How can I regulate my menstruation after menopause? What are the symptoms before menopause?

Amenorrhea is a common symptom in gynecological diseases and can be caused by a variety of different reasons. Amenorrhea is usually divided into primary and secondary. Primary amenorrhea refers to the absence of menstruation after the age of 18; secondary amenorrhea refers to the absence of menstruation for more than 6 months after menarche and at any time before normal menopause (except pregnancy or lactation). This distinction is largely artificial because the basic factors causing primary and secondary amenorrhea may sometimes be the same.

1. Clinical manifestations of physiological amenorrhea

(1) Prepubertal amenorrhea: Dehydroepiandrosterone (DHEA) and its sulfate can be detected in the urine of girls aged 6 to 9 years old. The level increases rapidly from the age of 10. This is a manifestation of the initial adrenal function. The androgens from the adrenal glands promote the appearance of pubic hair and axillary hair, and the body grows rapidly. Because the hypothalamus-pituitary-ovarian axis has yet to be further developed, the estrogen level is still low, the endometrium proliferates poorly, and it does not cause bleeding, so the menstruation is delayed. The absence of menstruation in this period before menarche is a physiological phenomenon. Some girls still have menstruation every few months for a year or so after menarche, and it is normal to have anovulatory menstruation.

(2) Lactational amenorrhea: If a breastfeeding woman stops breastfeeding at any time, her menstruation will usually resume 2 months after weaning.

(3) Menopausal transition and postmenopausal amenorrhea: During the menopausal transition, uterine bleeding may occur every few months. After menopause, the reproductive organs gradually atrophy and the uterus also shrinks.

2. Clinical manifestations of pathological amenorrhea

(1) Uterine amenorrhea and cryptomenorrhea:

① Imperforate hymen: Clinical symptoms gradually appear. Initially, you can feel periodic lower abdominal distension and pain, which gradually worsens. The hematoma compresses the urethra and rectum, which can cause urination and defecation difficulties, suprapubic spasmodic pain, anal distension, frequent urination, urgency, urination pain, and even drip-like urination. When a large amount of blood accumulates in the uterine cavity, it can cause ureteral displacement, distortion, hydronephrosis, and even hydronephrosis. When menstrual blood flows back into the pelvic cavity, it can stimulate the peritoneum and produce severe abdominal pain. During abdominal examination, A tender mass can be felt with deep tenderness. A few patients may have mild muscle tension and rebound tenderness. Gynecological examination reveals that the hymen is thinning and bulging, with no opening and a purple-blue surface. Rectal examination may reveal vaginal hematoma, enlarged and tender uterus, and sausage-like masses on both adnexa that are tender. Patients with a long course of disease may have irregular thickening and varying numbers of tender nodules. B-ultrasound or CT examinations may reveal a barrel-shaped cystic-solid mass in the vagina and fluid accumulation in the uterine cavity and fallopian tubes.

② Congenital absence of vagina: This disease is often caused by the absence of menstruation during adolescence, or the occurrence of cyclical lower abdominal pain, or difficulty in sexual intercourse after marriage, or infertility. During the examination, it is found that the breasts, secondary sexual characteristics and external genitalia are normally developed, and the ovarian function is normal; the basal body temperature (BBT) is biphasic, and the blood reproductive hormone measurement shows cyclical changes in women of childbearing age. If accompanied by an absent uterus or a rudimentary uterus, there may be no symptoms; if there is a functional endometrium in the uterus, there may be progressive and aggravated cyclical lower abdominal pain due to blood in the uterine cavity. During gynecological examination, it can be found that the vulva has no vaginal opening. If the patient is treated for a long time after marriage, a shallow pit formed by sexual intercourse can be found in the vestibule area. A cord-like trace of the uterus can be touched in the pelvic cavity of most patients. If the patient has a functional endometrium and is young, a small uterus can be found during the examination, or a normal or enlarged painful uterus can be touched, and sometimes a sausage-like thickened fallopian tube can be touched. B-ultrasound, CT and other imaging examinations can confirm the above findings and can also reveal urinary system malformations.

③ Transverse vaginal septum: Incomplete transverse septum does not cause amenorrhea because menstrual blood can flow out through small holes. Complete transverse septum causes menstrual blood discharge obstruction, resulting in primary amenorrhea and cyclical lower abdominal pain.

