Shanshan, a 15-year-old girl, was facing her midterm exams, but for the past two years, every period was incomplete and prolonged, and she had symptoms of anemia. Shanshan’s mother was anxious and kept asking the doctor why she had been undergoing treatment but repeatedly. After the doctor asked Shan about her treatment process, she found out that Shan had gone to many hospitals without regular review and stopped taking the medication after the bleeding had stopped because she was afraid of the side effects of hormones. In the previous article “Understanding gonorrhea, let’s start with menstruation”, we can learn that menstruation reflects the cyclical changes of our gonadal axis, and each menstrual cycle is a new beginning. For adolescent girls whose gonadal axis is not yet mature, there is no way to cure the condition in one treatment. It is irresponsible to stop taking the medication without following the course of treatment, which will only make the condition persist. Here we will talk about the medication for adolescent gonorrhea, and clarify the changing rules of medication dosage. Regular progesterone withdrawal Effective hemostasis, waiting for self-perfection As mentioned earlier, abnormal uterine bleeding in adolescent girls is caused by the inability to ovulate normally due to the imperfect development of the reproductive endocrine axis. The root cause of bleeding is anovulation leading to progesterone deficiency. Therefore, for adolescent girls who do not bleed a lot and whose anemia is not severe, the addition of progesterone can have a hemostatic effect. Since each cycle is a new beginning and stopping bleeding once does not guarantee a normal next period, progestin can be taken regularly every month until the reproductive endocrine axis is developed and can ovulate normally. Another recommended treatment is to take oral contraceptives (e.g. Mafron, Ursine, etc.) to stop bleeding in the first stage and to regulate menstruation in the second stage. When it comes to birth control pills, some people may question how a little girl can be given birth control pills. In fact, the pill is a combination of estrogen and progestin, and the following is a brief description of how it helps patients recover to dispel any doubts. The short-acting oral contraceptive pill is a synthetic high-efficiency progestin, and it is used for the whole cycle. The first use can stop bleeding, and the subsequent use can inhibit ovulation and make the endometrium shrink, so as to control the cycle and reduce the amount of bleeding. After stopping the pill, estrogen and progestin withdraw, the endometrium is shed comprehensively and menstrual-like bleeding occurs, which is also called withdrawal bleeding. After withdrawing the blood, the endometrium returns to its basal state and waits for the next menstrual cycle to come. The progestin in birth control pills is more powerful than natural progestin and can inhibit the hypothalamic-pituitary-ovarian axis (HPO axis), leaving the HPO axis in a resting state. After 3 to 6 cycles of regular medication, the HPO axis works again and ovulation and re-establishment of regular menstruation is possible. It also helps the adolescent girl’s body to recover. Then please see the next article “How to effectively treat delayed gonorrhea in young girls (below)” for details on how to take the medication.