Physical findings

1. Pallor not associated with tachycardia or signs of hypovolemia suggests chronic excessive blood loss secondary to anovulatory bleeding, adenomyosis, uterine myomas, or blood dyscrasia.

2. Fever, leukocytosis, and pelvic tenderness suggests PID.

3. Signs of impending shock indicate that the blood loss is related to pregnancy (including ectopic), trauma, sepsis, or neoplasia.

4. Pelvic masses may represent pregnancy, uterine or ovarian neoplasia, or a pelvic abscess or hematoma.

5. Fine, thinning hair, and hypoactive reflexes suggest hypothyroidism.

6. Ecchymoses or multiple bruises may indicate trauma, coagulation defects, medication use, or dietary extremes.

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