January 20, 2008

OLD PAM's menstruation

Sometimes, young women are reluctant to talk about their female problems. It is important for primary care physicians, then, to ask OLD PAM some screening questions about her menses.

Onset: When did your menses begin?
LMP: On what date did you last menstrual periods occur?
Duration: How often do your menstrual periods occur? How long do they last for?

Pain: Is there any pain associated with menstruation?
Activity: Are you sexually active?
Meds: Are you practicing any form of birth control?

Questions gathered from
Seller. Differential Diagnosis of Common Complaints. 4th ed. 2000. (the purple ddx book)


  1. Every time I reach this part of the history I freeze up because everyone has their list of "don'ts" -- especially with "sexually active."

    All the phrasings are either too vague ("No, I just lie there.") or too clinical ("Men, women, or both?"). Too vulgar ("What are you implying!"), or too uptight ("You sound like my grandma."). I wish we could just be like lawyers and spell it out completely:

    "Do you, or have you in a period of less than 6 months ago, have sexual intercourse (henceforth, SEX), including but not limited to the following acts: ...."

    "Are you and/or your sexual partner(s) using birth control, including but not limited to: ...."

  2. I think the patients usually feel a lot less uncomfortable than we do at times.

  3. I have no problems asking them. I am a 4th year and I just go str8 for it when it comes to that section. The thing is: if you don't ask, they may not tell and you are responsible for missing it. They are often uncomfortable but if you are comfortable and relaxed, they are comfortable and relaxed as well. So, don't freeze up. Smile when they do and explain that these are routine but very important questions...they will be happy you asked.