Patient's question:
Hello: Recently, my menstruation has been a bit abnormal, either coming much earlier than usual or with very little flow. I spend a lot of time in front of the computer. Is this related to computer radiation?Doctor's answer:
Hello, it is recommended that you have a test for the six hormones at the hospital for diagnosis, as it may be related to luteal phase deficiency.Clinical manifestations of luteal phase deficiency: Generally, it may include short menstrual cycles, spotting before menstruation, infertility or habitual abortion in women of reproductive age. To determine if there is luteal phase deficiency, basal body temperature should be measured. If the luteal phase temperature is shorter than 12 days, or if the temperature rise is slow, the decline is early, and the rise amplitude is less than 0.5°C, or if there is significant fluctuation in the luteal phase temperature, these are all signs of luteal phase deficiency. However, it is important to note that continuous measurement over three menstrual cycles is required to confirm the diagnosis. Additionally, if the endometrium is taken within 12 hours of menstruation and shows poor secretion, it can also serve as a reference.
Treatment for infertility caused by luteal phase deficiency should be based on different causes and adopt different treatment plans. Common methods include:
(1) Progesterone supplementation therapy: This is the most widely used method. It is suitable for cases with low progesterone levels in the mid-luteal phase, poor secretion observed in endometrial biopsy, or confirmed luteal phase deficiency based on clinical observation. Specific methods include:
① Progesterone vaginal suppositories 25mg inserted deeply into the vagina or rectum, twice a day (morning and evening), self-administered, starting 2 days after the rise in basal body temperature (on day 16 or 17 of the menstrual cycle) and continuing until menstruation begins.
② Progesterone oil injection, 10mg administered intramuscularly daily, or 20mg every other day, starting 2 days after the rise in basal body temperature.
③ Synthetic progestins:
- Medroxyprogesterone acetate (MPA): 2mg taken three times a day, or 5mg once at night, starting 2 days after the rise in basal body temperature.
- Hydroxyprogesterone: 125mg administered intramuscularly twice a week, starting 2 days after the rise in basal body temperature.
The recommended duration for progesterone supplementation therapy to treat infertility is typically to start 2–3 days after ovulation. Even for habitual early miscarriage, treatment should begin 2–3 days after ovulation, similar to treating infertility patients. Regarding the duration of medication, some scholars suggest stopping it on the 14th day after ovulation to prevent pseudopregnancy, while others recommend continuing until menstruation occurs. If menstruation does not occur after the delay, a pregnancy test can be performed. If pregnancy is confirmed, medication should be continued until the 12th week of gestation. It should be noted that synthetic progestins, whether administered via injection or orally, cannot replace progesterone.
(2) Human Chorionic Gonadotropin (HCG): Used before ovulation to induce ovulation, and after ovulation to stimulate luteal development, support luteal function, increase progesterone synthesis, and prolong luteal life. The dosage is 2000–3000 IU administered intramuscularly every other day for 3–4 doses, starting 3–4 days after ovulation; or 1000 IU administered intramuscularly daily for 7–8 consecutive days, starting 3 days after ovulation.
(3) Clomiphene: Some patients have been found to have poor luteal function when using clomiphene to induce ovulation. However, reports suggest that for naturally ovulating patients, especially when progesterone supplementation therapy is ineffective, clomiphene 50mg can be taken daily from the early follicular phase (day 3 of the menstrual cycle) for 5 consecutive days to improve pregnancy rates.
(4) Bromocriptine: Patients with luteal phase deficiency and elevated serum prolactin levels can be treated with bromocriptine: 25mg administered once or twice daily.