact it is having on her quality of life. A full blood count should be conducted in order to check for problems such as iron-deficiency anaemia, but a physical examination is only regarded as necessary if there are other symptoms present.

If an underlying condition is suspected, a referral to a gynaecologist should be made. However, in all other cases, possible treatments include a levonorgestrel-releasing intrauterine system, tranexamic acid, NSAIDs, combined hormonal contraception or cyclical oral progestogens. 

The choice should be made by the patient and based around considerations such as whether she is trying to conceive or any other medication she is taking or conditions she has, and this may also open up other management options, including surgery in some cases.