In complete vagina, patients with upper transverse septum may be found to have a lower vagina of certain length and width during gynecological examination, with a closed top and a diaphragm that feels fluctuating. The vagina above it is dilated and seems to have a cystic feeling. The lower transverse vaginal septum is sometimes difficult to distinguish from vaginal atresia. A careful gynecological examination combined with puncture of the posterior septum is an effective identification method.

④ Vaginal atresia: Clinical manifestations include primary amenorrhea, cyclical lower abdominal pain, etc. Gynecological examination shows that the vulva is hypoplastic and the hymen has no holes, but the surface color is normal and there is no outward bulging sign. During rectal examination, a vaginal cystic mass protruding toward the rectum can be found about 3 cm above the vulva. The mass has great tension during abdominal pain. Transabdominal or transrectal ultrasound exploration can detect a cystic barrel-shaped mass 3 to 4 cm above the anus. Under the guidance of B-ultrasound, puncture the mass through the vulva can extract old dark red blood or chocolate-like paste. Type II patients have complete vaginal atresia, and clinical manifestations include primary amenorrhea, cyclical lower abdominal pain, etc. Gynecological examination shows a mass with a diameter of 4 to 8 cm on one side or higher in the pelvic cavity, which is a malformed uterus or adnexal tumor.

⑤ Cervical atresia: If the patient has no endometrium, only primary amenorrhea will occur. If there is endometrium, the clinical manifestations are similar to congenital absence of vagina.

⑥ Congenital absence of uterus: The clinical manifestation is primary amenorrhea. The uterus cannot be palpated during anal and abdominal examination. Ultrasound, CT and MRI cannot detect the existence of the uterus.

Uterine amenorrhea (30%)

The cause of amenorrhea is in the uterus. Although the ovarian function is normal, the endometrium cannot produce a normal response, so menstruation does not occur. Common diseases that cause uterine amenorrhea include:

(1) Congenital uterine hypoplasia or absence: It is caused by the hypoplasia or aplasia of the paramesonephric duct during embryogenesis, which manifests as primary amenorrhea. After puberty, secondary sexual characteristics such as breasts, external genitalia, pubic region, and axillary hair develop normally. If the basal body temperature is measured, it can sometimes show ovulation. There may also be cyclical breast tenderness and lower abdominal discomfort. The chromosomes and gonads are normal for women. Various ovarian hormones and pituitary gonadotropins FSH and LH are at normal female levels. Pelvic examination and B-ultrasound confirm the absence of a uterus. If primary amenorrhea is accompanied by cyclical abdominal pain, congenital uterine or vaginal malformations should be considered, such as vaginal septum or hymen occlusion. Because the reproductive tract is obstructed, menstrual blood cannot be discharged. B-ultrasound can reveal uterine and vaginal hematoma. Surgery to open the channel will restore normal menstruation. Congenital uterine hypoplasia or absence will never have menstruation.

(2) Endometrial damage or adhesion: often occurs after induced abortion, postpartum or post-abortion curettage. Excessive scraping damages the endometrium, or post-operative infection causes uterine adhesions, resulting in amenorrhea. When the uterine cavity is partially adhered, menstrual blood cannot flow out, manifesting as amenorrhea accompanied by periodic abdominal pain and a feeling of heaviness. Comparing the symptoms with basal body temperature, or finding uterine blood on B-ultrasound, can confirm the diagnosis.

Some infections such as tuberculous endometritis, miscarriage or severe postpartum endometritis can destroy the endometrium and lead to amenorrhea, which is usually secondary amenorrhea. If a girl is infected with endometrial tuberculosis before puberty, it will manifest as primary amenorrhea.

(3) Uterine treatment: Uterine amenorrhea may occur after hysterectomy or endometrial resection or intrauterine radiotherapy.

(4) Androgen insensitivity syndrome: also known as testicular feminization, this is a special form of uterine amenorrhea. The patient's karyotype is 46, XY, and the gonads are testicles. Because the target organs lack androgen receptors or the receptors cannot perform normal biological functions, they fail to develop into normal males. Complete testicular feminization looks very similar to a woman, with breast development, but the uterus is absent and the upper vagina is blind. Patients often seek medical treatment for primary amenorrhea after puberty.

