Experience in nursing care for patients with amenorrhea

Amenorrhea is a common symptom of gynecological diseases, manifested as no menstruation or cessation of menstruation. Amenorrhea is usually divided into primary and secondary types. Primary amenorrhea refers to women over the age of 16 whose secondary sexual characteristics have developed, or women over the age of 14 whose secondary sexual characteristics have not yet developed and who do not have menstruation. Secondary amenorrhea refers to women who have had normal menstruation in the past but have stopped menstruating for more than 6 months due to some pathological reasons, or women who have stopped menstruating for more than 3 cycles based on their previous menstrual cycles.

【Nursing Assessment】

1. Medical history

Comprehensively and in detail understand the patient's growth and development history, menstrual history, marriage and childbearing history, and family genetic disease history, and identify congenital defects or other diseases and medications that cause amenorrhea. This includes the age of menarche, menstrual cycle, menstrual period, menstrual volume; delivery and puerperium process; amenorrhea time, amenorrhea inducement, and associated symptoms.

2. Physical and mental condition

Assess the patient's mental state, nutrition, overall development, height, weight, intelligence level, proportions of the trunk and limbs, observe whether there is excessive hair, pay attention to the development of the patient's secondary sexual characteristics, such as voice tone, breast development, pubic and axillary hair, pelvis, and whether the patient has a female body shape. Also check the breasts to observe whether there is milk secretion, etc.

Amenorrhea is the main symptom for patients to seek medical treatment, and it has a great impact on the self-concept of patients. Patients worry about the impact of amenorrhea on their health, sexual life and fertility. When the course of the disease is too long or repeated treatments are ineffective, it will increase the psychological pressure on patients and their families, manifested as depression, loss of confidence in treatment and care, which in turn affects the treatment effect.

3. Diagnostic examination

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1. Physical examination to assess mental state, check overall development and secondary sexual characteristics. Gynecological examination to check the development of internal and external genitalia, pay attention to any deformities and organic lesions. Also pay attention to check whether the thyroid gland is enlarged and whether there is galactorrhea. Pregnancy should be ruled out for women of childbearing age.

2. Uterine function examination mainly aims to understand the status and function of the uterus and endometrium.

(1) Diagnostic curettage: Applicable to married women. It is used to understand the condition of the cervical canal and uterine cavity, and to scrape the endometrium for pathological examination. In addition to understanding the presence of ovulation and corpus luteum function, it can also understand the presence of endometrial tuberculosis.

(2) Hysterosalpingography: This is used to understand the shape and size of the uterine cavity and the condition of the fallopian tubes, and to diagnose reproductive system malformations, tuberculosis, and intrauterine adhesions.

(3) Hysteroscopy: Observe the uterine cavity and endometrium under direct vision, and routinely take samples for pathological examination.

3. Drug withdrawal tests often use progesterone tests and sequential estrogen-progesterone tests. ① Progesterone tests are used to evaluate endogenous estrogen levels. After taking progesterone (progesterone or medroxyprogesterone acetate) for 5 days, withdrawal bleeding (positive reaction) occurs 3 to 7 days after stopping the drug, indicating that the patient's endometrium has been affected by a certain level of estrogen, but there is no ovulation; if there is no withdrawal bleeding (negative reaction) in the progesterone test, it means that the patient's estrogen level is low and does not respond to progesterone, and further estrogen-progesterone sequential tests should be performed. ② The method of the estrogen-progesterone sequential test is: take estrogen every day for 20 days, add progesterone for the last 5 days, and withdrawal bleeding occurs 3 to 7 days after stopping the drug, which is positive, indicating that the endometrium functions normally and responds to steroid hormones. Amenorrhea is caused by low estrogen levels in the patient's body. The cause is not in the uterus, and the cause should be further investigated. If there is no withdrawal bleeding, the test can be repeated once. If both tests are negative, it indicates that the patient's endometrium is defective or damaged, and the patient can be diagnosed with uterine amenorrhea.

4. Ovarian function test

(1) Basal body temperature measurement: In a normal menstrual cycle, the basal body temperature shows a biphasic pattern, that is, the basal body temperature in the second half of the menstrual cycle rises by 0.3 to 0.6°C compared with the first half, indicating normal ovarian function, ovulation or corpus luteum formation.

