Post-contraceptive amenorrhea syndrome

　　1. Causes of the disease

　　Long-term use of contraceptives causes the ovaries of women to be suppressed and become smaller, with small follicles and no corpus luteum, and the cortex often becomes hardening. This is quite similar to the ovarian shape of women in menopause. In the early stage of the menstrual cycle, contraceptives inhibit the secretion of follicle-stimulating hormone by acting on the hypothalamus and pituitary. In the middle stage, it inhibits luteinizing hormone and follicle-stimulating hormone and changes the release period of luteinizing hormone, thereby inhibiting ovulation. Most women can naturally resume normal menstruation after 2-3 months of amenorrhea after discontinuing the use of contraceptives. However, a small number of women still have this syndrome after the hypothalamus-pituitary-ovary axis function does not recover after discontinuation of the drug.

　　2. Pathogenesis

　　1. Patients with this condition have a smaller ovary, small and immature follicles, no corpus luteum, and the cortex is often hardening, similar to the ovary in menopause.

　　2. Oral contraceptives: The commonly used oral contraceptives are estrogen and progesterone combinations. The estrogen and progesterone doses of the Ⅰ and Ⅱ contraceptives used in China can inhibit the function of the hypothalamus-pituitary-ovary axis, suppress follicle development and ovulation. After periodic discontinuation, withdrawal bleeding of the uterus may occur. The second-generation low-dose contraceptives in the 1980s had lower estrogen content, resulting in insufficient endometrial proliferation in some patients, even with the addition of progesterone, which did not produce withdrawal bleeding. The third-generation products introduced in the 1980s used different doses of estrogen and progesterone in the monthly cycle, taking for 6 days, 5 days, and 10 days consecutively. In the middle 5 days, the estrogen dose was higher, and in the last 10 days, the progesterone dose was the highest, making the incidence of amenorrhea during the medication period less than 1%. Generally, the normal menstrual cycle returns within 3 months after discontinuation, so women who have been amenorrheic for 6 months after discontinuing oral contraceptives are called 'amenorrhea after oral contraceptives'. 95% to 98% of women who take oral contraceptives completely resume normal ovulation within one year after discontinuation. Women who still have amenorrhea after discontinuing oral contraceptives often have a history of irregular menstrual periods, long-term use of contraceptives, or the use of contraceptives with progesterone, such as implants, which can cause atrophy of the endometrium and the absence of withdrawal bleeding. This is due to the long-term suppression of the hypothalamus-pituitary axis by the drug, causing the body to remain in a low estrogen, high progesterone state. Women with amenorrhea after discontinuing contraceptives may also have galactorrhea, which may be related to the higher estrogen dose in the initial stage of oral contraceptives. At the same time, the suppression of the hypothalamus-releasing hormone of the gonadotropin-releasing hormone and the decrease of the prolactin inhibitory factor (dopamine) cause the pituitary prolactin cells to no longer suppress the secretion function, leading to an increase in blood prolactin and the appearance of galactorrhea. Another possibility is that there is a potential pituitary PRL microadenoma that has not produced clinical symptoms, so it has never been detected. After years of taking oral contraceptives, the pituitary prolactin microadenoma gradually grows, leading to excessive prolactin, so there is galactorrhea. Therefore, whether it is simple amenorrhea after oral contraceptives or accompanied by galactorrhea, FSH, LH, PRL, and E2 should be measured first to exclude pituitary prolactinoma, confirm the condition of low gonadotropin and low estrogen, and then treat according to the symptoms. Young women can induce follicle development with sequential estrogen and progesterone or clomiphene treatment, restoring ovulatory function. If the age has passed the menopausal period, only follow-up is needed.

　　Women who have taken contraceptives for a long time have their ovaries suppressed and become smaller, the follicles are small and without corpus luteum, and the cortex becomes more fibrotic. This is quite similar to the shape of the ovaries in perimenopausal women. In the early stage of the menstrual cycle, contraceptives inhibit the secretion of follicle-stimulating hormone by acting on the hypothalamus and pituitary. In the middle stage, they inhibit luteinizing hormone and follicle-stimulating hormone and change the release period of luteinizing hormone, thereby inhibiting ovulation.