Ovarian amenorrhea (30%)

(1) Congenital ovarian hypoplasia: Also known as Turner syndrome, it is the most common type of primary amenorrhea in girls. It is a disease of sex chromosome abnormality, most of which is an abnormal number of X chromosomes. The basic karyotype is 45, X. It can also be a sex chromosome structural abnormality, such as equal arms of X chromosomes, absence of long arms or short arms, ring X chromosomes, etc. Some are mosaics of multiple karyotypes. In addition to primary amenorrhea and underdeveloped secondary sexual characteristics, patients with this disease often have a group of physical abnormalities, such as short stature, webbed neck, multiple facial nevi, barrel chest, cubital valgus and other deformities. A few cases with 46, XX mosaicism may show secondary amenorrhea or occasional normal menstruation.

(2) Simple gonadal dysgenesis: It includes 46,XX simple gonadal dysgenesis and 46,XY simple gonadal dysgenesis. Except for the different karyotypes, the clinical manifestations of the two are similar, both of which are characterized by primary amenorrhea, underdeveloped secondary sexual characteristics, tall stature, long limbs, castrated body shape, and cord-like gonads. Gonads with XY karyotype are prone to tumors. Peking Union Medical College Hospital has reported 5 cases of XY simple gonadal dysgenesis, all of which underwent gonadal removal. Pathological examination confirmed that 4 cases had tumors, including 2 cases of gonadoblastoma, 1 case of sex cord tumor and 1 case of Sertoli cell tumor. Therefore, patients with XY simple gonadal dysgenesis should undergo gonadal removal as soon as possible.

(3) Premature ovarian failure: also known as early menopause, which means menopause occurs before the age of 40. It is occasionally seen in young women under 20 years old. Most of them are secondary amenorrhea, and very few are primary amenorrhea. The ovaries are atrophied, the estrogen level is low, and the FSH level rises to the menopausal level. The true mechanism of premature ovarian failure is not very clear. Some people have observed that premature ovarian failure is related to the autoimmune system. It has been found that premature ovarian failure is often accompanied by a variety of autoimmune diseases, such as Addison's disease, thyroiditis, hypoparathyroidism, myasthenia gravis, diabetes, etc. Antibodies against ovarian tissue can be detected. Anti-gonadotropin receptor antibodies have been observed on the ovaries, which hinder the binding of FSH to the receptors on the cell membrane. There are also reports that premature ovarian failure has familial factors, and the patient's mother or sister has experienced premature menopause.

(4) Ovarian insensitivity syndrome: The clinical manifestations are similar to those of premature ovarian failure, which may be primary amenorrhea or early menopause. The difference from premature ovarian failure is that these patients have a large number of normal follicles in their ovaries, but they are in a dormant state and cannot mature and ovulate. The pathogenesis of ovarian insensitivity syndrome is not very clear. The most common explanation is the presence of anti-gonadotropin receptor antibodies or post-receptor biological dysfunction in the ovaries. The reproductive hormone changes of this disease are the same as those of premature ovarian failure. If B-ultrasound or laparoscopy shows that the ovaries are not atrophic and there are small follicles, it can be distinguished from premature ovarian failure.

(5) Ovariectomy syndrome: Ovaries are removed or their tissues are destroyed. This is usually caused by surgical removal of both ovaries or radiotherapy of both ovaries, which results in the destruction of ovarian tissue and loss of function, manifesting as primary or secondary amenorrhea. Severe ovarian inflammation can also destroy ovarian tissue and cause amenorrhea.

Pituitary amenorrhea (30%)

(1) Primary hypogonadotropin: It is a rare genetic disease characterized by isolated gonadotropin deficiency. Patients often have primary amenorrhea, undeveloped sexual characteristics, and some also have olfactory disorders. The levels of pituitary gonadotropins FSH and LH as well as ovarian sex hormones are all low.

(2) Secondary hypopituitarism: pituitary damage, hemorrhage, inflammation, radiation and surgery can damage the anterior pituitary function, resulting in a deficiency of gonadotropin and other anterior pituitary hormones, such as thyroid-stimulating hormone and adrenocorticotropic hormone. In addition to hypogonadism, hypothyroidism and adrenocorticotropic hormone may also occur, manifesting as amenorrhea, weight loss, fatigue, intolerance to cold, hypoglycemia, hypotension, low basal metabolism and loss of libido. Sheehan syndrome, caused by ischemic necrosis of anterior pituitary tissue due to postpartum hemorrhage and shock, is a typical case of secondary hypopituitarism.

