Patient's question:
What to do if a woman in her 30s experiences menopause?Doctor's answer:
Okay, here is the English translation of the provided text, following your instructions:I. Correction of General Health Status
Female reproductive organs are a part of the whole body; therefore, general health affects the condition of the reproductive organs. Thus, treatment for amenorrhea should first correct the patient's general health status.
2. Etiological Treatment
Identify and treat the organic diseases causing amenorrhea appropriately. For example, treat tubal endometritis with anti-tuberculosis therapy. In patients with intrauterine adhesions, the uterine cavity should be dilated and an intrauterine device (IUD) placed to prevent recurrence. For pituitary or ovarian tumors, after definitive diagnosis, the treatment plan (surgery, radiotherapy, chemotherapy, or other comprehensive measures) is determined based on the tumor's location, size, and nature.
3. Hormone Replacement Therapy
Hormone replacement therapy can be used for congenital ovarian dysgenesis, or damage to the ovaries leading to premature failure. Generally, artificial cycle hormone therapy is applied. After starting hormone therapy, menstrual-like cyclical withdrawal bleeding occurs. This, on one hand, corrects the patient's physiological and psychological state, and on the other hand, promotes a certain degree of development of the reproductive organs and secondary sexual characteristics.
(1) Low-dose estrogen cycle therapy
Its effect is to promote pituitary function, secrete luteinizing hormone (LH), thereby increasing estrogen secretion by the ovaries and promoting ovulation.
(2) Estrogen-progestogen sequential therapy
Its effect is to suppress the hypothalamic-pituitary axis. After stopping the medication, menstruation may return and ovulation may occur.
(3) Estrogen-progestogen combined therapy
Its effect is to suppress pituitary gonadotropins. After stopping the medication, there may be an occasional rebound effect, causing menstruation to return and ovulation to occur. Oral contraceptives are taken once daily starting from the 5th day of the menstrual period, continuously for 22 days, then a break. The next course starts on the 5th day of the next menstrual period. This is repeated for 3 to 6 cycles.
(4) Induction of Ovulation
If the ovarian function is not exhausted and the patient desires fertility, ovulation can be induced using hormones or their analogs: 1. Hypogonadism: Follicle-stimulating hormone (hMG), extracted from the urine of postmenopausal women, is used to promote follicular development and estrogen secretion. Combined use of human chorionic gonadotropin (hCG), which is similar to pituitary luteinizing hormone, can promote follicular maturation leading to ovulation and the formation and development of the corpus luteum. 2. Hypogonadism with normal ovarian and pituitary response, but hypothalamic dysfunction or disharmony: Clomiphene citrate is used to promote the secretion of hypothalamic gonadotropin-releasing hormone (GnRH) to correct its function and induce ovulation. 3. Hypothalamic dysfunction leading to insufficient LHRH secretion: Pulsatile micro-injection of LHRH can be used to induce ovulation. 4. Bromocriptine: Used to treat hyperprolactinemia-related amenorrhea. Its effect is to inhibit prolactin by suppressing prolactin-releasing hormone (PRLRH). The initial dose is 1.25 mg, taken 2-3 times daily. If there is no significant response, the dose is gradually increased. The maximum daily dose should not exceed 10 mg.