In the last article, we talked about how the treatment of adolescent gonorrhea should not only stop the bleeding but also adjust the menstruation, but the treatment cycle is long and the medication is troublesome, so it is very undesirable for many patients to give up halfway like Shan. Today, we will sort out the principles of taking medication for the treatment of menstrual bleeding, and hope it will be helpful to you.
Progestin withdrawal method
This method can be used for young girls who are bleeding profusely but not in large quantities and whose anemia is not obvious. The mechanism of hemostasis is to convert the endometrium, which is continuously proliferating under the effect of estrogen, into a secretory phase to achieve the effect of hemostasis. The endometrium is shed more completely after stopping the drug, which acts as a pharmacological curettage. It is suitable for patients with hemoglobin level >80g/l and stable vital signs. Progesterone can be injected intramuscularly 20mg/d*3-5 days, or progesterone can be taken orally. The bleeding stops during the medication and will reappear after stopping the medication, usually not a lot of bleeding for a long time. Note that it should only be used for young girls with low bleeding and no obvious anemia. For girls with severe anemia, the patient cannot afford to bleed again before the hematocrit returns to normal because of the short duration of the medication.
Short-acting oral contraceptive pill method to stop bleeding
①321 method (for patients with heavy bleeding): 3 pills/day for 7 days; 2 pills/day for 7 days; 1 pill/day for 7 days and stop taking it for 21 days.
②Patients with moderate bleeding: 2 tablets/day, divided into two doses, and observe the effect of stopping bleeding after 7 days. If the bleeding has stopped after 7 days, change to 1 tablet/day and stop taking it until the 21st day; if the bleeding has not stopped after 7 days, continue to take 2 tablets/day and observe the effect after the same 7 days and then consider reducing the dosage.
③Patients with less bleeding: 1 tablet/day, stop taking the drug on day 21.
Consider estrogen hemostasis in children with hematocrit (Hb) <80g/L
High-dose estrogen can rapidly promote endometrial growth and stop bleeding by repairing the trauma in a short period of time. It is suitable for patients with adolescent gonorrhea who have long bleeding time and high volume resulting in anemia (hematocrit (Hb) <80g/L). Take estradiol valerate tablets as an example: 2 tablets/time (1mg/tablet), orally, once every 4-6 hours, for a total of 8-12 tablets per day. After 3 days from the time the bleeding stops, reduce the dose by 1/3 every 3 days. if bleeding occurs again during the reduction period, take the dose before the reduction for 3 days and then reduce the dose until the hematocrit level is >90 g/L. At this time, it is not possible to stop the medication immediately, and progestin must be added to match the withdrawal. In addition, patients with a history of hypercoagulable blood or thrombotic disorders should contraindicate the application of high doses of estrogen to stop bleeding.
Timely correction of anemia in children with moderate to severe anemia
Many children with adolescent gonorrhea lose a lot of blood and will have varying degrees of anemia. Don’t underestimate anemia. Long-term anemia can cause damage to the child’s whole body organs, such as enlarged liver and spleen, accelerated heart rate, enlarged heart, and in severe cases, heart failure and reduced digestive function. If the examination reveals moderate or severe anemia (moderate anemia: 60g/L <90g/L hematocrit; severe anemia: 30g/L <60g/L hematocrit), the child should be treated with iron in time and may need blood transfusion if necessary.
Adjustment of menstruation is crucial
Adjustment of menstruation is a key step in the treatment of adolescent gonorrhea, so do not give up halfway because of the long course of treatment and the trouble of taking medication. As mentioned earlier, adolescent menstrual bleeding is caused by the imperfect development of the reproductive endocrine axis and ovulation disorders, and menstruation can gradually become regular as the patient grows older and her body develops gradually. Therefore, we should not be overly nervous nor should we leave it alone.
The following two treatments can be referred to.
1. Regular use of progestin.
Since adolescent gonorrhea is due to the lack of progesterone, if progesterone is supplemented from the middle of menstruation, it can also achieve the purpose of adjusting the menstrual cycle. From the 15th day of withdrawal bleeding, take 10mg-20mg/day of dydrogesterone or 4mg-12mg/day of medroxyprogesterone, divided into 2-3 times a day; stop taking the drug for 10-14 consecutive days, which is a cycle, and there will be menstrual-like bleeding after stopping the drug. For example, if the patient has her period on the 1st, then she should start taking progesterone on the 14th and stop taking it for 14 consecutive days. If you really don’t want to count the days, you can also take progestin at a fixed time each month. If you get your period on the 1st, start taking progestin on the 15th and stop taking it for 10-14 days in a row and wait for your period. Each month thereafter, you will start taking the medication from the 15th, so that you are not prone to missing out. Each month is considered a cycle, and three cycles are a course of treatment, again requiring 3-6 courses of adjustment before trying to stop the medication.
Follow the above method for 3~6 cycles as appropriate and then wait and see if you can get your period on your own. If you still have irregular periods, you can still repeat the above treatment to ensure that you get your period once every 2 months. Over time, most teenage girls can gradually become regular.
2.Menstrual regulation by birth control pills
It is also an effective way to regulate menstruation. Specifically, the withdrawal of blood after hemostatic treatment is equivalent to a menstrual period, and the withdrawal of blood begins on the first day of taking the pill, 1 tablet/day, 21 days to stop, and 7 days between taking the next box. The dosing method is the same as for contraception of childbearing age. after 2 to 3 courses of treatment, you can try to stop the pill and observe whether the patient can resume normal menstruation.
Oral contraceptives are not to be discontinued in the middle of the course. In case of a missed dose, the doctor’s advice is: if you missed one pill in the first half of the menstrual regulation period, take an additional pill the next day; if you missed one pill in the second half of the period, consider stopping it so that the earlier menstruation will have little impact on the treatment.
Finally, we remind the majority of adolescent girls and parents, children’s academic pressure, but must be combined with work and rest, so that children maintain a positive and optimistic attitude, excessive mood swings will affect the child’s endocrine system, is also one of the important factors causing meritorious blood. In the diet to strengthen nutrition, eat more food rich in protein, iron and vitamins, such as meat, eggs, milk and fresh vegetables, fruits, etc., to reduce the symptoms of anemia. It is also important to keep warm, try not to stimulate with cold water during menstruation, and increase or decrease clothes according to weather changes. I wish all adolescent girls like Shan a speedy recovery and healthy growth!