(2) Vaginal exfoliated cell examination: If the smear shows normal cyclical changes, it indicates that the cause of amenorrhea is in the uterus. Observe the percentage of the surface, middle and bottom layers of cells in the smear. The higher the percentage of surface cells, the higher the estrogen level. If the smear shows very few or no surface cells and no cyclical changes, and FSH is elevated, it indicates that the lesion is in the ovary. If the smear shows different degrees of low estrogen, or continuous mild effects, if both FSH and LH are low, it indicates that amenorrhea is caused by hypofunction of the pituitary gland or above.

(3) Examination of cervical mucus: The more obvious the fern-like crystals are, the more significant the effect of estrogen is. If the smear shows rows of ellipsoids, it indicates that the cervical mucus has been affected by progesterone in addition to the effect of estrogen.

(4) Blood steroid hormone measurement: including radioimmunoassay of estradiol, progesterone and testosterone. If the concentration of estrogen and progesterone is low, it indicates abnormal ovarian function or failure; if the testosterone value is high, it indicates the possibility of polycystic ovary syndrome, ovarian masculinization tumor or testicular feminization. (5) B-type ultrasound monitoring: Starting from the 10th day of the menstrual cycle, B-type ultrasound is used to dynamically monitor follicle development and ovulation. When the diameter of the follicle reaches 18-20mm, it is a mature follicle and ovulation is estimated to occur within about 72 hours.

(6) Ovarian stimulation test: also known as human gonadotropin (HMG) stimulation test. HMG is injected intramuscularly for 4 consecutive days to understand whether the ovaries produce estrogen. If the ovaries do not respond to pituitary hormones, it indicates that the lesion is in the ovaries; if the ovaries respond, the lesion is in the pituitary gland or above the pituitary gland.

5. A positive estrogen test in the pituitary function test indicates that the patient's estrogen level is low. To determine the location of the primary cause, the following tests are required:

(1) Radioimmunoassay of blood PRL, FSH, and LH: PRL>25μg/L is considered hyperprolactinemia. When PRL is elevated, further head X-ray or CT examination should be performed to rule out pituitary tumors; FSH>40U/L indicates ovarian failure; LH>25U/L highly suspects polycystic ovary; FSH and LH both <5U/L indicate hypopituitarism, and the lesions may be in the pituitary or hypothalamus.

(2) Pituitary stimulation test: also known as GnRH stimulation test, used to understand whether hypopituitarism is caused by the pituitary gland or the hypothalamus. If the LH value is 2 to 4 times higher than before injection 15 to 60 minutes after intravenous injection of LHRH, it indicates that the pituitary function is normal and the lesion is in the hypothalamus; if the LH value still does not increase or increases insignificantly after repeated tests, it indicates that the lesion is in the pituitary gland.

(3) Imaging examination: When a pituitary tumor is suspected, a sella turcica X-ray should be performed. If negative, a CT or magnetic resonance imaging (MRI) examination is required. B-ultrasound examination can be performed when uterine malformation, polycystic ovary, adrenal hyperplasia or tumor is suspected.

(4) Other tests: For those suspected of having congenital malformations, chromosome karyotype analysis and banding tests should be performed. For those who consider amenorrhea to be related to thyroid dysfunction, blood T3, T4, and TSH should be measured. When amenorrhea is related to adrenal function, urine 17-keto, 17-hydroxysteroids, or blood cortisol tests can be performed.

【Nursing measures】

1. Strengthen psychological support. Pay attention to establishing a good nurse-patient relationship, encourage patients to express their feelings, and ask questions about health problems, treatment, and prognosis. Provide patients with diagnosis and treatment information, help them clarify some concepts, relieve patients' psychological pressure of worrying about the disease and its effects, and encourage them to build confidence and actively cooperate with the diagnosis and treatment process.

2. Promote the patient's interaction with society. During the diagnosis and treatment process, encourage the patient to interact with his peers and relatives, participate in social activities within his ability, maintain a good mood, and treat the disease correctly.

3. Guide the rational use of drugs and explain the effects, side effects, dosage, specific methods of use, time, etc. of sex hormones so that patients can cooperate correctly.

4. Health education: Explain the common related factors of amenorrhea, help the nursing object identify the high-risk factors leading to amenorrhea, and guide the treatment plan. Provide patients with adequate nutrition, encourage them to exercise more, maintain a standard weight, and improve their physical fitness.