The reason I accepted a low rate for my first locum job is simple: I didn’t know any better. I didn’t know the industry and I had no idea what to expect. Here is everything I wish I knew at the time

If you have heavy or long periods, painful periods (or general pelvic pain, presure, difficulty with urination and bowel movements), or difficulty getting pregnant or staying pregnant, have a conversation with your OBGYN provider about your symptoms. Fibroids can be felt on exam, but a pelvic ultrasound is the best way to diagnose them. (Transvaginal ultrasound, where the ultrasound probe is placed in the vagina, gives the best pictures of the uterus and pelvis. Sometimes your provider will follow up the ultrasound with a saline-infused-sonogram (an ultrasound with water pumped into the uterus) to get better pictures of the inside lining or an MRI (usually for surgical planning).

A reputable agent will work to earn your trust: they will ask questions about the types of roles you are looking for, if you’re willing to travel and how far, specific needs around accomodation, and your desired compensation, then discuss details of jobs that match your preferences before requesting your CV when you are ready to move forward with being “presented” to a facility.

I structure a differential diagnosis for post menopausal bleeding slightly differently than I do for AUB in reproductive-age patients for one main reason: the threat of endometrial cancer. Endometrial cancer is rare overall (affecting 3% of people with uteruses in the United States), but over 70% of cases occur in patients over the age of 55, and >90% present with post menopausal bleeding (1). EC can also present in a variety of ways, so it doesn’t matter as much if the bleeding is heavy, light, spotting or situational. It goes without saying that a missed or delayed diagnosis can be devastating, so every postmenopausal patient who walks into my office with bleeding gets a transvaginal ultrasound or endometrial biopsy to evaluate for endometrial cancer, and then I use the history and exam to rule out other potential causes (structural (benign), infection, urinary tract / gastrointestinal, atrophy, or other dermatologic). Let’s get into it:

While it is expected to have irregular periods in the perimenopausal period, once a full 12 months have passed without menses, they should not come back. Bleeding after menopause is NEVER normal.

From the first question to the final plan—this guide helps you assess postmenopausal bleeding without overtesting or missing critical diagnoses.

Abnormal uterine bleeding (AUB) isn’t a final diagnosis—it’s a symptom. And when someone walks into your office with heavy, irregular, or unexpected bleeding, the question isn’t “What’s the name of the condition?” It’s “What systems could be at play here?”

This is where we stop chasing zebras, resist the urge to blindly order an ultrasound, and start grouping possible causes into one of 5 meaningful categories for more diagnostic clarity, and a plan that helps you get your patient answers fast. Let’s break it down.

Abnormal uterine bleeding is one of the most common gynecologic complaints. It is also one where patients’ concerns are often ignored. As an OBGYN, I get referrals for this symptom all the time. While almost everyone gets a pelvic ultrasound, there are often gaps in the history or simple blood tests that would have helped the patients get some reassurance or relief before a three- to six- month wait to see me. This guide outlines key causes, targeted history, and the best labs and imaging for reproductive-age patients with AUB.

I don’t jump to conclusions or rush to label, and I don’t throw unnecessary tests or ultrasounds at symptoms just to “do something.” Diagnosis, done right, is thoughtful and deliberate. It’s a process of asking smart questions, ruling out the scary stuff, and making patients feel heard along the way.

The most concerning thing that can happen to a growth-restricted baby is stillbirth (dying in the womb). But sometimes your baby is healthy, but just small!

You should talk with your pregnancy provider about any other conditions that increase the risks of complications for you or your baby (e.g. high blood pressure, too much or too little amniotic fluid, kidney disease), or if there are any other abnormal findings on your baby’s ultrasounds.

As a physician you are capable of so much more than following the rules and doing what you are told; you are capable of building the life and career of your dreams, on your terms.