Synopsis
Take a private, inclusive and clinically discriminating reproductive history that establishes immediate risk, respects the person’s language and autonomy, and guides proportionate examination, testing, safeguarding and follow-up.
- Begin by explaining why particular questions matter, what will be recorded, and the limits of confidentiality; ask the patient how they prefer body parts, gender, partners and pregnancies to be described.
- Offer part of the consultation alone as routine, use a professional interpreter rather than a partner, and check that later messages, letters and portal access are safe.
- For bleeding, define last normal period, cycle interval and regularity, duration, flooding, clots, products changed, night leakage, pain, intermenstrual or postcoital bleeding and anaemia symptoms.
Key red flags
Syncope, shoulder-tip pain, unilateral pelvic pain or heavy bleeding with possible pregnancy raises ectopic pregnancy or haemorrhage and needs urgent location assessment.
A missed or atypical period with unilateral pain, syncope, shoulder-tip pain or bleeding requires pregnancy testing and urgent ectopic assessment even when contraception was reportedly used.
Investigation priorities
Obtain an accurate history and enable disclosure without a companion shaping the account.
Management branches
Any consultation includes menstrual, sexual, obstetric or reproductive symptoms.
- Explain the purpose of sensitive questions, confirm communication preferences and confidentiality limits, and arrange professional interpretation where needed.
- Offer time alone, identify safe contact routes and establish physiology, bleeding severity, pain, pregnancy possibility and immediate safeguarding threats.