(3) Pituitary tumors: This is also a common cause of pituitary amenorrhea. It can directly destroy the function of the anterior pituitary or disrupt the regulatory pathway between the hypothalamus and the pituitary, interfering with the secretion and regulation of reproductive hormones, leading to amenorrhea. There are many types of pituitary tumors, such as somatotropinoma, prolactinoma, thyrotropin-producing adenoma, adrenocorticotropic hormone adenoma, mixed tumor of gonadotropin adenoma and non-functional pituitary adenoma. The most common pituitary tumor associated with amenorrhea is prolactinoma.

Hypothalamic amenorrhea (10%)

It refers to disorders in the hypothalamus or above the hypothalamus, which lead to amenorrhea due to deficiency of hypothalamic gonadotropin-releasing hormone (GnRH) or disordered secretion, including hypothalamic-pituitary unit dysfunction, central nervous system-hypothalamic dysfunction, and amenorrhea caused by inappropriate feedback regulation of the hypothalamus caused by other endocrine abnormalities.

(1) Hypothalamic-pituitary dysfunction: It can be a congenital hypothalamic-pituitary defect or a disorder of the synthesis and secretion of the hypothalamic hormone GnRH secondary to injury, tumor, inflammation, radiation, etc. The most common clinical cause of amenorrhea due to hypothalamic-pituitary dysfunction is hyperprolactinemia, which is due to the lack of hypothalamic prolactin inhibitory factor (mainly dopamine), causing the pituitary gland to secrete excessive prolactin. In addition, any other reason that hinders the inhibition of prolactin secretion by dopamine can also cause hyperprolactinemia. For example, tumor compression of the pituitary stalk will block the inhibition of prolactin secretion by dopamine. Certain drugs increase prolactin secretion by consuming dopamine reserves or blocking the action of dopamine receptors, such as metoclopramide (Metoclopramide) and chlorpromazine (Chlorpromazine). Other pituitary adenomas and hypothyroidism Sucking on the nipple and chest stimulation can also cause increased prolactin secretion. The elevated prolactin level can also act on the hypothalamus, inhibiting the synthesis and release of GnRH, act on the pituitary gland, reducing the pituitary gland's sensitivity to GnRH, and act on the ovaries, interfering with the synthesis of ovarian steroid hormones. In addition to amenorrhea, lactation is often one of the important manifestations of hyperprolactinemia. However, many patients cannot discover lactation by themselves. About half of them are discovered during physical examinations when they seek medical treatment for amenorrhea or irregular menstruation. Laboratory tests will reveal elevated blood prolactin levels, >30ng/ml, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are equivalent to or lower than normal early follicular levels, and estrogen levels are low. In order to exclude pituitary tumors, sellar imaging examinations should be performed, and the visual field should be checked if necessary to alert to visual field defects caused by tumor compression of the optic nerve.

(2) Central hypothalamic dysfunction: Psychological factors, changes in the external or internal environment can cause amenorrhea through the central nervous system via the neuroendocrine pathways of the cerebral cortex, thalamus and hypothalamus, or through the limbic system of the brain to affect the hypothalamic function. In young women, the more common typical situation is that they may suddenly become amenorrhea after being mentally stimulated, emotionally stressed or changing the environment. The levels of FSH, LH and estradiol (E2) may be within the normal range. Amenorrhea occurs due to the disruption of the rhythm of GnRH pulse secretion, resulting in anovulation. It is also caused by deliberate weight loss and the pursuit of slimness. Anorexia nervosa caused by body shape is common among adolescent girls. They go from dieting to anorexia or develop weird eating habits, become severely emaciated, and suffer from amenorrhea, which leads to dysfunction of multiple organs such as thyroid, adrenal glands, gonads and pancreas, and even water and electrolyte disorders and extreme malnutrition that are life-threatening. Most of these patients can be traced to a medical history related to mental and psychological factors. Generally, FSH, LH and E2 levels are low. In addition, false pregnancy is also a central hypothalamic dysfunction caused by mental and psychological factors, which often occurs in infertile women who are eager to have children.

