During the general examination, clinicians should look for signs of anemia (eg, conjunctival pallor) and evidence of possible causes of abnormal uterine bleeding, including the following: Hirsutism, acne, obesity, and enlarged ovaries: Polycystic ovary syndrome Warm and moist or dry skin, eye abnormalities, tremor, abnormal reflexes, or goiter: A thyroid disorder Nipple discharge: Hyperprolactinemia Low body mass index: Possibly hypothalamic anovulation Hepatomegaly, jaundice, asterixis (flapping tremor of the wrist), or splenomegaly: A liver disorder Easy bruising, petechiae, purpura, or mucosal (eg, gingival) bleeding: A bleeding disorder Abdominal mass or ascites: Cancer, including gynecologic cancers In children, breast development and presence of pubic and axillary hair at a younger age than is typical for puberty: Precocious puberty In children, difficulty walking or sitting; bruises or tears around the genitals, anus, or mouth; and / or vaginal discharge or pruritus: Sexual abuse The abdomen is examined for distention, tenderness, and masses (particularly an enlarged uterus).