Woman With Dysmenorrhea

Abstract

A 30-year-old nonpregnant woman presented to the emergency department for a 1-month history of worsening lower abdominal cramping and intermittent vaginal bleeding. She had initiated a high-dose progesterone contraceptive a few months ago. Immediately before presentation, she discharged a mass of blood and tissue (Figure 1). She denied pregnancy, trauma, recent surgery or instrumentation, or the possibility of infection. She was afebrile, and other vital signs were normal; physical examination demonstrated a nontender abdomen; pelvic examination showed no source of vaginal bleeding.