Patient's question:
Detailed medical condition and consultation purpose: Six years ago, while breastfeeding my child, milk accumulated in my breasts and caused inflammation. I was given anti-inflammatory injections, which resolved the issue. However, a few years later, my breasts would become swollen and painful before my period. Last year, I had a check-up at the hospital and found a lump, which was detected by infrared imaging with an index of 165. After taking medication for a month, the index dropped. Later, I was prescribed medication for half a year, and now I feel significantly better—my breasts are no longer as painful before my period. However, my endocrine disorder remains severe. Previously, it was also the same way, with my period always being delayed by about a week or 10 days. I have tried all the medications for regulating my endocrine system, but none have worked. IDoctor's answer:
Hello: For patients with anovulation due to dysfunction of the hypothalamic-pituitary-ovarian axis, ovulation induction can be achieved using medication:(1) Clomiphene: Starting from the 5th day of the menstrual cycle, oral clomiphene at a dose of 50–150 mg/day for 5 consecutive days may lead to ovulation 5–11 days after discontinuation. If estrogen levels are low, a small dose of estrogen (diethylstilbestrol 0.125–0.25 mg/day) can be administered first for 20 consecutive days. This should be repeated for 1–3 cycles to enhance the sensitivity of the hypothalamic-pituitary-ovarian system, followed by clomiphene for ovulation induction to improve efficacy. If cervical mucus is scant and viscous, diethylstilbestrol 0.125–0.25 mg/day should be added for 7 consecutive days after completing clomiphene treatment.
(2) Hormonal artificial cycle with estrogen and progestogen: For patients with menstrual irregularities but with a certain level of estrogen, a sequential regimen of estrogen and progestogen can be used for 3 months as artificial cycle therapy, which may lead to ovulation after drug discontinuation.
(3) Human Chorionic Gonadotropin (HCG): HCG has luteinizing hormone (LH)-like effects, and administration near the mature stage of follicular development can induce ovulation. ① Clomiphene combined with HCG: Clomiphene at a dose of 50–150 mg/day for 5 consecutive days, followed by intramuscular injection of HCG 5000–10000 IU between days 4–16 of the menstrual cycle or when serum estradiol ≥1000 pmol/L or follicular diameter reaches 2.0 cm on ultrasound. ② Clomiphene, HMG, and HCG combination: Each vial of HMG contains 75 IU of FSH and 75 IU of LH, promoting follicular growth and maturation. Clomiphene at a dose of 50–