Patient's question:
I had sexual activity and then felt my menstrual cycle was irregular. Once, it even stopped for 40 days, and I thought I might be pregnant. But it wasn't. After taking Motherwort herbal preparation, my period came after a few days, but the amount was very little. However, it lasted a long time and came intermittently. It continued like this for 10 days. Previously, my period always lasted only 3 days. I also felt like I might have some inflammation and noticed some itching down there. So, I bought some anti-inflammatory medication myself and took it, and it got better.What I'm worried about is whether it will continue like this—if my period is always like this, it will be very troublesome.
Other: Additionally, I've been feeling some pain in my breasts lately. Usually, I only feel this pain during my menstrual period.
Doctor's answer:
Hello, your menstrual period is longer than usual. It is recommended to check the six hormones, as it may be related to luteal phase deficiency.Clinical manifestations of luteal phase deficiency: Generally, it may include shorter 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 rises slowly, falls early, or the rise amplitude is less than 0.5°C, or if there is significant temperature fluctuation during the luteal phase, these are all signs of luteal phase deficiency. However, it is important to note that continuous measurement for 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 can be used for any cause if low progesterone levels are detected in the mid-luteal phase, endometrial biopsy shows poor secretion, or if luteal phase deficiency is clinically confirmed. The specific methods are as follows:
① Progesterone vaginal suppositories 25mg are inserted into the deep vagina or rectum twice a day (morning and evening) by the patient. Treatment begins 2 days after the rise in basal body temperature (on day 16 or 17 of the menstrual cycle) and continues until menstruation.
② Progesterone oil is given by intramuscular injection at 10mg daily or 20mg every other day, starting 2 days after the rise in basal body temperature.
③ Synthetic progestins:
- Medroxyprogesterone acetate 2mg is taken three times a day or 5mg once at night, starting 2 days after the rise in basal body temperature.
- Hydroxyprogesterone is given by intramuscular injection twice a week, with each dose being 125mg, starting 2 days after the rise in basal body temperature.
The recommended duration of progesterone supplementation therapy for treating infertility is to start 2–3 days after ovulation. Even for habitual early miscarriage, medication should be started 2–3 days after ovulation, similar to treating infertility patients. Regarding the duration of medication discontinuation, some scholars suggest stopping it on the 14th day after ovulation to prevent pseudopregnancy. Others recommend continuing medication until menstruation occurs. If menstruation does not occur after delay, a pregnancy test can be performed. If pregnancy is confirmed, medication should be continued until the 12th week of gestation. As for the use of synthetic progestins, whether by injection or oral administration, they cannot replace progesterone.
(2) Human chorionic gonadotropin (HCG): It can induce ovulation before ovulation and stimulate luteal development after ovulation, supporting luteal function, increasing progesterone synthesis, and prolonging the luteal phase. The dosage is 2000–3000 IU of HCG given by intramuscular injection every other day for 3–4 times, starting 3–4 days after ovulation; or 1000 IU of HCG given by intramuscular injection daily for 7–8 days, starting 3 days after ovulation.
(3) Clomiphene: Some patients have shown poor luteal function after ovulation induction with clomiphene. However, reports suggest that for naturally ovulating patients, especially when progesterone supplementation therapy is ineffective, clomiphene 50mg can be taken daily from the 3rd day of the menstrual cycle for 5 days to improve pregnancy rates.
(4) Bromocriptine: Patients with infertility due to poor luteal function, accompanied by elevated serum prolactin, can be treated with bromocriptine: 25mg taken 1–2 times a day.
Precautions:
1. Maintain a cheerful mood, avoid mental stress and emotional fluctuations. Some individuals may experience lower abdominal bloating, back pain, breast tenderness, mild diarrhea, fatigue, drowsiness, emotional instability, irritability, or depression during menstruation, all of which are normal and should not cause excessive anxiety.
2. Pay attention to hygiene to prevent infection. Keep the external genitalia clean. Abstinence from sexual intercourse during menstruation is strictly required. Keep warm and avoid cold exposure. Avoid overexertion. Those with heavy menstrual flow should avoid consuming brown sugar.
3. Underwear should be soft, cotton, breathable, and changed frequently. Washed underwear should be dried in the sun.
4. Avoid cold, sour, spicy, and other irritating foods. Drink plenty of water to maintain regular bowel movements. Those with blood heat should eat more fresh fruits and vegetables before menstruation and avoid stimulating foods like garlic, onions, leeks, and ginger. Those with poor blood qi should increase nutrition, such as milk, eggs, soy milk, pork liver, spinach, pork, chicken, and mutton, and avoid cold fruits and melons.