Rachel is 41, In Oct or Nov of 2016 she began having heavy periods of 1 to 2 weeks duration and repeating again in two weeks then missing 4-6 weeks. She went in in Jan and had evaluation and was told it was probably hormonal, Today I learned she had a large clot pass and is filling a supper overnight pad in 3 hours. She has been experiencing severe cramping (not in past medical hx) with her menses since Nov. She is also more fatigued, having issues with working, stress, kids and spouse. How urgent is she be checked for further evaluation? BC pills have made her depressed in the past. They are using a condom.