Patient's question:
Hello!I had my period on October 28th, but it hasn’t come yet. I took a test on day 31, but it was negative, and I still don’t have any pregnancy symptoms. Only when I press my nipples do they feel a little sore. I’m very anxious. My period hasn’t come, and I’m not pregnant either. What’s wrong with me? Should I see a doctor? What aspects should I focus on?
Urgently waiting!!! Thank you!!!!!!
First follow-up question: I went to the hospital again on December 4th for a check-up. The doctor said there was no pregnancy confirmed through a urine test. One doctor suggested I get progesterone injections, while another said I should wait a bit longer until day 40 if my period still hasn’t come.
Doctor's answer:
Reasons for absent menstruation: Common causes include systemic diseases such as anemia, nephritis, tuberculosis, endocrine disorders, ovarian abnormalities, and postoperative sequelae of artificial abortion. Traditional Chinese medicine (TCM) considers the reasons for menstrual cessation to be multifaceted, such as blood loss, multiple births, excessive sexual activity, excessive worry, emotional depression, and exposure to cold and dampness. The differentiation of symptoms can be categorized into two major types: "deficiency" and "excess.""Deficiency" is often characterized by insufficient yin and blood, even to the point of exhaustion, with an empty blood sea and no blood to descend. It is primarily caused by insufficient qi and blood and kidney deficiency. Treatment focuses on tonifying the spleen and kidneys. When qi and blood are sufficient, menstruation will occur on schedule. "Excess" menstrual cessation is mainly due to the obstruction of pathogenic factors, blocked meridians, and the inability of menstrual blood to descend.
The most common causes include qi stagnation, blood stasis, phlegm-dampness, and cold-dampness. Patients often experience discomfort such as the sensation of menstruation approaching but not arriving, lower abdominal pain, breast tenderness, and lower back pain.
Guidelines:
1. Artificial cycle therapy using hormone drugs: The first step involves taking ethinyl estradiol (0.5-1 mg) orally every night for 20 days. The second step involves intramuscular injection of 10 mg of fluoxetine daily for the last 6 days of ethinyl estradiol treatment. After completing this treatment, menstruation will typically occur within 3-5 days. Subsequently, ethinyl estradiol should be taken again starting from the 6th day after menstruation to begin the next artificial cycle. Generally, 3 consecutive cycles are recommended, though more cycles may be used. Under the guidance of artificial menstrual cycles, menstruation may gradually normalize.
2. Human chorionic gonadotropin (HCG) at a dose of 1000 international units, starting on the 10th day of the menstrual cycle, with intramuscular injections every other day for a total of 5 times. This can also stimulate ovarian function to induce menstruation.
TCM has extensive research on inducing menstruation. Based on pulse diagnosis and clinical manifestations, formulas such as Honghua Taoren Decoction, Siwu Decoction, and Ba Zhen Tang can be used for treatment.
The issue of adolescent girls experiencing menstrual cessation or absence due to dieting and weight loss may seem strange to some, but it is a severe and objective reality. In Western countries like the United States, the incidence of amenorrhea among dieting women is as high as 20% or more. Although China has not conducted statistics on this matter, it is frequently reported in gynecological clinics. This issue should be given sufficient attention by women.