Patient's question:
What to do if a woman in her 30s experiences menopause?Doctor's answer:
I. Correcting the Overall Health ConditionFemale reproductive organs are a part of the whole body, so overall health affects the condition of the reproductive organs. Therefore, when treating amenorrhea, it is essential to first correct the patient's overall health condition.
2. Etiological Treatment
Identify and treat the organic diseases causing amenorrhea appropriately. For example, tuberculosis endometritis should be treated with antitubercular therapy. In cases of intrauterine adhesions, the uterine cavity should be dilated, and an intrauterine device should be placed to prevent re-adhesion. For pituitary or ovarian tumors, after a definitive diagnosis, treatment should be determined based on the tumor's location, size, and nature, with options including surgery, radiotherapy, chemotherapy, or other comprehensive measures.
3. Hormone Replacement Therapy
Hormone replacement therapy can be used for congenital ovarian dysgenesis, or when ovarian function is impaired or destroyed, leading to premature aging. Generally, artificial cyclic hormone therapy is applied. After hormone administration, menstrual-like cyclical withdrawal bleeding occurs. On one hand, this corrects the patient's physiological and psychological state, and on the other hand, it promotes a certain degree of development of the reproductive organs and secondary sexual characteristics.
(1) Low-Dose Estrogen Cyclic Therapy
The effect is to promote pituitary function, secrete luteinizing hormone, thereby increasing estrogen secretion by the ovaries and promoting ovulation.
(2) Estrogen-Progestogen Sequential Therapy
The effect is to inhibit the hypothalamic-pituitary axis, and after stopping the medication, menstruation may return, along with ovulation.
(3) Estrogen-Progestogen Combined Therapy
The effect is to inhibit pituitary gonadotropin, and after stopping the medication, there may be occasional rebound effects, leading to the return of menstruation and ovulation. Oral contraceptives are taken once daily, starting from the 5th day of the menstrual period, and continued for 22 days, followed by a 7-day break. The next cycle begins on the 5th day of the next menstrual period, for a total of 3–6 cycles.
(4) Inducing Ovulation
If the ovarian function has not, and the patient desires fertility, hormone or its analogs can be used to induce ovulation:
1. Hypothalamic-Pituitary Dysfunction
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, as well as the formation and development of the corpus luteum.
2. Hypogonadism with Normal Ovarian and Pituitary Response
Clomiphene citrate is used to promote the secretion of hypothalamic gonadotropin-releasing hormone, correcting its function and inducing ovulation.
3. Hypothalamic Dysfunction with Insufficient LHRH Secretion
Pulsatile micro-injection of LHRH can be used to induce ovulation.
4. Use of Bromocriptine
It is used to treat hyperprolactinemia-induced amenorrhea. Its effect is to inhibit prolactin by suppressing prolactin-releasing hormone. Initially, a low dose of 1.25 mg is taken twice or three times daily. If there is no significant response, the dose is gradually increased, with a maximum daily dose not exceeding 10 mg.