1. Breast Health
   1. Any breast problems?
   2. Breast pain, changes, nipple discharge, lumps, and areas of concern?
   3. Past history of breast surgeries, including biopsy or removal of benign lesions? Breast augmentation or reduction?
   4. Personal or family history of female cancers? Breast, ovarian, cervical, endometrial, or vulvar?
   5. Previous history of mammography or any breast imaging (ultrasound, X- Ray)? If so, when, what was the result?
   6. “Do you examine your own breasts?” ****
2. OB/GYN Health
   • Symptoms
     • **Abdominal and pelvic pain (**ectopic pregnancy, ruptured ovarian cyst, endometriosis, pelvic inflammatory disease, ovarian torsion)
     • Post-coital vaginal bleeding (cervical ectropion, cervical cancer, gonorrhoea, chlamydia and vaginitis.)
     • Intermenstrual vaginal bleeding: contraception (e.g. Mirena coil), ovulation, miscarriage, gonorrhoea, chlamydia, uterine fibroids, perimenopause and malignancy (e.g. uterine cancer, cervical cancer, vaginal cancer).
     • Post-menopausal bleeding: (vaginal atrophy, HRT and malignancy (e.g. uterine cancer, cervical cancer and vaginal cancer).
     • Changes in vaginal discharge: (bacterial vaginosis, chlamydia and gonorrhoea)
     • Dyspareunia: (endometriosis, vaginal atrophy, gonorrhoea and chlamydia)
     • Vulval skin changes and itching: (vaginal atrophy, vaginal thrush, gonorrhoea and lichen sclerosus)
     • Systemic symptoms: fatigue (e.g. anaemia), fever (e.g. pelvic inflammatory disease) and weight loss (e.g. malignancy).
   • periods
     • When was the last menstrual period? Was it normal?
     • whats normal flow for you?
     • how long do periods last for you?
     • How often do periods occur (10-12 periods a year)?
     • Age of start of menstrual periods?
     • (if menopause) Age when menses stopped? Any vaginal bleeding since menopause? (menopause begins one year after last menses)
   • Pregnancy
     1. Gravida (# pregnancies)
     2. Para (# deliveries)
     3. Live Births (full term or premature)
     4. Still Births
     5. Multiple Births
     6. Spontaneous Abortions
     7. Therapeutic Abortions
     8. Living Children
   • Screening
     • When was last cervical screening test? Was it normal?
     • Personal or family history of female cancers?
     • sexual Hx
     • Possibly currently pregnant?
   • surgical Hx OB/GYN surgeries? C-Sections?
   • FamHx bleeding /clotting disorders