A)iit is understood from question that husband semen analysis is normal. After repeat Ed twice)the female should be asked about menstrual history .irregularity associated severe dysmenorrhea.usually a n ovulatory cycle are irregular .dymenorrhea points towards endometriosis especially if there is deep dysparunea .she should be inquired about coitus frequency.any history of headache milky discharge from breast. Will point toward high prolactin..she should be asked if has history of weight gain acne hair growth as all this are symptoms of PCOif she feels lethargic. Constipated ...?thyroid dysfunction.history of drugs as anti psychotic ,immunosuppressant .previous history of any uterine surgery ,evacuation.family history of any genetic disease history of premature menopause,in her sisters.occupational history excessive stress.alcohal intake
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Patient accurate Bmi. General physical examination blood pressure.ferrieman Galway scoring if
¿hirsuitism .velvety brown patches on nape of neck axillla acanthosis nigricans.breast examination if nipple discharge.abdominal exam for any mass? Ovarian cyst?tenderness
