Diagnostic step	Pertinent signs, symptoms, and tests	Conditions
History	Pelvic pain	Miscarriage, ectopic pregnancy, PID, trauma, sexual abuse or assault
	Nausea, weight gain, urinary frequency, fatigue	Pregnancy
	Weight gain, cold intolerance, constipation, fatigue	Hypothyroidism
	Weight loss, sweating, palpitations	Hyperthyroidism
	Easy bruising, tendency to bleed	Coagulopathy
	Jaundice, history of hepatitis	Liver disease
	Hirsutism, acne, acanthosis nigricans, obesity	Polycystic ovary syndrome
	Postcoital bleeding	Cervical dysplasia, endocervical polyps
	Galactorrhea, headache, visual-field disturbance	Pituitary adenoma
	Weight loss, excessive exercise, stress	Hypothalamic suppression
Physical examination	Thyromegaly, weight gain, edema	Hypothyroidism
	Thyroid tenderness, tachycardia, weight loss, velvety skin	Hyperthyroidism
	Bruising, jaundice, hepatomegaly	Liver disease
	Enlarged uterus	Pregnancy, leiomyoma, uterine cancer
	Firm, fixed uterus	Uterine cancer
	Adnexal mass	Ovarian tumor, ectopic pregnancy, cyst
	Uterine tenderness, cervical motion tenderness	PID, endometritis
Laboratory tests	Beta-subunit human chorionic gonadotropin	Pregnancy
	Complete blood count with platelet count and coagulation studies	Coagulopathy
	Liver function tests, prothrombin time	Liver disease
	Thyroid-stimulating hormone	Hypothyroidism, hyperthyroidism
	Prolactin	Pituitary adenoma
	Blood glucose	Diabetes mellitus
	DHEA-S, free testosterone, 173-hydroxyprogesterone if hyperandrogenic	Ovarian or adrenal tumor
	Papanicolaou smear	Cervical dysplasia
	Cervical testing for infection	Cervicitis, PID
Imaging and tissue sampling	Endometrial biopsy or dilatation and curettage	Hyperplasia, atypia, or adenocarcinoma
	Transvaginal ultrasonography	Pregnancy, ovarian or uterine tumors
	Saline-infusion sonohysterography	Intracavitary lesions, polyps, submucous fibroids
	Hysteroscopy	Intracavitary lesions, polyps, submucous fibroids