Prolonged Menstrual Bleeding

[rmnurse11]

24F with prolonged menstrual bleeding and hx of irregular cycles- sometimes up to 50 days. Hospitalized once and treatments to stop bleeding didn't work. Put on the pill which then helped. Had full work up with pelvic ultrasound, thyroid panel, blood dyscrasias eval all WNL. Androgens WNL. Went off the pill and now prolonged bleeding has come back.

Thinking anovulation so starting on inositol, vitex, iron support but wondering if further work up is needed. What else could be causing this? Are other treatments indicated?