Symptoms or findings may suggest a cause for the pelvic mass: Vaginal bleeding and pelvic pain with a positive pregnancy test: Ectopic pregnancy, another obstetric complication, or, rarely, gestational trophoblastic disease Dysmenorrhea: Endometriosis, adenomyosis, or uterine fibroids Fever and pelvic pain: Tubo-ovarian abscess Postmenopausal bleeding: Increased suspicion of uterine cancer Hormonal effects, such as precocious puberty, virilization, or abnormal uterine bleeding: A masculinizing or feminizing ovarian tumor Examination During the general examination, the examiner should look for signs of nongynecologic (eg, gastrointestinal, urologic, endocrine) disorders and for ascites.