| Periods skipped > 35 days | PCOS, thyroid, prolactin imbalance, stress, weight changes, perimenopause | Hormonal panel, USG TVS, lifestyle plan, cyclical hormones if needed |
| Painful periods (dysmenorrhea) | Primary cramps, endometriosis, fibroids, adenomyosis, IUD-related | USG, NSAID plan, hormonal options, endometriosis evaluation |
| Trying for > 12 months — no conception | Anovulation, tubal factor, low ovarian reserve, male factor, endometriosis | AMH, day-3 hormones, USG, partner referral, ovulation induction or IUI/IVF guidance |
| White / yellow discharge with itching | Vulvovaginal candidiasis, bacterial vaginosis, trichomoniasis | Targeted treatment, partner evaluation if needed, hygiene plan |
| Burning during urination | UTI, vulvovaginitis, atrophic vaginitis (post-menopause), STI | Urine R/M + culture, empirical antibiotics, prevention plan |
| Hot flashes, night sweats, mood | Perimenopause, thyroid, anxiety, sleep apnea | FSH/estradiol review, MHT/HRT consideration, lifestyle plan |
| Heavy bleeding (menorrhagia) | Fibroids, PCOS, thyroid, coagulation issues, endometrial pathology | USG, hemoglobin, hormonal therapy, iron correction, surgical referral if indicated |
| Pain during sex (dyspareunia) | Vaginismus, infection, endometriosis, low estrogen, psychological factors | Compassionate evaluation, lubricant/estrogen plan, pelvic floor referral, counselling |