SUBGROUP CHIEF COMPLAINT POSSIBLE DIFFERENTIALS

Abnormal Uterine ● Prepubertal

Bleeding ○ E2 withdrawal at birth
○ Foreign body
○ Sarcoma
○ Trauma
○ Ovarian tumor
● Menarche
○ Coagulation defect
○ HPO immaturity
○ Psychogenic
● Reproductive
○ Pregnancy
○ Anovulation
○ Anatomy
● Post-Menopausal
○ Carcinoma
○ Vaginal atrophy
○ E2 replacement
○ Anatomic

PALM-COEIN
● Polyp
○ Reproductive age group
○ Sx: HMB, intermenstrual spotting, post-coital
bleeding
● Adenomyosis
○ Multigravid, older age group
○ Sx:HBM, progessive dysmenorrhea
● Leiomyoma
● Malignancy
● Coagulopathy
● Ovulatory
○ PCOS (irregular mens)
● Endometrial
● Iatrogenic
● Not Classified

Vaginal Bulge/Protrusion ● Pelvic Organ Prolapse

Pain ● Abdominal Pain (most common causes)

○ PID
○ Adnexal torsion secondary to ONG
○ Ectopic pregnancy
○ Appendicitis
● Unilateral Pelvic Pain
○ Ruptured corpus luteum cyst
○ Ectopic pregnancy
○ Endometrioma, ruptured
○ Adnexal torsion
○ Appendicitis
● Dyspareunia
○ Endometriosis
● Cyclic Pain/Dysmenorrhea
 ○ Endometriosis
○ Adenomyosis
○ Endometrioma
○ Pelvic Congestion Syndrome
● Genital Pain
○ Herpes

Vaginal Discharge ● Lower Genital Tract Infections

○ Bacterial vaginosis
○ Trichomoniasis
○ Vulvovaginal candidiasis
■ Itchy vagina/pruritus
○ Mixed vaginal infection
● PID

Post-coital Bleeding ● Endocervical and Cervical Polyps

○ Can be intermenstrual spotting or HMB din
● Cervical Tuberculosis
● Endometrial polyp
● Cervical Cancer

Amenorrhea Primary Amenorrhea

Secondary Amenorrhea
● Uterine Causes
○ Intrauterine Adhesions or Synechia (Asherman
Syndrome)
● Central Nervous System and Hypothalamic Causes
○ Drugs
○ Stress and Exercise
○ Weight Loss
○ PCOS
○ Functional Hypothalamic Amenorrhea
● Pituitary Causes
○ Hyperprolactinemia
● Ovarian Causes (hypergonadotropic hypogonadism)
○ Cystic degeneration of the ovaries
○ Premature ovarian failure/insufficiency

Infertility ● Ovulatory dysfunction

● PCOS
● Leiomyoma
● Endometriosis
● Adenomyosis

Abdominal Enlargement ● RULE OUT YUNG F’s

○ Fluid
■ Ascites
■ Abscess, Pseudocyst
○ Flatus
○ Feces
■ Constipation
○ Fetus
○ Fat
■ Weight gain
○ Phantom Growth/Tumors
 ● Endometriosis (if accompanied by dyspareunia)
● Adenomyosis
● Leiomyoma
● Epithelial stromal tumors
○ Serous tumor
○ Mucinous tumor
○ Endometrioid Tumor
● Benign ovarian new growth
○ Benign Cystic Teratoma
○ Endometrioma
○ Fibroma
■ Meig’s Syndrome

Vaginal Lesions ● Syphilis

● Herpes
● Chancroid
● Donovanosis
● Lymphogranuloma venereum

Hot Flushes ● Menopause

Annual Check-Up