Components of Review of Systems (ROS) in a Well Woman's Exam
A comprehensive review of systems during a well woman's exam should include questioning about general symptoms, skin, lymph nodes, eyes, mouth, cardiopulmonary, gastrointestinal, endocrine, neurologic/psychiatric, genitourinary, and orthopedic systems, with special attention to reproductive health symptoms.
General Components of ROS
The review of systems should systematically assess:
General
- Unexplained weight loss or gain
- Fever, night sweats
- Changes in energy level
- Sleep patterns
- Overall health concerns 1
Skin
- Rashes, lesions, or ulcers
- Skin discoloration
- Changes in moles 1
Lymph Nodes
- Localized or generalized enlargement 1
Eyes/Vision
- Vision changes or loss
- Eye pain or redness 1
Mouth/Oral
- Gum disease
- Oral lesions or ulcers
- Oral pain 1
Cardiopulmonary
- Chest pain
- Shortness of breath
- Palpitations
- Wheezing
- Orthopnea 1
Gastrointestinal
- Nausea, vomiting
- Abdominal pain
- Diarrhea
- Changes in bowel habits 1
Endocrine
- Symptoms of hyperglycemia
- Thyroid disease symptoms
- Hirsutism
- Galactorrhea 1
Neurologic and Psychiatric
- Headaches
- Memory loss or concentration issues
- Depression, anxiety, mood changes
- Paresthesias, numbness, or weakness
- Dizziness
- Sleep disorders 1
Female-Specific ROS Components
Genitourinary
- Dysuria
- Urethral or vaginal discharge
- Vaginal lesions
- Hematuria 1
Reproductive/Gynecologic
- Menstrual history (age at menarche, cycle length and characteristics)
- Onset/severity of dysmenorrhea
- Abnormal vaginal bleeding
- Sexual health concerns
- Dyspareunia (painful intercourse)
- Contraceptive use and needs 1
Obstetric (if applicable)
- Gravidity, parity
- Previous pregnancy outcomes and complications 1
Mental Health Screening
- Depression screening
- Anxiety assessment
- Domestic violence screening
- Posttraumatic stress disorder screening 1, 2
Important Considerations
Age-Specific Concerns
- For adolescents: developmental milestones, menstrual patterns
- For perimenopausal women: vasomotor symptoms, changes in menstrual patterns
- For postmenopausal women: vaginal dryness, sexual function changes 3
Risk-Based Questioning
- Family history of gynecologic cancers or breast cancer
- Personal history of STIs or pelvic inflammatory disease
- Infertility concerns 1
Clinical Pearls and Pitfalls
High-Value Care: The ROS has been shown to have a therapeutic yield of approximately 7%, making it a valuable case-finding maneuver in ambulatory patients 4
Avoid Unnecessary Examinations: While a comprehensive ROS is valuable, the American College of Physicians recommends against routine pelvic examinations in asymptomatic, non-pregnant women as they provide little clinical value and may cause unnecessary discomfort and anxiety 1, 2
Communication Approach: Use clear, non-judgmental language and establish rapport before asking sensitive questions about sexual health, domestic violence, or mental health 2
Documentation: Thoroughly document both positive and pertinent negative findings from the ROS to establish baseline health status and identify changes at future visits 1
By systematically addressing these components in the ROS during a well woman's exam, clinicians can identify potential health concerns that warrant further investigation while providing comprehensive preventive care.