A 31-year-old woman develops secondary amenorrhea 8 months after suction curettage for a missed abortion. She has monthly cyclic lower abdominal pain, normal serum FSH, LH, prolactin, and thyroid function, and fails to withdraw-bleed after a progesterone challenge. What is the most likely diagnosis?

• A Sheehan syndrome
• B Weight-related hypothalamic amenorrhea
• C Premature ovarian insufficiency
• D Asherman syndrome (intrauterine adhesions) ✓

Explanation

Post-curettage amenorrhea with cyclic pelvic pain, a completely normal endocrine panel, and failure of withdrawal bleeding points to intrauterine adhesions obstructing the cavity and outflow. Sheehan syndrome would show deficient pituitary axes with failure of lactation, while premature ovarian insufficiency gives raised FSH. Hysteroscopy is both the gold standard for diagnosis and the treatment, with adhesiolysis followed by estrogen therapy.

Reference: Novak's Gynecology, 15th ed.

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