(3) Other endocrine abnormalities cause inappropriate feedback regulation:

① Excessive androgen: Excessive androgen can come from the ovaries and (or) adrenal glands. Clinically, the most common condition in adolescent girls is polycystic ovary syndrome, whose main pathophysiological characteristics are excessive androgen and persistent anovulation, manifested as a series of symptoms and signs such as amenorrhea or menstrual disorders, hirsutism and obesity, and polycystic ovary enlargement. Excessive androgen mainly comes from the ovaries and partly from the adrenal glands. The increased androgen is converted into estrogen in the peripheral tissues. This continuous and non-cyclical estrogen conversion increases the sensitivity of the pituitary gland to Gn-RH, resulting in increased LH secretion and loss of cyclicity, while FSH is relatively insufficient. The androgen level in the blood circulation of patients with polycystic ovary syndrome is about 50% to 100% higher than that of normal women. If androgen is abnormally elevated, attention should be paid to distinguishing it from other conditions, such as ovarian or adrenal androgen-secreting tumors, congenital adrenal hyperplasia caused by enzyme defects, and other abnormalities of sexual development.

Congenital adrenal hyperplasia is another common condition of androgen excess in girls. It is caused by the lack of a certain enzyme in the adrenal cortex during the synthesis of steroid hormones, resulting in excessive production of androgens, which disrupts the function of the hypothalamic-pituitary-gonadal axis and causes menstrual disorders or amenorrhea. In addition, patients often have varying degrees of masculinization and even genital malformations.

② Abnormal thyroid hormone: Thyroid hormone is involved in the metabolism of various substances in the body. Therefore, too much or too little thyroid hormone can directly affect reproductive hormones and reproductive function. For example, some patients with hyperthyroidism may experience oligomenorrhea or amenorrhea.

③ Secretory hormone tumors: Ovarian and adrenal tumors are more common. The excessive secretion of sex hormones by the tumor can inhibit the secretory regulation function of the hypothalamus and pituitary gland through a feedback mechanism, destroying their periodicity and leading to anovulation or amenorrhea. The nature of the hormones secreted by the tumor can be judged based on the abnormal increase in estrogen or androgen levels in the blood. A careful pelvic examination and imaging examinations of the corresponding parts, such as pelvic and adrenal B-ultrasound, CT scan, MRI, etc., are helpful in the diagnosis of the tumor.

④ Exercise and amenorrhea: Athletes, ballet dancers, etc., who engage in high-intensity activities and have too little body fat, may experience exercise-induced amenorrhea. The energy consumption and mental stress of training and competition may affect the neuroendocrine metabolic function, causing abnormal hypothalamic GnRH secretion and leading to amenorrhea.

⑤ Drug-induced amenorrhea: Some drugs can affect the function of the hypothalamus and cause amenorrhea, especially thiazide sedatives. Large doses of them can often cause amenorrhea and lactation. Menstruation can resume after stopping the drug. A small number of women develop secondary amenorrhea after injecting long-acting contraceptives or taking large doses of oral contraceptives for a long time. This is caused by the continuous inhibition of the hypothalamic-pituitary axis by drugs.

⑥ Obesity: Obesity is sometimes accompanied by other endocrine abnormalities. Here we refer to simple obesity. Body weight is closely related to the hypothalamus-pituitary-gonadal axis. Adipose tissue is the site of estrogen accumulation and the main site for the extraglandular conversion of androgens into estrogen. Excessive adipose tissue leads to an increase in estrogen. This non-cyclically produced estrogen produces a continuous inhibition of the hypothalamus-pituitary gland through a feedback mechanism, leading to anovulation or amenorrhea.

1. Oligomenorrhea or late menstruation can develop into amenorrhea. Actively treating oligomenorrhea or late menstruation can reduce the incidence of amenorrhea.

2. Clarifying the cause and location of amenorrhea will have a certain reference value for the effect and prognosis of amenorrhea treatment. For example, for hypothalamic amenorrhea, which is caused by mental factors, environmental changes, malnutrition, etc., the prognosis of drug treatment is better. For uterine amenorrhea caused by Mycobacterium tuberculosis, the endometrium has been destroyed and the possibility of resuming menstruation is low. For example, if the progesterone test is positive (menstruation can be resumed after taking progesterone), the prognosis is better.

3. In traditional Chinese medicine literature, there are cases where people conceive without having menstruation throughout their lives, which are called "dark menstruation". You need to be cautious about this and carefully inquire about the medical history before taking any medicine.

