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A 30-year-old gravida 2, para 0011 patient presents with 15 months of secondary infertility. She notes a change in her menstrual pattern with light menstrual bleeding consisting of menstrual spotting for 1 day every 31 days. She reports significant cyclic pain with spotting. She had normal menstrual cycles with four days of flow prior to her last pregnancy two years ago that ended in a miscarriage at nine weeks. She failed medical management of first-trimester loss and underwent a dilation and curettage (D&C) for evacuation of products of conception. The procedure was uneventful; however, she did require a course of antibiotics afterwards for postoperative endometritis. The couple did not report any issues with conceiving their previous pregnancies. She denies any significant past medical or surgical history other than the D&C.
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