🩸 Heavy or Painful Periods
♀ Built for women · 8 markers · $110.25
with code CAMERON $122.50
Periods that soak through protection, last more than 7 days, pass large clots, or pain that stops you functioning.
🩸 Order this exact panel — 10% off
All 8 markers load into your cart in one click. No doctor's visit, drawn at any Quest location in the US, results by email in about two weeks. Code CAMERON applies automatically.
Add all 8 markers — $110.25 → Open the full Bloodwork Vault →Why this panel
Bloodwork cannot diagnose endometriosis or fibroids — those need imaging or laparoscopy, and any panel claiming otherwise is selling you something. What bloodwork does do is find the causes that ARE treatable and get missed: iron deficiency from the bleeding itself, thyroid disease, androgen excess, and an underlying bleeding disorder.
What this panel can settle, and by what logic
Heavy menstrual bleeding has a measured differential, and this panel reaches part of it. A meta-analysis pooling 45 studies and 41,541 patients put the prevalence of an underlying bleeding disorder at 30% (95% CI 14 to 46), polycystic ovary syndrome at 8% (95% CI 4 to 12) and thyroid abnormality at 3% (95% CI 0 to 6) Comishen 2024. Two of those three are on this list.
- Ferritin with the Iron Panel (Iron, TIBC, Transferrin Saturation) and a Complete Blood Count (CBC) with Differential grades the consequence. Iron stores empty first and hemoglobin falls last, so the common finding is an exhausted ferritin under a normal blood count Cancado 2025. The Complete Blood Count (CBC) with Differential indices matter for a second reason: a low mean cell volume with a normal or high red cell count is the pattern that raises thalassemia trait rather than iron deficiency, and the two are separated by index-based discrimination rather than by ferritin alone Xiao 2021.
- TSH (Thyroid-Stimulating Hormone) with Free T4 (Thyroxine) covers the 3%. Both underactive and overactive thyroid disturb bleeding, and this is the cheapest correctable cause in the whole differential.
- Total Testosterone with Free Testosterone and Prolactin covers the ovulatory causes. Androgen excess with irregular heavy bleeding points at PCOS, and a raised prolactin points somewhere else entirely.
- Comprehensive Metabolic Panel (CMP) is not padding here. Liver disease impairs synthesis of clotting factors and kidney disease impairs platelet function, and both show up as heavy bleeding before they show up as anything else.
What it cannot settle, and what would
It cannot test for the commonest category in that differential, and the platelet count is what fools people. A Complete Blood Count (CBC) with Differential counts platelets; it does not measure what they do. In the same pooled analysis, platelet function defects ran at 9% (95% CI 7 to 12) and von Willebrand disease at 8% (95% CI 7 to 10) Comishen 2024 — both with entirely normal platelet counts. The tests that reach them are von Willebrand factor antigen and activity, factor VIII and platelet function studies, none of which is on this panel or any panel like it.
And the younger you are, the more that gap matters. Bleeding disorders were present in 39% of adolescents with heavy menstrual bleeding (95% CI 18 to 60) against 16% of adults Comishen 2024, and the diagnosis in adolescents is routinely delayed, with iron deficiency anemia accumulating while it is Kalvehalli Kashinath 2023. If your periods have been heavy since the very first one, the hematology referral is the purchase, not this.
It cannot see the uterus. Fibroids, adenomyosis, polyps and endometrial pathology are ultrasound findings and endometriosis is usually a laparoscopic one. Eight normal results here exclude none of them, and pain as the dominant symptom should route you to a pelvic ultrasound rather than to a second blood test.
It has no hs-CRP, which limits what the ferritin can be trusted to say. Ferritin is an acute-phase protein and the inflammation correction methods exist because of it Luo 2023. Here the transferrin saturation on the Iron Panel (Iron, TIBC, Transferrin Saturation) is the cross-check to read instead.
Draw conditions that decide whether the money is wasted
This is the one panel in the female-health set where the honest draw day is defined by the bleed rather than by the follicular phase.
- Draw within a few days AFTER a period ends, not before one. Ferritin sits at its lowest right after the loss, which is the value that represents what you are actually running on across the month Cancado 2025. A tube taken three weeks later reads the recovery rather than the deficit.
- Stop oral iron for 5 to 7 days first. Serum iron and transferrin saturation on the Iron Panel (Iron, TIBC, Transferrin Saturation) track the last tablet rather than the store, so a supplemented panel can look repleted while Ferritin — the slow number and the one worth paying for — is still empty. Absorption itself is dose-timing dependent: alternate-day dosing was studied against consecutive-day dosing in iron-depleted women for exactly this reason von Siebenthal 2023.
- If a bleeding disorder is on the table, do not have the blood taken during a bleed, an infection or straight after exercise. Coagulation factors move with stress, inflammation and estrogen, which is why the 2021 diagnostic guidelines specify how and when factor levels are measured rather than treating a single value as final Kalvehalli Kashinath 2023. That testing is a hematology order, and it is worth getting right the first time.
- Morning for TSH (Thyroid-Stimulating Hormone) and the androgens, and repeat rather than act on a single TSH. Day-to-day and diurnal variation in TSH are large enough that one value is a sample from your own distribution van der Spoel 2021, and female androgen concentrations need the assay caveat that comes with them Casals 2023.
How you would know it answered your question, and what each pattern means next
Five patterns, and one of them should take you off this page entirely.
