Beware of "menstrual disorders" which are not gynecological diseases

Menstrual disorders

Galactorrhea

Infertility

When girls encounter these problems, they immediately think of going to the hospital to see the obstetrics and gynecology department, but there may be another "culprit" lurking behind these symptoms.

Outpatient clinic news

Xiao Li, a 23-year-old sophomore, has been feeling depressed recently and often refuses to attend gatherings and other group activities. It turns out that she has a hidden problem: "Half a year ago, she began to experience menstrual disorders and menstrual flow reduction for no reason. What's more embarrassing is that she has breast leakage. When the weather warms up, she only wears single clothes to school, and her clothes are soaked with breast milk. She is a "single dog", so how can she secrete breast milk inexplicably? Her classmates also found out. Xiao Li was ashamed and in pain. With the persuasion and accompaniment of her classmates, she went to the gynecology outpatient clinic for treatment.

After listening to her situation, the doctor tested her for six sex hormones.

What are the six sex hormones?

①FSH——Follitropin;

②LH——luteinizing hormone;

③PRL——prolactin;

④E2——estradiol;

⑤P——progesterone;

⑥T——testosterone.

The significance of the six sex hormones

1. Oocyte stimulating hormone (FSH): also known as follicle stimulating hormone. Low FSH values ​​are seen during estrogen and progesterone treatment, Sheehan syndrome, etc. High FSH is seen in premature ovarian failure, ovarian insensitivity syndrome, primary amenorrhea, etc. If FSH is higher than 40mIU/ml, ovulation-inducing drugs such as clomiphene are ineffective.

2. Luteinizing hormone (LH): The normal value of LH in the non-ovulatory period is generally 5-25mIU/ml. A value lower than 5mIU/ml indicates gonadotropin insufficiency, which is seen in Sheehan syndrome. If high FSH is combined with high LH, ovarian failure is certain and no other tests are necessary. LH/FSH ≥ 3 is one of the bases for diagnosing polycystic ovary syndrome.

3. Prolactin (PRL): A level higher than 17.6ng/ml is hyperprolactinemia. Excessive prolactin can inhibit the secretion of FSH and LH, inhibit ovarian function, and inhibit ovulation.

4. Estradiol (E2): Low values ​​are seen in ovarian dysfunction, premature ovarian failure, and Sheehan's syndrome.

5. Progesterone (P): Low blood P values ​​in the late ovulation period are seen in luteal insufficiency, ovulatory dysfunctional uterine bleeding, etc.

6. Testosterone (T): High blood T value is called hypertestosteroneemia, which can cause infertility. When suffering from polycystic ovary syndrome, blood T value also increases. Hirsutism, more common in the lips, mandibular cheeks, lower abdomen, pubic area, inner thigh and outer calf, accompanied by acne, seborrheic and hair loss. Hirsutism is not synchronous with hyperandrogenism.

Check the results

Xiao Li had a blood test for sex hormones: her prolactin level was 10 times higher than the normal range! So she immediately took a pituitary MRI at the doctor's suggestion, and the truth finally came out: it turned out that Xiao Li had a pituitary tumor.

Pituitary tumors are one of the most common benign tumors in the brain, accounting for about 10-20% of intracranial tumors. They are more common in women of childbearing age. Although this tumor is benign, it can secrete excessive prolactin, causing hyperprolactinemia, inhibiting the normal functions of the hypothalamus and pituitary gland, and causing a decrease in the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). It not only affects the ability of the ovaries to synthesize steroid hormones, leading to insufficient estrogen and progesterone, and causing oligomenorrhea or amenorrhea, but also can lead to follicle development disorders and infertility. In addition, prolactin can also act on mammary duct cells, causing non-pregnant women to secrete milk.

The diagnosis of pituitary prolactinoma is not difficult. It is mainly based on 1. clinical manifestations, 2. blood prolactin measurement, and 3. imaging examination. The three aspects of evidence are determined by taking blood samples to measure the blood prolactin concentration.

This is a benign tumor, and the doctor recommended drug treatment first. After Xiao Li took the drug for one month, her prolactin level dropped to the normal range, and her menstrual disorders and galactorrhea were also significantly improved.

Drug treatment is a long-term process that requires perseverance. Any dosage adjustment, especially drug reduction and discontinuation, needs to be carried out under the strict guidance of a professional physician and closely followed up.

References

1. Obstetrics and Gynecology, 9th Edition Duan Tao

2. Huashan Golden Pituitary Huashan Hospital Affiliated to Fudan University 2019-07-19

3. Wei Zikun. Thyroid dysfunction and hyperprolactinemia. Journal of Radioimmunology, 2011.24(1):47-50

Note: There is no copyright issue for the pictures in this article

Liu Zhou, Wang Ying, Zhao Jiangxia, Zhoupu Hospital, Pudong New Area, Shanghai

Funded by Shanghai Science and Technology Commission's Science Popularization Project

(Project No.: 20DZ2311100)