Common Gynecological Symptoms

Patients present with a wide range of symptoms. Common complaints include:

Menstrual Disorders

• Irregular menstrual cycles (frequent, infrequent, or absent periods)
• Heavy menstrual bleeding (menorrhagia)
• Painful periods (dysmenorrhea)
• Intermenstrual bleeding (spotting between periods)
• Postmenopausal bleeding

Vaginal and Vulvar Symptoms

• Vaginal discharge (abnormal color, odor, or consistency)
• Itching, burning, or irritation (vaginal or vulvar)
• Pain during intercourse (dyspareunia)
• Vaginal dryness

Pelvic Pain and Masses

• Chronic pelvic pain
• Pain during urination or bowel movements
• Pelvic or lower abdominal swelling or masses

Reproductive and Fertility Concerns

• Difficulty conceiving (infertility)
• Recurrent pregnancy loss
• Concern about ovulation or menstrual cycle tracking

Urinary and Bowel Symptoms

• Urinary frequency, urgency, or incontinence
• Painful urination (dysuria)
• Difficulty emptying the bladder
• Constipation or pain during defecation

Sexual and Hormonal Concerns

• Decreased libido
• Hirsutism (excess facial or body hair growth)
• Acne and oily skin (hormonal imbalances)
• Hot flashes and night sweats (menopausal symptoms)
• Breast pain or lumps

Pregnancy-Related Issues

• Suspected pregnancy
• Early pregnancy bleeding or pain (concern for miscarriage or ectopic pregnancy)
• Hyperemesis gravidarum (severe nausea and vomiting in pregnancy)

A thorough history is essential to determine the underlying cause. Important questions to ask include:

1. Menstrual History

• When did your periods first start (menarche)?
• How often do you get your periods? (Cycle length)
• How long does your period last?
• When was your last menstrual period (LMP)?
• Have your periods always been irregular, or is this a new problem?
• Do you experience heavy bleeding, light bleeding, or missed periods?
• Do you have intermenstrual spotting or postcoital bleeding?
• Do you experience painful periods (dysmenorrhea)?

2. Associated Symptoms

• Do you have any symptoms of hormonal imbalance, such as:
  • Acne, excessive hair growth (hirsutism), or scalp hair thinning?
  • Weight gain or difficulty losing weight?
  • Breast discharge (galactorrhea)?
  • Hot flashes or night sweats?
  • Mood changes, irritability, or depression?
• Do you experience pelvic pain or abdominal bloating?
• Any recent unexplained weight loss or weight gain?
• Do you experience excessive fatigue or weakness?

3. Reproductive and Sexual History

• Are you sexually active?
• Do you use any form of contraception? (Type and duration)
• Have you had any pregnancies, miscarriages, or abortions?
• Any difficulty getting pregnant (infertility concerns)?
• Have you noticed changes in libido or vaginal dryness?

4. Medical and Surgical History

• Do you have any known medical conditions such as:
  • Polycystic ovary syndrome (PCOS)
  • Thyroid disorders (hypothyroidism or hyperthyroidism)
  • Diabetes mellitus
  • Hyperprolactinemia
• Have you had any pelvic surgeries or gynecological procedures?
• Any history of chemotherapy, radiation, or chronic illness?

5. Medications and Substance Use

• Are you taking any hormonal medications, including birth control or emergency contraception?
• Have you recently stopped using birth control pills or injections?
• Do you take any herbal remedies or over-the-counter supplements?
• Do you use any recreational drugs, alcohol, or smoke cigarettes?

6. Family History

• Any family history of early menopause, PCOS, or thyroid disease?
• Any relatives with a history of clotting disorders or cancers (e.g., ovarian, uterine)?

7. Psychosocial and Lifestyle Factors

• Do you experience high levels of stress?
• Have there been any recent major life changes (e.g., loss of a loved one, exams, work stress)?
• How is your diet and exercise routine?
• Have you been engaging in excessive physical activity? (e.g., athletes, dancers)

A detailed history, along with clinical examination and investigations (e.g., hormonal profile, pelvic ultrasound, thyroid function tests), helps in identifying the cause of irregular menstrual cycles and guiding appropriate management.