4. Currently, there are quite a few women taking diet pills, some of whom suffer from amenorrhea as a result. Some also suffer from amenorrhea due to anorexia caused by dieting due to obesity, and some suffer from amenorrhea after multiple abortions. All of the above amenorrhea can be prevented. Some drugs must be taken under the guidance of a doctor to prevent adverse reactions.

5. For patients with intractable amenorrhea who do not respond well to Chinese or Western medicine alone, a combination of Chinese and Western medicine can be used for cyclical treatment. After the effect takes effect, the dosage of Western medicine can be gradually reduced, and finally Chinese medicine treatment can be used.

Western medicine treatment of amenorrhea

Etiological treatment: Find the organic disease that causes amenorrhea and give appropriate treatment. For example, tuberculous endometritis should be treated with anti-tuberculosis. Patients with intrauterine adhesions should have their uterine cavity dilated and an IUD placed to prevent adhesions again. After the diagnosis of pituitary or ovarian tumors is clear, the treatment plan is determined based on the location, size, and nature of the tumor, and surgery, radiotherapy, chemotherapy, or other comprehensive measures may be selected.

Sex hormone replacement therapy: Hormone replacement therapy can be used for patients with congenital ovarian dysplasia, or ovarian function damage or destruction leading to premature aging. Generally, sex hormone artificial cycle therapy is used. After the use of sex hormones, menstrual-like periodic withdrawal bleeding occurs, which corrects the patient's physiological and psychological state on the one hand, and promotes the development of reproductive organs and secondary sexual characteristics to a certain extent on the other hand.

(A) Low-dose estrogen cyclic therapy: Its function is to promote pituitary function, secrete luteinizing hormone, thereby increasing ovarian estrogen secretion and promoting ovulation.

(ii) Sequential estrogen-progestin therapy: Its function is to inhibit the hypothalamic-pituitary axis. Menstruation may resume and ovulation may occur after discontinuation of the drug.

(III) Estrogen and progesterone combined treatment: Its function is to inhibit pituitary gonadotropin. After stopping the drug, there is a rebound effect occasionally, which can restore menstruation and ovulation. Take oral contraceptives once a night, starting from the fifth day of menstruation, and stop taking them after 22 days. The second course of treatment starts on the fifth day of the next menstruation, and a total of 3 to 6 cycles are required.

(IV) Inducing ovulation: If the ovarian function is not exhausted and the patient desires to have children, hormones or their analogues can be used to induce ovulation:

1. Pituitary insufficiency: Follicle-stimulating hormone (hMG) extracted from the urine of postmenopausal women is used to promote the development of follicles and secrete estrogen. Combined use of human chorionic gonadotropin (hCG), which is similar to pituitary luteinizing hormone, can promote follicle maturation and ovulation, and promote the formation and development of the corpus luteum.

2. In cases of sexual dysfunction, normal responses of the ovaries and pituitary gland, and insufficient or uncoordinated function of the hypothalamus, chlorpheniramine can be used to promote the secretion of gonadotropin-releasing hormone in the hypothalamus to correct its function and induce ovulation.

Amenorrhea Treatment with Traditional Chinese Medicine

1. Liver and kidney deficiency syndrome

[Symptoms] Menstruation has not come after the age of 18, or the menarche is late, or the menstruation is delayed and the amount is small, light in color, and thin in texture, gradually leading to amenorrhea; weakness in the waist and knees, or heel pain, dizziness, tinnitus, weight loss and fatigue, infertility after a long marriage, dark circles under the eyes, or pigmentation on the right side of the face, pale tongue with a thin white coating, deep and thin pulse or weak pulse on the radial side; poor development of the uterus, immature genitals or ovarian anovulation function.

【Treatment method】Tonify the kidney, nourish the liver and regulate menstruation.

