From my wife's reports, please advise the next course of action.

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I have gone through the history and details that suggest excessive bleeding or menorrhagia and frequent bleeding or polymenorrhea (attachment removed to protect patient identity). Yes, frequent and excessive bleeding will lead to loss of blood, depletion of stores and finally into anemia. It has a great impact on the quality of life. Hence, it needs to be evaluated and treated accordingly. The ultrasound shows an evidence of polycystic ovaries. Her uterus is perfectly fine or she does not have any masses or fibroids. Also, her coagulation profile is absolutely perfect. Does she gain weight recently or any history of hypothyroidism or hirsutism (mustache)? What is her BMI?

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I have considered that too. Ultrasound shows mild hepatomegaly that is liver enlargement with heterogeneous echogenicity. In most of the cases, it is due to fatty liver. It is known as a non-alcoholic fatty liver disease (NAFLD). But again, her liver function tests and lipid profile are fine. Even her sugar is within normal limits. But, her BMI and triglycerides are above normal limits. Sometimes, NAFLD and PCOD coexist. On the whole, there is no immediate concern. Your wife needs to concentrate on weight loss and eat healthy low-calorie and low-fat food and good work out. Everything would fall into place then. Repeat her FBS (fasting blood sugar), LFTs (liver function tests) and ultrasound abdomen after 10 to 12 weeks.