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Seek urgent medical attention via NHS 111, A&E, or 999 if you experience: Very heavy bleeding with dizziness, fainting, or signs of shock Severe abdominal pain with bleeding Positive pregnancy test with severe pain or heavy bleeding Investigations for persistent menstrual irregularities may include: Pregnancy test (first line) Full blood count (to assess for anaemia) Thyroid function tests Hormonal profile (FSH, LH, oestradiol, prolactin, testosterone) Pelvic ultrasound scan if structural abnormalities are suspected Consideration of referral to gynaecology if symptoms persist or are severe Your GP can help determine whether menstrual changes are likely related to weight loss and metabolic improvements or whether further investigation is warranted

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