[Prescription] Cuscuta australis, wolfberry, rehmannia glutinosa, cornus officinalis, Chinese yam, processed Polygonum multiflorum, placenta (grind and swallow), Codonopsis pilosula, Chinese angelica, Millettia reticulata, donkey-hide gelatin (melt and drink), Cistanche deserticola, and Cnidium monnieri. Add or subtract: If combined with liver qi stagnation, with symptoms of depression, chest tightness and flank pain, occasional sighing, and deep, thin and stringy pulse, remove cornus fruit and Millettia reticulata from the above formula, and add bupleurum g, processed cyperus rotundus, white peony root, Rhizoma Atractylodis Macrocephalae, and rose to invigorate the kidney, soothe the liver and regulate the pulse; if combined with leukemia, with abdominal distension and pain that refuses to be pressed, pale and dark tongue with petechiae, and deep, thin and astringent pulse, add safflower, Achyranthes bidentata, Trillium, and Curcuma zedoaria to invigorate the kidney, eliminate numbness and regulate the pulse; if combined with phlegm obstruction, obesity, thick leucorrhea, heaviness and fatigue: if the tongue is pale, fat, and has tooth marks, add Atractylodes lancea, Cyperus rotundus, Amomum villosum, Citrus reticulatae, and Arisaema consanguineum to invigorate the kidney, guide phlegm and regulate the pulse; if the uterus is small, add Cyperus rotundus, Amethyst (pre-boiled), and Antler tablets (pre-boiled) to promote the development of the uterus.

【Usage】Decoction in water twice and take 1 dose per day. Same below.

2. Kidney Yang Deficiency

[Symptoms] Menstruation is too late or too scanty, with light red color, thin menstrual volume, and menstruation gradually stopping; fear of cold, cold limbs, back pain, mental depression, hair loss, loss of libido, or infertility, or edema of the face and limbs, frequent urination or nocturia, or diarrhea at dawn, pale complexion, fat tongue with tooth marks, thin white fur, deep and thready or deep and weak pulse; small uterus, immature or petite genitals, underdeveloped secondary sexual characteristics, low estrogen levels, low blood FSH, LH and cortisol or urine 17-hydroxy, 17-ketone, and no ovulation.

【Treatment method】Warm the kidney, assist yang and regulate menstruation.

[Prescription] Rehmannia root (or Amomum villosum), stir-fried yam, cornus fruit, wolfberry, dodder seed, antler (fried first), aconite root (fried first), cinnamon bark (added later), epimedium, curculigo, baicalensis, raspberry, esculenta seed, and stir-fried angelica.

[Usage] Decoction in water twice and take 1 dose per day.

(The above information and its contents are for reference only, please consult a doctor for details)

1. Peach kernel and beef blood soup

Ingredients: 10-12 grams of peach kernels, 200 grams of fresh cow blood (coagulated blood), and a little salt.

Preparation method: Cut the ox blood into pieces, add peach kernels and appropriate amount of water to make soup, and add a little salt to season when eating.

Efficacy: It has the effects of removing blood stasis, promoting blood circulation, regulating blood circulation, and improving menstruation, beautifying the skin and improving complexion. It is suitable for amenorrhea, blood dryness, constipation and other symptoms.

2. Fungus and walnut candy

Ingredients: 120 grams of black fungus, 120 grams of walnut kernels, 200 grams of brown sugar, and appropriate amount of rice wine.

Method: Grind the fungus and walnuts, add brown sugar and mix well, seal in a porcelain jar. Take 30g each time, twice a day, until menstruation comes.

Efficacy: It nourishes the liver and kidney, replenishes qi and blood, and nourishes the Chong and Ren meridians. It is suitable for amenorrhea caused by uterine hypoplasia.

3. Black Bean and Double Red Soup

Ingredients: 50g-100g of black beans, 5g of safflower, 30g-50g of brown sugar.

Method: Put the first two ingredients in a stewing pot, add appropriate amount of water, stew until the black beans are cooked through, remove the safflower, add brown sugar and mix well.

Efficacy: It nourishes the liver and kidneys, promotes blood circulation and menstruation, and beautifies and darkens hair. Suitable for amenorrhea caused by blood deficiency and qi stagnation.

4. Pork and turtle meat

Ingredients: 1 turtle, 500 grams of lean pork, and appropriate amount of rice wine.

Method: Kill the live turtle, remove its head, feet and blood, clean it and put it in a casserole, add lean pork and an appropriate amount of water, boil it over high heat first, then simmer it over low heat until it is well cooked. Eat it in several times, and you must eat several turtles in a row for it to be effective.

Efficacy: replenish qi and blood, nourish Chong and Ren meridians. Suitable for Chong and Ren meridians (uterine hypoplasia) and amenorrhea due to qi and blood deficiency.

5. Pigeon meat, scallion and ginger porridge

Ingredients: 150 grams of pigeon meat, 20 grams of chopped green onion and ginger, 50 grams of minced pork, 100 grams of glutinous rice, 1 gram of ground pepper, 10 grams of cooking wine, and appropriate amounts of sesame oil, salt, and MSG.

