Red flags The following findings are of particular concern: Syncope or hemorrhagic shock (eg, tachycardia, hypotension) Peritoneal signs (rebound, rigidity, guarding) Postmenopausal vaginal bleeding Fever or chills Sudden severe pain with nausea, vomiting, or diaphoresis Interpretation of findings Acuity and severity of pelvic pain and its relationship to menstrual cycles can suggest the most likely causes (see table Some Gynecologic Causes of Pelvic Pain).