- Heavy since your first period, normal platelets, low Ferritin: the finding is the history, not the panel. Ask for von Willebrand testing, and ask in a hematology clinic rather than a general one — underdiagnosis in this exact group is what the guideline updates were written about Kalvehalli Kashinath 2023.
- Ferritin under 30 ng/mL: treat, and retest at 12 weeks rather than at 4. A store depleted over years of cycles refills over months, and an early value mostly reads yesterday's dose Cancado 2025 von Siebenthal 2023.
- Low mean cell volume with a normal or raised red cell count and a normal ferritin: this is not iron deficiency and iron will not fix it. Thalassemia trait is the alternative and it is separated from iron deficiency by red cell indices and hemoglobin electrophoresis Xiao 2021.
- TSH (Thyroid-Stimulating Hormone) outside range: repeat at 8 to 12 weeks before treating, then expect bleeding to settle over 2 to 3 cycles rather than immediately, since the endometrium responds cycle by cycle van der Spoel 2021.
- Everything normal and the bleeding unchanged: the useful result. With bleeding disorders at 30% of this population and structural causes invisible to blood Comishen 2024, the next two steps are a pelvic ultrasound and a coagulation workup, not a repeat of these eight markers.
Sources read for these sections
- Comishen KJ, et al. Etiology and Diagnosis of Heavy Menstrual Bleeding among Adolescent and Adult Patients: A Systematic Review and Meta-Analysis of the Literature. Journal of Thrombosis and Haemostasis 2024 · PMID 39617186
- Kalvehalli Kashinath S, Kouides PA. The diagnosis, natural history, and management of von Willebrand disease in women in the age of guidelines. Expert Review of Hematology 2023 · PMID 36609196
- Cancado RD. Defining Global Thresholds for Serum Ferritin: A Challenging Mission in Establishing the Iron Deficiency Diagnosis in This Era of Striving for Health Equity. Diagnostics (Basel) 2025 · PMID 39941219
- Luo H, et al. A Practical Guide to Adjust Micronutrient Biomarkers for Inflammation Using the BRINDA Method. Journal of Nutrition 2023 · PMID 36792034
- von Siebenthal HK, et al. Alternate day versus consecutive day oral iron supplementation in iron-depleted women: a randomized double-blind placebo-controlled study. eClinicalMedicine 2023 · PMID 38021373
- Xiao H, et al. Differential diagnosis of thalassemia and iron deficiency anemia in pregnant women using new formulas from multidimensional analysis of red blood cells. Annals of Translational Medicine 2021 · PMID 33569443
- van der Spoel E, et al. Within-Person Variation in Serum Thyrotropin Concentrations: Main Sources, Potential Underlying Biological Mechanisms, and Clinical Implications. Frontiers in Endocrinology 2021 · PMID 33716972
- Casals G, et al. Recommendations for the measurement of sexual steroids in clinical practice. A position statement of SEQCML/SEEN/SEEP. Advances in Laboratory Medicine 2023 · PMID 37359897
The 8 markers — and why each one is here
Anemia from blood loss, plus the platelet count that hints at a bleeding disorder
Both under- and overactive thyroid cause heavy or irregular bleeding
Androgen excess points at PCOS rather than a bleeding cause
Ordering the panel tells you your numbers. The protocol tells you what to do with them — the bleeding disorder affecting 1 in 100 that almost nobody gets tested for, the one question that sorts the whole differential, the iron loop that makes bleeding worse, and the non-hormonal drug most women have never been offered.
Join Skool — $10/mo →What this panel is ordered to decide
A panel is a set of numbers until it settles something. These are the decisions this one feeds — each links the pathway it belongs to, what that pathway claims, and what its test list is read for.
Timing is the whole test. Progesterone must be drawn around day 21 of a 28-day cycle — roughly seven days after ovulation — and a draw at the wrong point is worse than no draw, because it reads as normal.
Related panels
Frequently asked questions
8 markers: Complete Blood Count (CBC) w/ Differential, Ferritin, Iron Panel (Iron, TIBC, UIBC, Sat%), TSH (Thyroid-Stimulating Hormone), Free T4 (Free Thyroxine), Prolactin, Total & Free Testosterone (ECLIA/Direct), Comprehensive Metabolic Panel (CMP).
$122.50 before discount, $110.25 with code CAMERON applied automatically. Individual markers add a one-time $10 draw fee. Ordered through Marek Diagnostics and drawn at any Quest Diagnostics location in the US.
No. These are ordered direct-to-consumer through Marek Diagnostics — you order online, walk into a Quest location, and results are emailed to you in about two weeks. No physician visit or insurance required. Not available in NY, NJ or RI.
Any day of your cycle for the blood count and iron — but note ferritin is lowest right after a period, which is arguably the most honest time to check. Morning for the hormones.
Low ferritin with heavy bleeding is the common finding and it is very treatable. Abnormal platelets or fibrinogen → ask about a bleeding disorder workup. Raised TSH → thyroid disease causes heavy periods and is easy to fix. High testosterone with irregular cycles points at PCOS instead. Normal results do not rule out endometriosis or fibroids — if pain is your main symptom, ask for a pelvic ultrasound.
Where this goes next
This page is how to read the panel. What to DO about each result — the dosing, the order to correct things in, the week-by-week schedule and what to retest — is a lesson inside Skool.