Author: Yu Qi (Peking Union Medical College Hospital)
When you go to the hospital with light menstrual flow, the doctor will carry out corresponding examinations according to the patient’s condition.
It should be noted that women who are sexually active and suddenly change their menstrual flow should first rule out pregnancy-related problems.
1. Suspected problems with menstrual blood drainage channels
Learn about recent abortions or uterine cavity operations by asking the medical history. Ultrasound to check for post-menstrual effusion.
・ If cervical adhesions are considered: You can perform endocervical exploration 3 to 7 days after menstruation is clean.
・ If considering intrauterine adhesions: menstruation is clean for 3 to 7 days, avoid sex, and perform hysteroscopy.
If the diagnosis is clear, hysteroscopic surgery can be used to separate the adhesions, an intrauterine device is placed during the operation, and estrogen is applied for 3 months after the operation to repair the endometrium. A hysteroscopy was performed 3 months later to reassess the recovery of the endometrium.
Image source: Zhanku Hailuo
2. Suspected endometrial damage
This test is only required for those with fertility requirements.
Pelvic ultrasonography can look at endometrial thickness and see if there is a thin lining of the uterus. Especially after abortion or uterine cavity operation, the menstrual flow is reduced.
The best time for ultrasound to check endometrial thickness is when the follicles are mature (18-22 mm in average diameter) and not expelled (at the doctor’s discretion).
If the endometrium is less than 8 mm, hysteroscopy can be performed first. If intrauterine adhesions are found, doctors usually first separate the adhesions, place an intrauterine device during the operation, and apply high-dose female Hormones to promote endometrial growth for up to 3 months.
3 months later, hysteroscopy was performed to reassess the endometrium.
Three, suspected infectious tuberculosis
For patients with fertility requirements, no specific complaints, primary infertility, decreased menstrual flow, the possibility of reproductive tract tuberculosis should be considered.
Related tests for genital tract tuberculosis include: tuberculin test, hysterosalpingography, hysteroscopy, endometrial biopsy, etc.
If TB is diagnosed, and if it is active, anti-TB treatment should be given.
But unfortunately, the base layer of the intima is destroyed by tuberculosis, and there is currently no effective method to restore the growth of the intima, and the intima does not respond to estrogen, no matter how much estrogen is applied Nor can it change the resulting menstrual problems.
Image source: Zhanku Hailuo
4. Suspected ovarian hypofunction
For women with irregular menstruation, basic hormone testing should be performed when menstrual blood is seen for 2 to 4 days. If there is no menstrual cycle, blood can be drawn at any time. Through the follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) examination, to understand ovarian function.
This test is even more important for women with fertility requirements. If there is ovarian hypofunction, aggressive intervention at a very early stage may increase the chance of conception.
For patients with reduced menstrual flow due to ovarian dysfunction, it is impossible to increase menstrual flow by changing ovarian function.
The current advocacy of “ovarian maintenance” has no scientific basis at all. But we can apply hormone replacement to supplement estrogen, so that the endometrium proliferates and menstrual flow increases.
V. Suspected endocrine disease sex hormone test
After the prolactin (PRL) test is usually performed, if the result exceeds 3 times the normal value and there are clinical symptoms, the sellar area MRI should be checked with plain scan and enhanced to check for space-occupying Lesion-induced hyperprolactinemia.
In the case of hyperprolactinemia, the patient is prescribed bromocriptine to reduce prolactin to restore ovulation and menstruation.
Many female patients are concerned: Under what circumstances is prolactin more accurate? The doctor’s advice: in the morning on an empty stomach or eating pure carbohydrates (such as drinking only a bowl of rice porridge or steamed bread), be careful not to be too full or too hungry, arrive at the hospital at 9-11 am, first wake up and sit for half an hour, and then take blood. Minimize all kinds of stress or strenuous exercise.
In the measurement results, T (testosterone) is the value of total testosterone, which cannot truly reflect the level of free testosterone that works in the body.
There is often a need to pay more attention to signs of hyperandrogenism, such as lip whiskers, facial acne, and hair around the mammary below the umbilicus.
These clinical signs and findings are more meaningful than laboratory measurements of testosterone T for the diagnosis of hyperandrogenism.
If polycystic ovary syndrome is diagnosed, Diane-35 (ethinyl estradiol cyproterone tablets, which can be used for oral contraception) can be used to reduce androgen in the body while the patient loses weight level, restore regular menstruation.
Image source: Zhanku Hailuo
thyroid function test:
Evaluate for decreased menstrual flow due to the presence of thyroid disease. If you are hypothyroid, you need to add thyroxine tablets.
Combined short-acting oral contraceptives cause:
Clinical compound short-acting oral contraceptives are commonly used in the treatment of diseases that cause menorrhagia.
Compound short-acting oral contraceptives can inhibit the proliferation of the endometrium, change the asynchrony between the endometrium and embryonic development, and interfere with the implantation of fertilized eggs. This leads to decreased menstrual flow. Menstrual flow will return to normal after stopping the drug.
The doctor would like to say to you about the low menstrual flow:
Patients with reduced menstrual flow, if they have fertility requirements, need to identify the cause and treat according to the cause. Among them, patients with endometrial tuberculosis and ovarian dysfunction are difficult to achieve fertility.
For infertile patients, no uterine/cervical adhesions, no endocrine disease, normal ovarian function, and reduced menstrual flow is not a big problem.
Many women believe that menstrual blood can help expel toxins. They worry that the reduction of menstrual flow will make the toxin excretion unsmooth, affect health, and cause facial pigmentation and poor complexion. In fact, this is all scientifically unfounded.
Mstruation is just a phenomenon, and 5 ml is defined as normal menstrual flow internationally, so in most cases there is no need to worry too much. Women with endometrial tuberculosis and no fertility requirements do not need treatment for oligomenorrhea or amenorrhea as long as the ovaries are functioning normally.
For patients with ovarian failure, any treatment that attempts to correct ovarian function is useless, that is to say, we know that ovarian function is declining. Still powerless to stop it, it can only be allowed to decline.
But when the ovaries fail completely and women lose the protection of estrogen, we can use hormone replacement therapy to replenish estrogen in the body to achieve regular menstruation.
Co-author: Lin Lin, Attending Physician, Department of Obstetrics and Gynecology, Guangxi Maternal and Child Health Hospital
*The content of this article is for the popularization of health knowledge. It cannot be used as a specific diagnosis and treatment recommendation, nor can it replace the face-to-face consultation of a licensed physician. It is for reference only.
*The copyright of this article belongs to Tencent Medical Dictionary. Unauthorized reprinting by media is prohibited. Illegal reprinting will be investigated for legal responsibility according to law. Individuals are welcome to forward to the circle of friends.