Helen, a 50-year-old receptionist, presents with a six-month history of heavy menstrual bleeding, which requires the use of seven to eight super pads a day on the first two days of her cycle.

She has a past history of pre-eclampsia, uterine fibroids and iron deficiency anaemia.

There is a family history of hypertension and breast cancer.

Helen denies any associated headaches, palpitations, diaphoresis or anxiety. There are also no urinary symptoms, including haematuria.