　　The patient's ovaries become smaller, the follicles are small, immature, and without corpus luteum, the cortex becomes more fibrotic, similar to the ovaries during menopause, and cannot become pregnant.

　　1, Some patients with this syndrome have symptoms such as nausea, dizziness, headache, fatigue, loss of appetite, breast tenderness, hyperpigmentation, melasma, increased leukorrhea, and lower limb pain.

　　2, Patients who have stopped taking contraceptives for more than 3 months still have amenorrhea, or have sparse menstruation, obvious irregular menstrual cycle, galactorrhea, and are accompanied by infertility.

　　It occurs in women of childbearing age who take contraceptives improperly. The proportion of amenorrhea after stopping the drug is 0.8% to 1%, which is similar to the incidence of amenorrhea in the normal population. This disease seriously affects the daily life of patients, so it should be actively prevented.

　　The levels of estrogen and progesterone are both low and flat, and the levels of luteinizing hormone and follicle-stimulating hormone are at the lowest level. After injection of Gn-RH, neither of these promoting hormones shows a peak response, indicating that the hypothalamus and pituitary are in an inhibited state.

　　One, Post-contraceptive amenorrhea syndrome food therapy

　　1, Peach kernel and beef blood soup. 10-12 grams of peach kernel, 200 grams of fresh beef blood (coagulated), and a small amount of salt. Cut the beef blood into pieces, boil with peach kernel in an appropriate amount of water, and add a small amount of salt for seasoning when eating. It has the effects of breaking blood stasis, promoting blood circulation, and beautifying the skin. It is suitable for amenorrhea, blood dryness, constipation, and other symptoms.

　　2, Fungus and walnut sugar. 120 grams of black fungus, 120 grams of walnuts, 200 grams of brown sugar, and an appropriate amount of yellow wine. Grind the black fungus and walnuts into powder, mix with brown sugar, and seal in a porcelain jar. Take 30 grams, twice a day, until menstruation returns. It has the effects of nourishing the liver and kidney, benefiting Qi and blood, and nourishing the Chong and Ren meridians. It is suitable for amenorrhea due to uterine underdevelopment.

　　3, Black bean double red soup. 50-100 grams of black beans, 5 grams of safflower, and 30-50 grams of brown sugar. Place the first two ingredients in a steaming bowl, add an appropriate amount of water, and steam until the black beans are fully cooked. Remove the safflower and add the brown sugar, mix well. It has the effects of nourishing the liver and kidney, promoting blood circulation and menstruation, and beautifying the hair. It is suitable for amenorrhea with blood deficiency and Qi stagnation.

　　4, Pork and turtle meat. One turtle (Chinese softshell turtle), 500 grams of lean pork, and an appropriate amount of yellow wine. Kill the live turtle, remove the head, feet, and blood, wash it, and place it in a pot. Add the lean pork and an appropriate amount of water, bring to a boil with strong fire, and then simmer over low heat until tender. Eat in several servings, and it is necessary to eat several turtles to be effective. It nourishes Qi and blood, and strengthens the Chong and Ren meridians. It is suitable for amenorrhea due to insufficient Chong and Ren meridians (uterine underdevelopment) and Qi and blood deficiency.

　　5. Pigeon meat, scallion, and ginger porridge. 150 grams of pigeon meat, 20 grams of scallion and ginger paste, 50 grams of minced pork, 100 grams of glutinous rice, 1 gram of pepper powder, 10 grams of cooking wine, appropriate amounts of sesame oil, salt, and monosodium glutamate. Cut the pigeon meat clean of bones and刺 into pieces, put it in a bowl, add pork, scallion and ginger paste, cooking wine, and salt, mix and set aside. Rinse the glutinous rice clean, add 1000 milliliters of water to the pot, boil, and add the pigeon meat and others, cook into porridge, and finally add sesame oil, monosodium glutamate, and pepper powder. It has the effects of nourishing the kidneys and Qi, dispelling wind and detoxifying, harmonizing the blood, and pleasing the color. It is suitable for the use of amenorrhea due to blood deficiency.

