How to check for amenorrhea

Amenorrhea is a very recurrent clinical symptom. According to different causes, it can be divided into primary and secondary, physiological and pathological. The harm caused by amenorrhea to female patients must not be underestimated. Everyone should pay attention to it. Once the symptoms are found, they should actively go to the hospital for examination. So, how should women with amenorrhea be examined?

(I) Physical examination: including intelligence, height, weight, development of secondary sexual characteristics, developmental abnormalities, goiter, galactorrhea, skin color and hair distribution. For patients with primary amenorrhea and infantile sexual characteristics, the sense of smell should also be checked for loss.

(ii) Gynecological examination: the development of internal and external genitalia and whether there are any deformities. Married women can understand the level of estrogen in the body by examining the vaginal and cervical mucus.

(III) Laboratory auxiliary examinations: If a woman with a history of sexual activity experiences amenorrhea, pregnancy must be ruled out first.

1. Evaluate estrogen levels to determine the degree of amenorrhea

(1) Progesterone test: Bleeding after the withdrawal of progesterone indicates that there is a certain level of endogenous estrogen in the body. If there is no withdrawal bleeding after stopping the drug, there may be two situations: ① low endogenous estrogen levels; ② amenorrhea caused by uterine disease.

(2) Estrogen-progesterone test: Take estrogen such as estradiol valerate or 17β-estradiol or conjugated estrogens, and then add progesterone after 20 to 30 days. If there is withdrawal bleeding after stopping the drug, uterine amenorrhea can be ruled out. If there is no withdrawal bleeding after stopping the drug, uterine amenorrhea can be confirmed. However, if the medical history and gynecological examination have confirmed uterine amenorrhea and amenorrhea due to dysplasia of the lower reproductive tract, this step can be omitted.

2. Hormone level measurement: It is recommended to stop taking estrogen and progesterone drugs for at least two weeks before measuring the levels of FSH, LH, PRL, thyroid stimulating hormone (TSH), etc. to assist in diagnosis.

(1) PRL and TSH determination: Blood PRL>1.1nmol/L (25mg/L) is diagnosed as high PRL blood disease; simultaneous increase in PRL and TSH levels indicates amenorrhea caused by hypothyroidism.

(2) FSH and LH measurement: FSH>40U/L (measured twice or more with an interval of 1 month) indicates ovarian failure, FSH>20U/L indicates ovarian dysfunction, and LH<5U/L or within the normal range indicates that the lesion is in the hypothalamus or pituitary gland.

(3) Measurement of other hormones: In patients with obesity or clinical signs of hyperandrogenism such as hirsutism and acne, it is necessary to measure insulin, androgens (testosterone, dehydroepiandrosterone sulfate), progesterone and 17-hydroxyprogesterone to determine whether there are diseases such as insulin resistance, hyperandrogenism or congenital 2l-hydroxylase deficiency.

Patients with amenorrhea should pay attention to adjusting their lifestyle habits. They should avoid dairy products in their diet. Yogurt, dairy products, sugar, and meat can easily cause skin fever, so dairy products should be avoided as much as possible. They can eat more lettuce, kelp, salmon (with bones), sardines, etc. Drinking more water or juice can effectively control body temperature.