The initial approach to any female complaining of oligomenorrhea should begin obtaining the patient history It is essential to keep in mind that children and teenagers may not feel comfortable sharing certain information in front of their parents or caregivers due to developmental reasons as well as individual preferences The emergency physician should start by obtaining a history both with parents or caregivers present and with the patient and parents alone Some patients may feel comfortable discussing sexual information in front of parents and caregivers, however others will prefer to keep this information confidential Note past medical history and current medications Obtain a brief menstrual history including onset of menstruation, timing of the last menstrual period, duration and frequency of typical menstruation cycles, number of pads or tampons used in a day, bleeding in between cycles, and the presence and size of clots passed Inquire about sexual preferences, experience, birth control methods used, prior pregnancies, or STI history Ask about recent weight loss, caloric intake and restrictions, physical activity, self-inducing vomiting, or use of any medications, supplements or practices (including laxatives, diet pills, ipecac, intermittent fasting) for the purpose of weight loss Pertinent historical factors that can help exclude potentially dangerous causes of oligomenorrhea include any indicators of acute abdomen such as presence of abdominal pain, nausea, emesis, fever, or loss of appetite Ascertain symptoms of increased intracranial pressure such as visual changes, neurologic symptoms, early morning emesis, or headache that is persistent, worsening, or waking the patient from sleep Inquire about the presence of palpitations, tachycardia, sweating, weight loss, or agitation that may suggest hyperthyroidism Conversely, symptoms of hypothyroidism such as weight gain, cold intolerance, fatigue, and depressed mood should also be obtained Examination Vital signs should be noted including the patient’s height, weight, and body mass index (BMI) Tachycardia and hypotension may raise suspicion for ectopic pregnancy Papilledema, blurred vision, cranial nerve VI palsy, visual field deficits, or other focal deficits may indicate increased intracranial pressure associated with pituitary tumors Bradycardia and hypotension may suggest malnutrition due to caloric restriction, purging, or excessive energy expenditure Note general appearance, mental status and perfusion, and perform a general examination to identify imperforate hymen, prolapsed urethra, or other apparent structural or mechanical causes Note features such as overall body habitus, hirsutism, acanthosis nigricans, and acne An abdominal examination focus on the presence of peritoneal signs, a gravid uterus, or a palpable mass Pubertal