Clinicians should ask about the following: Menstrual history, including date of last normal menstrual period, age at menarche and menopause (when appropriate), cycle length and regularity, quantity and duration of typical menstrual bleeding, and the frequency of dysmenorrhea Previous episodes of abnormal bleeding, including frequency, duration, quantity, and pattern (cyclicity) of bleeding Sexual history, including possible history of sexual assault Review of systems should seek symptoms of possible causes, including the following: Missed menses, breast swelling, and nausea: Pregnancy-related bleeding Abdominal pain, sometimes with light-headedness or syncope: Ectopic pregnancy or ruptured ovarian cyst Chronic pelvic or abdominal pain, bloating, change in bowel habits, or weight loss: Gynecologic cancer Easy bruising and excessive bleeding during toothbrushing, minor lacerations, or venipuncture: A bleeding disorder Past medical history should identify disorders known to cause vaginal bleeding, including a recent spontaneous or induced abortion or structural disorders (eg, uterine fibroids, cervical or endometrial polyps).