A 29-year-old woman with secondary amenorrhea after a septic abortion

© Cambridge University Press 2015. History of present illness: A 29-year-old gravida 3, para 1-0-2-1 woman presents to your office reporting no menses since her second spontaneous abortion, which she experienced 6 months prior. She has a history of regular menstrual cycles preceding her two recent spontaneous abortions, and one uneventful normal spontaneous vaginal delivery four years ago. Her first spontaneous abortion was diagnosed at 11 weeks\u27 gestation, and was treated with dilation and curettage. The most recent spontaneous abortion was diagnosed at nine weeks\u27 gestation, when she presented to the emergency department with five days of heavy bleeding per vagina. A dilation and sharp curettage was performed; however, the patient returned 3 days later with a fever to 39.4°C, a tender uterus, leucocytosis, and retained products of conception identified on ultrasound. Another dilation and sharp curettage was performed and the patient received postoperative antibiotics as an outpatient for seven days. The remainder of her postoperative course was unremarkable thereafter but she continues to report cyclic pelvic pain since that event. Her medical history is otherwise unremarkable. She is sexually active with one partner, with whom she desires another pregnancy. She has not been using any contraception. She smokes socially and works as a sales associate. Physical examination General appearance: Well-developed, well-nourished young woman Vital signs: Temperature: 37.1°C Pulse: 80 beats/min Blood pressure: 110/70 mmHg Respiratory rate: 16 breaths/min BMI: 24 kg/m2Breasts: No masses, adenopathy, or nipple discharge Abdomen: Soft, nontender, no masses External genitalia: Normal Vagina: Normal mucosa, no lesions, scant discharge Cervix: Parous, no lesions Uterus: Normal size, minimally tender, retroflexed, mobile Adnexa: Nontender, no masses Laboratory studies: Urine pregnancy test: Negative