A 30 year old G4P1 woman is concerned that her periods have changed in quality. They used to be regular at 29 days, heavy, lasting 5 days, but since the last few months, she's had minimal to no periods. She doesn't have any vaginal pain or discharge. Her gynecologic history is as follows: at age 18, she had an elective first trimester medical abortion; at age 22, she had a daughter at full term without complications; at age 26, she had a spontaneous first trimester abortion; and several months ago, she had to surgically terminate a second trimester pregnancy due to fetal demise. She has no significant past medical history and takes no medications. She is married but has multiple sexual partners; she does not use protection. She denies domestic violence. She smokes a pack per day. Family history is noncontributory.
A urine pregnancy test is negative. A hysterosalpingogram is shown below.
Challenge: What's the diagnosis?
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