Method: Remove the bones of the pigeon meat and cut it into pieces, put it in a bowl, add pork, chopped green onion and ginger, cooking wine and salt, mix well and set aside. Wash the polished rice, add 1000 ml of water to the pot, boil it, add the pigeon meat, etc., and add sesame oil, MSG and pepper powder when it becomes porridge.

Efficacy: It has the effects of nourishing the kidney and qi, dispelling wind and detoxifying, and harmonizing blood and pleasing complexion. It is suitable for amenorrhea caused by blood deficiency.

6. Fried Pig’s Feet and Sunflower Stem

Ingredients: 250 grams of pig's trotters, 10 grams of sunflower stalks.

Method: First wash the pig's feet, scrape off the dirt, put them into a casserole, simmer until they are well cooked, add the sunflower stems, boil until it becomes a thick juice, remove the residue, and drink the juice. Take 2-3 times a day, 20 ml-30 ml each time.

Efficacy: It has the effect of promoting blood circulation, promoting qi and removing blood stasis. It is suitable for amenorrhea of ​​blood stasis type.

7. Cuttlefish, mushroom and bamboo shoot congee

Ingredients: 1 dried cuttlefish, 50 grams each of soaked shiitake mushrooms and winter bamboo shoots, 100 grams each of lean pork and glutamate rice, 1 gram of pepper, 10 grams of cooking wine, and appropriate amounts of salt and MSG.

Method: Remove the bones from the dried cuttlefish, soak it in warm water until it swells, wash it, and cut it into strips; cut the pork, mushrooms, and winter bamboo shoots into strips for later use. Wash the glutinous rice, put it in a pot, add the shredded pork, cuttlefish, mushrooms, winter bamboo shoots, and cooking wine, and boil until it is cooked. Finally, add salt, MSG, and pepper.

Efficacy: It can replenish essence and qi, regulate menstruation, stop bleeding, beautify skin and keep youthful. It is suitable for amenorrhea, increased leucorrhea, dull complexion and other symptoms.

8. Coix Decoction

Ingredients: 30 grams each of coix seed and coix root.

Method: Cut coix seeds and coix roots into sections and boil them in water, remove the residue and drink the juice. Drink on an empty stomach in the morning and evening, and use for more than 10 doses.

Efficacy: It has the effects of clearing turbidity and dampness, and guiding blood downward. It is suitable for amenorrhea caused by phlegm, turbidity and water retention blocking the menstruation.

9. Stir-fried cuttlefish with shredded ginger

Ingredients: 50 grams of ginger, 250 grams of boneless cuttlefish.

Preparation method: Cut the ginger into shreds, wash and slice the cuttlefish, add oil and stir-fry, and serve as a side dish.

Efficacy: It has the effects of nourishing blood, regulating menstruation and beautifying. It has an auxiliary therapeutic effect on those with blood deficiency and amenorrhea.

10. Stewed pigeon with turtle shell

Ingredients: 30 grams of turtle shell, 1 white pigeon, and a little rice wine.

Preparation method: Crush the turtle shell and put it into the belly of a cleaned white pigeon. Add appropriate amount of water and a little rice wine. Put it in a clay pot and stew it until cooked. Season and serve.

Efficacy: It has the effects of nourishing the kidney and replenishing qi, dispersing stagnation and promoting menstruation, and moisturizing the skin and beautifying the face. It is suitable for amenorrhea caused by physical weakness.

11. Stewed Pig's Trotter with Achyranthes

Ingredients: 15 grams of Sichuan Achyranthes, 2 pig trotters, 80 ml of rice wine.

Method: Scrape the pig's trotter and remove the hair. Cut it in half and cut it into several small pieces. Put it into a large stew pot with the ox knee. Add 500 ml of water and stew until the pig's trotter is cooked. Remove the ox knee and eat the remaining trotter meat and soup.

Efficacy: It has the effects of promoting blood circulation, relieving menstruation and beautifying the skin. It is suitable for women with amenorrhea due to qi stagnation and blood stasis.

1. Avoid spicy foods such as chili peppers and mustard.

2. Avoid eating overly salty foods such as salted fish, bacon, pickles, etc.

3. In particular, dairy products such as milk, yogurt, and mutton should be avoided in the diet.