　　6. Stewed pig's hoof and sunflower stalk. 250 grams of pork trotters, 10 grams of sunflower stalk. First, clean the pig's hoof, remove the dirt, put it in a pot, and simmer over low heat until tender, add the sunflower stalk, boil and simmer into a thick juice, remove the dregs, and drink the juice. Take 2-3 times a day, 20-30 milliliters each time. It has the effects of promoting blood circulation and Qi, and removing blood stasis. It is suitable for amenorrhea caused by blood stasis.

　　7. Cuttlefish, mushroom, and bamboo shoot porridge. 1 dried cuttlefish, 50 grams of soaked mushrooms and bamboo shoots, 100 grams of lean pork, 100 grams of glutinous rice, 1 gram of black pepper, 10 grams of cooking wine, appropriate amounts of salt and monosodium glutamate. Remove the bones of the dried cuttlefish, soak in warm water to swell, wash clean, and cut into strips; the pork, mushrooms, and bamboo shoots are also cut into strips for later use. Rinse the glutinous rice clean, cook in a pot, add the strips of meat, cuttlefish, mushrooms, bamboo shoots, and cooking wine, cook until tender, and finally add salt, monosodium glutamate, and black pepper. It has the effects of tonifying essence and Qi, regulating the menstrual cycle, constricting blood, and beautifying the skin. It is suitable for amenorrhea, increased leukorrhea, and pale complexion.

　　8. Coix Seed Decoction. 30 grams of Coix Seed and Coix Seed Root. Cut the Coix Seed and Coix Seed Root into sections and decoct in water, remove the dregs and drink the juice. Take it on an empty stomach in the morning and evening, for more than 10 doses. It has the effects of promoting diuresis and removing dampness, and guiding blood downward. It is suitable for amenorrhea caused by phlegm and dampness blocking the uterine channels.

　　9. Stir-fried cuttlefish with ginger slices. 50 grams of ginger, 250 grams of boneless cuttlefish. Cut the ginger into strips, wash the cuttlefish clean and slice it, stir-fry with oil, and serve as a side dish. It has the effects of nourishing blood and regulating the channels, and beautifying the skin. It has an auxiliary therapeutic effect on amenorrhea due to blood deficiency.

　　10. Stewed turtle shell with pigeon. 30 grams of turtle shell, 1 pigeon, a little rice wine. Crush the turtle shell and place it in the cleaned pigeon's belly, add an appropriate amount of water and a little rice wine, place it in a porcelain bowl and steam until cooked, season and eat. It has the effects of nourishing the kidneys and Qi, dispersing nodules and regulating the channels, and nourishing the skin and beautifying the face. It is suitable for amenorrhea caused by physical weakness.

　　11. Stewed pork trotters with Achyranthes Root. 15 grams of Achyranthes Root, 2 pork trotters, 80 milliliters of yellow wine. Clean the pork trotters and remove the hair. Cut into several pieces after cutting open both sides, and put them together with the Achyranthes Root in a large stew pot, add 500 milliliters of water, steam until the pork trotters are tender, remove the Achyranthes Root, and eat the remaining pork trotter meat and soup. It has the effects of promoting blood circulation and regulating the channels, and beautifying the skin. It is suitable for amenorrhea caused by Qi stagnation and blood stasis in women.

　　II. Dietary taboos or dietary precautions

　　1. Avoid: foods that are not beneficial to nutrition and blood essence

　　Such as garlic, radish, tea, white radish, pickled vegetables, pickled vegetables, winter melon, etc., excessive consumption can damage the generation of essence and blood, leading to amenorrhea due to a lack of source of menstrual blood. Therefore, these foods should be avoided.

　　2. Avoid: cold foods

　　Various cold drinks, cold dishes, cold fruits, cold aquatic products, and other foods can cause vasoconstriction after consumption, aggravating blood coagulation, leading to amenorrhea. Therefore, these foods should be avoided.

