Treatment of primary amenorrhea

If menstruation does not come, it is very painful for every woman, because the importance of menstruation is self-evident. Menstruation is not only a normal physiological phenomenon, but also a way to eliminate toxins from the body. So what should we do when we encounter primary amenorrhea? What is the treatment for primary amenorrhea? Let’s take a look at it together.

Treatments for primary amenorrhea include:

1. Endocrine therapy

a. Estrogen supplementation: (1) For patients with a small uterus or those who are uncertain whether they have a uterus, give Premarin, starting with 0.3 mg/day and gradually increasing to 0.625 mg 1-2 times a day depending on the situation. Perform B-ultrasound again in 1-3 months to observe the presence and size of the uterus. (2) For those who lack secondary sexual characteristics and have a uterus, those who have undergone orchiectomy and have ovarian hypoplasia, or those who have no ovaries, small doses of estrogen supplementation should be given for a long time.

b. Artificial cycle: Artificial cycle supplementation is given to those with a uterus who need estrogen. Especially for those who are too tall and whose epiphysis has not healed, they should take a longer time to supplement (about one year or more) to stop their height from continuing to grow.

c. Other hormone supplements: For hypothyroidism and congenital adrenal hyperplasia, cooperate with the internal medicine endocrinologist to give thyroid hormone and prednisone supplements.

d. Application of estrogen and androgen: For patients with unhealed epiphyses and short stature, such as Turner syndrome, small doses of estrogen and androgen should be used to increase height before estrogen supplementation. Levitra 0.625 mg can be taken twice a week, which can increase height by 2-3 cm in 3-6 months. Long-term use can make the body height over 150cm.

e. Application of bromocriptine: Patients with hyperprolactinemia and normal ovarian function have a better recovery. Bromocriptine can be used to lower PRL and promote ovulation. Start with 1.25 mg and gradually increase the dose until PRL is normal, then slightly reduce the dose for long-term maintenance. Take the medicine with a small amount of food before going to bed at night, then eat, and then go to sleep to reduce side effects. At the same time, measure basal body temperature to observe menstruation and ovulation.

2. Surgical treatment

(1) Hymenotomy: An X-shaped incision is made on the hymen under anesthesia. The edges of the incision are sutured with intestinal sutures, antibiotics are used to prevent infection, and accumulated blood is drained.

(2) Artificial vaginoplasty: Under anesthesia, a transverse incision is made between the vagina and the rectum. Blunt separation is performed to create a gap of 9-10 cm and a diameter of 3-4 cm. The vagina is then covered with a thigh skin flap or amniotic membrane implant. Insert the vagina model. Change the model daily after opening. After half a year, remove the model for 1-2 hours every day and start sexual intercourse. Gradually increase the removal time. If you stop sexual intercourse for a long time, you still need to place a vaginal model. Patients should learn to change models before discharge. A short vagina can be treated without surgery by using a vaginal model, from small to large, and mechanical expansion until sexual intercourse is satisfied.

(3) Laparotomy: The purpose is to perform a biopsy to determine whether the gonad is a testicle or an ovary. If the testicle is in the abdominal cavity, it should be removed to prevent tumors.

(4) Vulvoplasty: First decide whether to have a male or female child, and consult a urologist if necessary. For testicular feminization, testicular removal to create a female vulva should be considered. The clitoris may be removed if it is too large due to adrenal cortical hyperplasia.

The treatment of primary amenorrhea is not very complicated. The key lies in the patient himself. If the patient has a positive attitude, then the disease can be cured quickly. If the patient's attitude is bad and negative, then the disease will become more and more serious and eventually lead to the occurrence of other diseases. I think this is something none of us want to see.