Patient's question:
Hello! I am 34 years old and have one child. Due to several uterine scrapings in the early years of my marriage, my originally normal menstruation became infrequent, lasting only two days each month. This condition persisted for about seven or eight years, and now it has worsened. I have also taken many traditional Chinese herbal medicines and a month's course of ethinyl estradiol tablets, but they have not been effective. This month, my menstruation lasted only one day. Following medical advice, I had blood tests on the fifth day of my period. The results are as follows: Follicle-stimulating hormone (FSH): 11.34 Estradiol: 16.0 Testosterone: 27.77 Progesterone: 1.1 Luteinizing hormone (LH): 5.7 Prolactin: 6.68 The doctor said it is very serious, and hormones cannot be used long-term.Doctor's answer:
Hello: Based on your condition, it should be multiple miscarriages that have caused premature ovarian failure! In addition to amenorrhea, only a small number of women with premature ovarian failure experience symptoms similar to menopausal syndrome. However, young women who have been in a long-term low-estrogen state may develop uterine atrophy, reduced vaginal secretions, dyspareunia, and even osteoporosis, so estrogen supplementation should be administered promptly. Currently, it is believed that premature ovarian failure is not necessarily irreversible, especially for patients who wish to conceive, active treatment should still be pursued.(1) Artificial cycle: Periodic supplementation with estrogen and progesterone can prevent the atrophy of reproductive organ epithelium and calcium loss, and can also protect the cardiovascular system and prevent lipid metabolism changes. Estrogen can be started at any time, such as ethinyl estradiol 0.5–1 mg, once daily, for 22 consecutive days. Progesterone should be supplemented starting on the 11th day of medication, such as oral medroxyprogesterone acetate (MPA, also known as dydrogesterone) 8–10 mg, once daily, for 10 days. If progesterone injections are used, they should be started on the 16th day of estrogen intake, with a daily intramuscular injection of 10 mg, for 5 consecutive injections. If ethinyl estradiol 5 μg is taken, it should be taken once daily, for 20–22 days, followed by progesterone.
(2) Inducing follicular development: After a stage of artificial cycle treatment, a small dose of estrogen can be used alone, such as ethinyl estradiol 0.5 mg or 0.25 mg (ethinyl estradiol 12.5 μg), once daily, for 3 weeks, followed by a 1-week break. Regardless of whether withdrawal bleeding occurs, the second cycle of treatment should be started, with 3 cycles constituting one course of therapy. After the estrogen level slightly increases and FSH and LH are suppressed, HMG can be appropriately used to stimulate follicular development, even ovulation.
(3) Immunosuppressants: Cortisol therapy can be used for patients with adrenal insufficiency.
(4) Traditional Chinese medicine (TCM) treatment or integrated Chinese and Western medicine treatment: Commonly used herbs that nourish yin, reduce fire, tonify the kidneys, and invigorate blood circulation are combined with estrogen to gradually restore ovarian function.