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Abstract: The patient, Ms. Huang, had been suffering from amenorrhea for several months due to multiple miscarriages and scrapings. Hospitalization for surgical treatment was recommended, and the patient agreed. The patient was given hysteroscopic endometrial electrosurgery + balloon dilatation. After the operation, the patient’s endometrium returned to normal and her menstruation came normally 3 months later, and her menstrual cycle, period and volume gradually became normal.
Basic information】Female, 30 years old
Type of disease】Secondary amenorrhea
Hospital】Jinan Hospital of Integrative Medicine
Date of Consultation】October 2021
Treatment plan】Surgical treatment (hysteroscopic endometrial electrosurgery + balloon dilation) + medication (carboprost suppository + ornidazole injection + ceftriaxone sodium for injection + estradiol valerate tablets)
Treatment period】7 days of hospitalization, 3 months of home medication, 1 month of outpatient review after discharge
Treatment effect】The patient’s endometrium returned to normal, her menstruation came normally, and her menstrual cycle, period and volume gradually became normal.
I. Initial consultation
Patient Ms. Huang came to our hospital in October 2021 and reported that she had regular menstruation in the past. Her last menstrual period was on February 10, 2021. After detailed questioning, the patient was informed that due to the lack of any contraceptive measures, she had been pregnant several times before and had been treated by abortion, medication abortion and curettage, with menstruation not arriving after the last curettage. During this period, she was examined and treated with oral Chinese medicine and Western medicine, but the effect was poor, and now her menstruation was still coming, so I came to our hospital. After examining the ultrasound of uterine adnexa, blood HCG and sex hormone six, it was initially judged that secondary amenorrhea was caused by uterine adhesions, and she was admitted to the hospital.
II. Treatment history
Due to the poor effect of drug treatment, surgery was recommended, and the patient expressed willingness to actively cooperate with the treatment. Subsequently, routine blood and urine tests, blood grouping, coagulation system, biochemical complete set, viral complete set, and electrocardiogram were completed, which did not indicate any abnormality. On October 12, hysteroscopic endometrial electrosurgery was performed. A sublingual carboprost suppository was given to soften the cervix. Immediately after endometrial electrosurgery, a balloon was placed in the uterine cavity, i.e., balloon dilation, to compress and stop bleeding, support the uterine cavity, and prevent recurrence of adhesions. Postoperatively, antibiotic ornidazole injection and ceftriaxone sodium for injection were given to prevent infection, and estradiol valerate tablets were administered to repair the endometrium.
III. Treatment effect
After the surgical treatment, the patient’s uterus was reconstructed and the endometrium gradually returned to its normal state. During the hospitalization period, the patient did not show any symptoms of infection and was discharged after 7 days of hospitalization. The patient was followed up after taking estradiol valerate tablets orally for 3 months. The patient’s menstruation came normally, and now her menstrual cycle, period and volume have gradually normalized, and the treatment effect is good, and the patient expressed satisfaction with the treatment effect.
IV. Precautions
We are glad that the patient’s menstruation gradually returned to normal after the treatment. Patients need to pay attention to the fact that although the surgery helps patients to recover their health, it also causes certain trauma to the body, so patients should take more rest, do not overexert themselves, and eat as much light and nutritious food as possible, like eggs, milk, lean meat, etc., and also eat more fresh vegetables and fruits. Pay attention to personal hygiene, wash the vulva with warm water every night, prohibit sexual intercourse and tub bath for 1 month, and follow up with the gynecological clinic after 1 month to assess the recovery of the endometrium after surgery by ultrasound.
V. Personal insight
There are many causes of secondary amenorrhea in women, such as endocrine disorders and organic lesions of the uterus, etc. In this case, the patient was caused by organic lesions of the uterus with cavity adhesions. In the case of amenorrhea caused by organic lesions, conservative treatment with drugs is not effective and surgical treatment is required. If a woman does not have a requirement to prepare for pregnancy, she must take good contraceptive measures and try to avoid and reduce the number of abortions and scrapings to prevent the development of uterine adhesions.