Patient's question:
I had sexual activity and then felt that my menstrual cycle was irregular. Once, it even stopped for 40 days, and I thought I might be pregnant. But it turned out not to be. After I took Motherwort herbal preparation, a few days later my period came, 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 would always finish in 3 days. I also felt like I might have some inflammation and noticed some itching down there. So, I bought some anti-inflammatory medicine myself and took it, and it got better. What I’m worried about is whether it will continue like this—if every time I have my period, it’s like this, it would be very troublesome. Other: Additionally, I’ve also felt some pain in my breasts recently. Generally, I only feel this kind of pain during my menstrual period.Doctor's answer:
Hello, your menstrual period is longer, and it is recommended to check the six hormones, which may be related to luteal function insufficiency.Clinical manifestations of luteal function insufficiency: 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 function insufficiency, basal body temperature should be measured. If the luteal phase temperature is shorter than 12 days, or the temperature rise is slow, the decline is early, and the rise amplitude is less than 0.5°C, or the luteal phase temperature fluctuates significantly, these are all signs of luteal function insufficiency. 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 function insufficiency 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. Regardless of the cause, if low progesterone levels are found in the mid-luteal phase, poor secretion is observed in endometrial biopsy, or luteal function insufficiency is confirmed clinically, this method can be used. 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 themselves, 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 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 medication time for progesterone supplementation therapy to treat infertility is generally recommended 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, some scholars suggest stopping it on the 14th day after ovulation to prevent pseudopregnancy. Others recommend continuing medication until menstruation begins. 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. As for the use of synthetic progestins, whether by injection or oral administration, it 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 lifespan of the corpus luteum. 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 consecutive days, starting 3 days after ovulation.
(3) Clomiphene: The use of clomiphene to induce ovulation has been found to result in poor luteal function in some patients. 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 (i.e., starting on day 3 of the menstrual cycle) for 5 consecutive days, which can improve pregnancy rates.
(4) Bromocriptine: Patients with infertility due to poor luteal function who also have elevated serum prolactin levels can be treated with bromocriptine: 25mg taken 1–2 times a day.
Precautions:
1. Maintain a happy mood, avoid mental stress and emotional fluctuations. Some individuals may experience lower abdominal distension, lower 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. Maintain cleanliness of the external genitalia. Abstinence from sexual intercourse during menstruation is strictly prohibited. Keep warm and avoid cold exposure. Avoid overexertion. Those with heavy menstrual flow should avoid consuming brown sugar.
3. Underwear should be soft, cotton, and well-ventilated. Wash and change it frequently, and dry the underwear 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 circulation should increase nutrition, such as milk, eggs, soy milk, pork liver, spinach, pork, chicken, and mutton, and avoid cold fruits and vegetables.