How many types of ovulation-inducing drugs are there for the treatment of anovulatory dysfunctional uterine bleeding?

Ovulation-promoting drugs are suitable for patients with functional uterine bleeding during puberty and childbearing years, especially infertile patients. Generally, they include the following 4 types:

(1) Clomiphene (CC) is a non-steroidal compound with weak estrogenic effects. It competitively binds to estrogen receptors in the hypothalamus to produce anti-estrogen effects, inhibiting the negative feedback of endogenous estrogen on the hypothalamus, inducing the release of gonadotropin-releasing hormone and inducing ovulation. It is suitable for patients with functional uterine bleeding who have a certain level of estrogen in their bodies.

(2) Human chorionic gonadotropin (HCG) has a similar effect to LH and induces ovulation. It is suitable for people with a certain level of FSH and a moderate level of estrogen in their body.

(3) Human gonadotropin (HMG) E5H stimulates the maturation of follicles. The estrogen produced induces ovulation through positive feedback, which causes the pituitary gland to secrete sufficient LH. ) After the bleeding stops, HMG 75-150U is injected intramuscularly every day until the follicles develop into heat. HMG is discontinued and HCG 5000-10000U is added by intramuscular injection to increase the ovulation rate. It should be noted that the use of HMG is prone to ovarian hyperstimulation syndrome, so it is only used for patients with functional uterine bleeding who are not well responsive to clomiphene and who want to have children.

(4) Gonadotropin-releasing hormone agonist (GnRHa) In the past, GnRHa was used in small doses in pulse form to play an incremental regulatory role, promoting follicle development and inducing ovulation. Now, it is advocated to use GnRHa as pre-treatment first. The principle is that GnRH agonists have a regulatory effect on the pituitary gland, thereby reducing endogenous estrogen levels and achieving a hemostatic effect. GnRHa has a significant hemostatic effect on functional bleeding, but its high cost and osteoporosis caused by long-term use have prevented the drug from being widely used in clinical practice.