Ovulatory dysfunction

　　There are many causes of ovulatory dysfunction, such as endocrine disorder, ovarian lesions, and systemic diseases.

　　One, endocrine disorder

　　Disorder of hypothalamus-pituitary-ovary function can cause anovulatory menstruation, menstrual irregularity, amenorrhea, and other conditions leading to ovulatory dysfunction.

　　Two, ovarian lesions

　　Ovarian lesions such as congenital incomplete ovarian development, polycystic ovary syndrome, early ovarian failure, functional ovarian tumors, and ovarian endometrioma can also lead to ovulatory dysfunction.

　　Three, systemic diseases

　　Severe malnutrition, hyperthyroidism, and other conditions can affect ovarian function and lead to ovulatory dysfunction.

　　Four, other reasons

　　1. Weight: Both obesity and excessive thinness can interfere with the coordination of the endocrine system, and controlling weight is helpful for preventing and treating ovulatory dysfunction.

　　2. Diet: Beverages rich in caffeine, such as coffee, strong tea, cola, etc., although there is no consistent conclusion on their impact on infertility, it is generally recommended not to consume them in excessive amounts. In addition, smoking and drinking, regardless of gender, will affect fertility, so they should be avoided when planning to have children, and high-calorie foods should be avoided in diet. All these can lead to ovulatory dysfunction.

　　3. Changes in menstrual cycle: The normal cycle is about 25-35 days, and there will be a little vaginal discharge when approaching the ovulation period. If the menstrual period is always delayed, even once every few months, or always not on time, it is advisable to seek medical attention early. Otherwise, it may cause ovulatory dysfunction.

　　Ovulatory dysfunction can be accompanied by diseases such as infertility, disorder of sex hormone metabolism, and menstrual irregularity.

　　1. Infertility

　　Not ovulating in women means that there is no combination of eggs and sperm, and then fertilization is completed. Therefore, ovulatory dysfunction can be the main cause of female infertility.

　　2. Endocrine disorder

　　If a woman does not ovulate for a long time, it will lead to the disorder of sex hormone metabolism, and the excessive proliferation of the uterine endometrium, causing cyclical antagonism of gestagens, which is easy to lead to the occurrence of endometrial cancer.

　　3. Menstrual irregularity

　　Ovulatory dysfunction can bring a series of menstrual problems for women, such as menstrual irregularity, amenorrhea and other problems, and can also lead to symptoms such as hirsutism and obesity.

　　4. Miscarriage

　　Due to insufficient corpus luteum function, it also affects the preparation and maturity of the 'bed' of the endometrium before the fertilized egg implants, which is a cause of infertility and early miscarriage, especially repeated spontaneous miscarriage. This is common before menarche and before menopause, and can also occur during the reproductive period.

　　5. Underdeveloped secondary sexual characteristics

　　The underdevelopment of secondary sexual characteristics can lead to changes in women's body shape and posture, with poor development of hair and breasts.

　　The sensations during the ovulatory period vary from person to person. The presence of the above sensations does not necessarily mean ovulation. However, usually, people who feel lower back pain, lower abdominal pain, or dysmenorrhea when the menstrual period begins are more likely to have ovulation, while those without ovulation often do not have dysmenorrhea.

　　1. Changes in libido

　　Some people may show increased libido, which is easy to cause sexual excitement, while others may show decreased libido.

　　2. Lower back pain and abdominal pain

　　When ovulating, some people may feel lower back pain and mild lower abdominal pain, but the presence of these sensations does not necessarily mean ovulation because many diseases can also cause lower back pain and abdominal pain.

　　3. Slight vaginal bleeding

　　A few patients may have slight vaginal bleeding between two menstrual periods, less than the amount of menstruation, which is called 'ovulatory bleeding' and should be treated.

　　4. Increased leukorrhea

　　Most people will have a significant increase in leukorrhea during the ovulatory period, which becomes as transparent as egg white and can be stretched into a thread-like shape. If there is no discomfort such as vaginal itching or stickiness, there is no need to be alarmed.

　　5. Others

　　Some patients may experience breast tenderness, irritability, depression, and so on.

　　Ovulatory disorders can not only cause inability to become pregnant normally but can also lead to symptoms such as menstrual irregularity, amenorrhea, hirsutism, obesity, and others. In addition, if there is no ovulation for a long time, the metabolism of sex hormones is disordered, and the endometrium overgrows without the opposing effect of cyclic progesterone, which is prone to endometrial cancer and breast cancer. Therefore, in daily life, we should pay attention to the prevention of ovulatory disorders.

　　1. Abnormal menstrual cycle

　　Women should pay close attention to their menstrual cycle, and if it shortens or delays, it should be taken seriously. The normal ovulatory cycle for women is 25-35 days. When approaching the ovulatory period, there will be a small amount of secretion in the vagina. If a woman's menstrual cycle often delays, some even once every few months, or several times a month, she should go to the hospital for a check-up.

　　2. Control weight

　　Weight loss is a lifelong career for many women, but they don't realize that in addition to a slim figure, controlling weight is also beneficial to women's health. Of course, controlling weight includes gaining and losing weight, neither too fat nor too thin, because both obesity and thinness can affect the normal operation of the endocrine system, which controls the menstrual cycle, that is, women's ovulation. Therefore, women should not sacrifice health for beauty.

　　3. Quit smoking and drinking

　　In fact, whether male or female, smoking and drinking are harmful to physical health. Of course, for women, this is particularly important because smoking and drinking can affect women's endocrine system, affecting normal ovulation in women. If ovulation is not normal, it will affect women's fertility. If ultimately, women cannot become pregnant normally, this is a result that none of us wants to see.

