Clinicians should also ask about The age at which symptoms began Their nature and severity Factors that relieve or worsen symptoms (including the effects of contraceptives) Degree of disruption of daily life Effect on sexual activity Presence of pelvic pain unrelated to menses Response to nonsteroidal anti-inflammatory drugs (NSAIDs) History of dyspareunia or infertility (associated with endometriosis) Review of systems should include accompanying symptoms such as cyclic nausea, vomiting, bloating, diarrhea, and fatigue.