A 35 years old, multigravida aboed 5 months back at 17 weeks of gestation. She has not got her periods yet. Urine pregnancy test is negative. Estrogen progesterone withdrawal test is negative. The likely diagnosis is:

In Patient with secondary amenorrhea, after ruling out pregnancy progesterone challenge test is to be done. Patients with anovulation will get menses with progesterone. (Progesterone acts only on estrogen primed endometrium. In patients with anovulation, estrogen is present but progesterone is absent). Patients with both hypothalamo/ pituitary failure and ovarian failure will get menses with E + P. Absence of withdrawal by E + P indicates end organ failure. The Patient had a second-trimester aboion, following which a curettage may have been done to remove the retained products leading to Asherman syndrome The best diagnostic method is hysteroscopy and this is treated by Adhesiolysis