　　4. Pay attention to diet

　　On the diet, women should pay special attention to drinking less caffeine-rich beverages, as caffeine has a certain effect on women's endocrine, although this has not been reached a consensus. However, for the health of the body, it is still better to drink less. Similarly, women should eat less spicy, fried, and other foods, develop good eating habits, which are beneficial for women's ovulation.

　　Ovulatory disorders inevitably lead to infertility. For infertility due to ovulatory disorders, timely treatment should be provided, and before treatment, it is necessary to check for ovulatory disorders:

　　1. Endometrial examination

　　Under the influence of孕激素 and ovarian estrogen, the endometrium of women changes significantly during the middle of the menstrual cycle. The first 5-7 days of the menstrual period are the late secretory phase changes, and the endometrial examination within 12 hours of menstruation or during menstruation indicates an increased phase change, indicating that the patient has not ovulated.

　　2. Basal body temperature measurement

　　The body temperature usually rises within 2-3 days after ovulation, and in a few patients, the temperature rises on the day of ovulation. The BBT method for monitoring ovulation can be used for measurement, which is simple and economical, but has a large error.

　　3. Cervical mucus examination

　　Even in the second half of the menstrual period, fern-like plant-like substances can still be detected in women, indicating no ovulatory phenomenon.

　　4. Ultrasound follicle examination

　　Ultrasound can distinguish follicles of 2-4mm in size. Starting from the 9th day of the menstrual cycle, observe once every 1-3 days on average, and observe continuously. In this way, it can be seen that the follicles are gradually growing and moving closer to the ovary.

　　Patients with ovulatory disorders should pay attention to rest and avoid spicy and stimulating foods during treatment. Add foods such as scallions, beans, pumpkins, garlic, ginger, chestnuts, oranges to the diet; in addition, vinegar, soy sauce, vegetable oils, chili, pepper, and other spices, as well as beef and chicken broths. In addition, Job's tears can promote ovulation, while Gardenia jasminoides and Xiaoyao pills can also be used, as can Danggui Shaoyao Powder.

　　The treatment plan for ovulatory disorders should be considered comprehensively based on factors such as the patient's age, disease course, hemoglobin level, and follow-up conditions. The general principle is that during the bleeding stage, hemostasis and correction of anemia should be rapid and effective. After hemostasis, it is necessary to identify the cause as clearly as possible and carry out targeted treatment, choose an appropriate plan to control the menstrual cycle or induce ovulation, and prevent recurrence and long-term complications.

　　1. Dysfunctional uterine bleeding without ovulation

　　Drug treatment is the first-line treatment method. For patients in the adolescent and reproductive age, the main treatment is hemostasis, adjustment of the menstrual cycle, and promotion of ovulation. For patients in the perimenopausal period, the treatment principle is hemostasis, adjustment of the menstrual cycle, reduction of menstrual volume, and prevention of endometrial lesions.

　　1. Hemostasis

　　(1) Combination therapy of estrogen and progestin: When the amount of bleeding is not much, oral low-dose birth control pills can be taken on the first day of the menstrual period for a total of 21 days, then stop for 7 days, making a cycle of 28 days; for acute massive bleeding, when the condition is stable, a combined oral contraceptive can be used, and the dose can be reduced by 1/3 every 3 days after hemostasis, until a maintenance dose is reached, and the treatment is stopped after 21 days.

　　(2) Estrogen: Suitable for acute massive bleeding in adolescence, reduce the dose by 1/3 every 3 days to the maintenance dose after stopping bleeding, or can use estradiol benzoate, start to reduce the dose 3 days after stopping bleeding, usually reduce the dose by 1/3 every 3 days, stop medication on the 21st day from the date of stopping bleeding.

　　(3) Progesterone: Intramuscular injection of progesterone daily, for 5 days; dienogest, for 10 days; An-gong Huang-ti-kong: for 10 days.

　　2. Adjust menstrual cycle

　　(1) Artificial cycle: Kuei-jia-le, once a night starting from the 5th day of bleeding, for 21 consecutive days, until the 11th day of medication, intramuscular injection of progesterone injection every day, both drugs are used up at the same time, stop medication for 3-7 days bleeding, repeat medication on the 5th day of bleeding, use in combination for 3 cycles.

　　(2) Combination of estrogen and progesterone: Start with combined oral contraceptives from the 5th day of the withdrawal bleeding of the stopping bleeding cycle, for 21 consecutive days, followed by withdrawal bleeding. Three consecutive cycles make up a course.

　　(3) The second half of the cycle therapy: Take medroxyprogesterone acetate from the 15th to 16th day after stopping bleeding, for 10 consecutive days. Three cycles make up a course.

　　3. Promote ovulation

　　(1) Clomiphene: Starting from the 5th day of bleeding, for 5 consecutive days, if ovulation fails, the medication can be repeated.

　　(2) Chorionic gonadotropin: Used in combination with other ovulation-inducing drugs, intramuscular injection when the follicle development is close to maturity as detected by B-ultrasound, to induce ovulation.

　　Two. Amenorrhea caused by ovulatory disorders

　　1. Artificial cycle therapy, the method is the same as before.

　　2. Treatment with pure progesterone, the method is the same as the second half of the cycle therapy.

　　Three. Infertility caused by ovulatory disorders

　　1. WHOI-type ovulatory disorders: Lesions in the hypothalamus, pulsatile administration of GnRH for ovulation induction is recommended; lesions in the pituitary: ovulation induction with gonadotropins containing LH is recommended.

　　2. WHOII-type ovulatory disorders: Clomiphene citrate for ovulation induction, the method is the same as before; metformin orally; ovarian puncture.

　　3. Ovulatory disorders caused by other reasons: Special treatment of the underlying disease, such as hyperprolactinemia, thyroid disease, adrenal disease, still without ovulation, can be induced to ovulate with ovulation-inducing drugs.