　　3. Avoid: Fatty and greasy foods

　　Such as egg yolk, duck yolk, pig brain, pork liver, pork kidney, lard, pork fat, pork intestines, pork heart, mutton, sheep liver, crucian carp, cuttlefish, chicken, turtle, crucian carp, grass carp, shrimp, hairtail, clams, crab, cream, and chocolate, etc. These foods contain high protein, cholesterol, and fat. Eating too much can easily cause excessive nutrition in the body, further increasing fat accumulation, aggravating obesity, blocking the meridians, and preventing the normal flow of menstrual blood. Therefore, they should be eaten less or avoided.

　　4. Avoid: Carrots

　　Carrots are rich in nutrition, but they have the function of causing amenorrhea and inhibiting ovulation. For women who want to conceive, eating too much is not easy to get pregnant, so they should be avoided.

　　Three, what to eat for post-contraceptive amenorrhea syndrome

　　1. For those with虚证 amenorrhea, more foods with nourishing effects should be eaten: mutton, chicken, lean pork, longan, walnuts, jujube, chestnut, lotus seed, Lycium barbarum, and Dioscorea opposita.

　　2. For those with实证 amenorrhea, the diet should be light and easy to digest, and more foods with the effect of activating blood and promoting the menstrual flow should be eaten, such as hawthorn, rapeseed, black beans, black fungus, cuttlefish, orange, and orange cake, etc.

　　Precautions before the treatment of post-contraceptive amenorrhea syndrome:

　　First, traditional Chinese medicine treatment:

　　1. Kidney Qi deficiency:Primary amenorrhea, or late menarche, with delayed menstrual flow, less quantity, pale and dark color, thin quality, and eventually leading to amenorrhea. There is dizziness, tinnitus, soreness in the loins and knees, frequent nocturia, scanty leukorrhea, dark complexion, pale tongue with thin, moist coating, deep and thin pulse, and weak pulse at the cubital and heel.

　　Treatment method: Tonify the kidney and enrich essence, and regulate the Chong and Ren meridians.

　　Prescription: Cuscuta chinensis, Lycium barbarum, Prepared Rehmannia, Rubus chrysosporus, Angelica Sinensis, He Shou Wu, Polygonatum odoratum, Angelica Sinensis, Schisandra chinensis, and each 15 grams, Semen Cuscutae, Epimedii, and Morinda officinalis each 10 grams.

　　Ready-made medicine: Shenrou Pill.

　　2. Liver and kidney deficiency:Abortion, miscarriage, long-term illness, or postpartum, with gradually decreasing menstrual quantity, delayed menstrual flow, and even amenorrhea. There is dizziness, blurred vision, soreness in the loins and knees, irritability, hot flashes, scanty leukorrhea, dryness in the genital area, and even emaciation, sallow complexion, insufficiently moisturized skin, hair loss, decreased libido, pale tongue with thin white or yellow coating, and a thin, forceless pulse.

　　Treatment method: Nourish the liver and kidney, and nourish blood to fill essence.

　　Prescription: Prepared Rehmannia, Dioscorea, Schisandra chinensis, Lycium barbarum, He Shou Wu, Angelica Sinensis, Poria, and each 15 grams, Fructus Corni 12 grams, Eucommia ulmoides, Cuscuta chinensis, and Morinda officinalis each 10 grams.

　　Ready-made medicine: Gynecological Jin Pill.

　　3. Qi and blood deficiency:The menstrual cycle gradually delays, with decreasing quantity, pale color, and thin quality, followed by cessation. There is fatigue, weakness, shortness of breath, and a lack of words. There is dizziness, blurred vision, palpitations, insomnia, thin and lackluster hair, insufficiently moisturized skin, pale tongue with thin white coating, and a thin, weak pulse.

　　Treatment method: Tonify Qi, nourish blood, and regulate the menstrual cycle.

