A 15-year-old gravida 0 para 0 female presents to the emergency department with vaginal bleeding, suprapubic abdominal pain, and 1 episode of nonbloody and nonbilious vomiting. She has a medical history of moderate persistent asthma, attention-deficit/hyperactivity disorder, and learning delay. She reports that her menarche was at age 12 years and her menstrual cycles are regular, except for the last one. Her last menstrual cycle was on May 23. She missed her cycle in June. She started to bleed on July 30, which continued until the presentation on September 5. Three days before admission, the patient was seen by her primary care physician for fatigue and vaginal bleeding. The urine pregnancy test result was negative. We do not have access to details of the physical examination performed by the patient’s primary care physician. Oral contraceptive pills were prescribed for abnormal uterine bleeding (AUB). However, the patient did not take the...

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