　　Prescription: Astragalus, Prepared Astragalus, Atractylodes, Poria, Angelica Sinensis, White Peony, and Prepared Rehmannia each 15 grams, Polygala and Prepared Licorice each 10 grams, Tangerine Peel and Cinnamon each 6 grams.

　　Ready-made medicine: Babao Kunshun Pill, Wuji Bai Feng Pill.

　　4. Qi stagnation and blood stasis: The menstrual cycle is irregular, with decreasing quantity, eventually leading to amenorrhea. After a sudden outburst of anger, the menstrual flow may abruptly stop, accompanied by depression, pain in the chest, sides, breasts, and lower abdomen. The tongue may be dark with petechiae or spots, and the coating thin and white or yellow. The pulse is wiry and涩.

　　Treatment method: Regulating qi, promoting blood circulation, removing blood stasis and opening the meridians.

　　Herbal medicine: Angelica sinensis, Paeonia lactiflora, Cynanchum wilfordii, Curcuma wenyujin, Rehmannia glutinosa each 15 grams, Prunus persica 12 grams, Carthamus tinctorius, Fructus Aurantii, Platycodon grandiflorus, Ligusticum chuanxiong, Licorice each 10 grams.

　　Traditional Chinese medicine: Xuefu Zhuyu Wan.

　　5, Phlegm dampness blockage:The menstrual period is delayed, the amount of menstrual blood gradually decreases and eventually stops, fatigue, gradual obesity, chest and epigastric fullness, decreased appetite, abundant phlegm, abundant leukorrhea, pale, plump tongue, white greasy coating, slippery pulse.

　　Treatment method: Drying dampness and phlegm, promoting blood circulation and opening the meridians.

　　Herbal medicine: Poria cocos, Atractylodes macrocephala, Angelica sinensis each 15 grams, Pinellia ternata, Citrus reticulata, Licorice, Cyperus rotundus, Acorus tatarinowii, Fructus Aurantii, Rhizoma Corydalis, Ligusticum chuanxiong, each 10 grams, ginger 3 slices.

　　Traditional Chinese medicine: Erchen Wan.

　　Second, Recipes

　　1,Recipe One:

　　Prescription: Angelica sinensis, Bupleurum chinense, Paeonia lactiflora, Salvia miltiorrhiza, Atractylodes macrocephala, Prunus persica, Poria cocos, Cistanche deserticola each 15 grams, Aconitum carmichaelii each 10 grams.

　　Usage: Decocted in water, take one dose a day, take twice a day.

　　Efficacy: Taking 6-40 doses of medicine, the effective rate reaches 96.6%, and the cure rate is 90%

　　2,Recipe Two:

　　Prescription: Angelica sinensis, Bupleurum chinense, Prunus mume each 15 grams, wheat 60 grams, jujube 20, licorice 10 grams.

　　Usage: Take one dose a day, decocted in water, take twice a day, one month as one course.

　　Efficacy: Taking 2-3 courses of treatment consecutively, the cure rate reaches 100%. Breakline of traditional Chinese medicine for post-abortion amenorrhea syndrome Western medicine treatment method

　　Third, Western Medicine Treatment:

　　When amenorrhea lasts for more than 6 months, treatment should be given. The principle of treatment is to induce ovulation, which is usually achieved by using clomiphene citrate, which is effective for the majority of cases and can restore ovulation. If clomiphene citrate alone is ineffective, clomiphene citrate-hCG or prednisone-clomiphene therapy can be used, which can achieve satisfactory results. Bromocriptine can be given to those with galactorrhea and amenorrhea. If the above treatments are ineffective, the therapy with human chorionic gonadotropin can be tried, but attention should be paid to avoid the occurrence of excessive stimulation syndrome. This syndrome generally advocates a progesterone test before treatment to observe whether there is withdrawal bleeding, and in addition, it is necessary to perform adrenal cortical function tests, thyroid function tests, Gn-RH stimulation tests, and determine the levels of follicle-stimulating hormone, luteinizing hormone, and estrogen in the blood to master the condition and treatment response.