Patient: I would like to ask you to help me. Female, 26 years old, she had one medical abortion in the past, her menstruation is not very regular, she had her menstruation on October 2, she took Fluconazole 150mg on October 26 due to mycosis fungoides, she took it again on the next day, she used Dacrynin suppositories for 7 days, during the period she washed with cleansing lotion, she had vaginal bleeding on October 29, the amount was small, brown color, she had tested with urine test paper on October 31 (-), she took Uggs On November 13, the amount of blood increased and felt similar to the usual menstruation. On November 14, she felt pain in her right lower abdomen and took amoxicillin for 3 days, the pain was relieved, and on November 17, she washed her vulva and found flaky discharge. On the 25th, the urine test paper (+), blood B-HCG>500mIU/ml, ultrasound examination: uterus anteriorly positioned, normal shape, size about 5.3*3.2cm, uniform echogenicity of muscle layer, endometrial line is not thick about 0.2cm, no abnormality in the uterine cavity, right ovary about 3.6*1.9cm, left about 3.3*1.7cm normal echogenicity, no liquid dark area in the rectal fossa of the uterus. Ultrasound was repeated on November 28: a 2.2*2.2cm mixed mass was seen in the right adnexal area and a 2.2cm liquid dark area was seen in the left iliac fossa. The blood B-HCG was 964 mIU/ml, and she was considered to be “ectopic pregnancy” and was hospitalized. On November 29, her net weight was measured at 51 KG, and she was given MTX 75 mg intramuscularly and 2 tablets of mifepristone orally at 5:00 pm on the same day. On November 30, she took 2 tablets of mifepristone at 5:00 a.m. and 2 tablets of mifepristone at 5:00 p.m. The vaginal bleeding increased significantly that night and was the same as the maximum amount during menstruation. On December 1, the vaginal bleeding decreased. On December 5, she had a repeat ultrasound: a 2.1*2.1 cm mixed mass in the right adnexal area near the ovary, B-HCG 205.47 mIU/ml, liver function ALT 88 U. She was given hepatoprotective treatment with diammonium glycyrrhizinate and reduced glutathione. On December 8, the liver function ALT decreased to 49U, and MTX 75mg was administered intramuscularly. On December 9, B-HCG 162.29mIU/ml was checked. On December 12, liver function ALT 48U and blood count: WBC 3800 were rechecked, and one subcutaneous injection of Reba was given. On December 16, after rechecking B-HCG 23.34 mIU/ml, ultrasound: 2.9*2.3CM mixed mass in the right adnexal area and ovarian cyst on the left side. The doctor said it was a physiological cyst and did not need to be treated. Immediate laparoscopic treatment was recommended. I refused because considering that conservative treatment itself is expectant therapy, the blood HCG drops at a normal rate, the mass is absorbed more slowly, and perhaps there are measurement errors. On December 17, started taking herbal medicine, which was said to be anti-inflammatory, stop bleeding and promote mass absorption. On December 26, ultrasound: uterus size 5.3*3.3cm, endometrium line is centered, thickness 0.6cm, muscle layer echogenicity is uniform, blood flow is normal. A 2.4*2.1cm heterogeneous mass with clear border was seen in the right adnexal area; a 6.5*5.1cm liquid dark area with peritoneum was seen in the left adnexal area, and there was no blood flow signal in the left mass. Blood B-HCG: 0.00mIU/ml January 16, 2009, ultrasound examination: uterus size 5.4*3.2cm, endometrium line centered, 1.4cm thick, uniform muscle layer echogenicity, normal blood flow. A 2.2cm*2.2cm uneven mass with clear border and no internal blood flow was seen in the right adnexal area. No abnormality was seen in the left adnexal area. Ultrasound suggests: right adnexal region heterogeneous mass. I had one menstrual period on December 27, and have been having vaginal bleeding for almost 3 months since October 29, and currently there is no abdominal pain and a small amount of brown bleeding. Why is it still bleeding? Zhou Jun, Department of Gynecology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Anhui Province, China: Hello, from the information you provided about your condition, the conservative treatment of your ectopic pregnancy is successful, because most of the drugs to kill the embryo will cause irregular vaginal bleeding and for a longer period of time. From the perspective of traditional Chinese medicine, the mass in the right adnexal area and the vaginal bleeding is caused by stagnant blood and the new blood cannot return to the menstruum. You can go to the hospital to prescribe some Chinese herbs to invigorate blood stasis and eliminate stasis to produce new blood. Patient: How long is it? I got my period on the 23rd of this month and finished it on the 29th, but I still have a small amount of brown bleeding, which I think is not normal. It has been bleeding for 3 months. Anhui Provincial Hospital of Traditional Chinese Medicine Zhou Jun: long time is about 1 month, but your menstrual flow time should be said to be normal cycle, only the period is prolonged, you can first take Chinese medicine, while insisting on basal body temperature, to exclude whether there is luteinizing atrophy situation, if so, you can supplement progesterone treatment, you can also take oral antibiotics to prevent bleeding for a long time caused by endometritis and bleeding. Patient: I went for a gynecological examination yesterday and intended to scrape the uterus, but the doctor (rotating physician) said that coffee-colored things were visible in the posterior vault and no blood was seen after wiping the cervix, suggesting that I should not scrape the uterus for the time being, as scraping itself is prone to infection and bleeding, and she considered that it might be caused by irregular peeling of the endometrium. I was told to take progesterone intramuscularly for 3 days and to scrape the uterus medically. Will it work? Yesterday I changed hospitals for ultrasound, the doctor looked for a long time to find the mass, and finally saw it and said the image is very blurred, the boundary is not clear, said maybe it is in the absorption period, do not understand … I’ll have a blood HCG test tomorrow. I stopped taking herbal medicine when I got my period, and I’m afraid it will cause bleeding because it’s a blood activator. Can I experiment with luteinizing insufficiency now? How can I supplement progesterone? Since the bleeding has been there for 3 months, I want to infuse anti-inflammatory drugs intravenously, what is better to infuse? Anhui Provincial Hospital of Traditional Chinese Medicine, Department of Gynecology, Zhou Jun: If the routine blood test is normal, just take oral antibiotics, when you have menstruation, you can eat herbs to activate blood circulation and remove blood stasis, because you do not have a lot of menstruation, vaginal bleeding is not clean, Chinese medicine says that blood stasis does not go to the new blood can not return to the menstruation, all bleeding is not clean. If you are treated with progesterone now, it is not possible to take the injection only for 3 days, and you will still bleed after stopping the medication. You can take oral medroxyprogesterone 8mg/day on the 15th day of menstruation, stop taking the medication for 10 days and wait for your period to come. Contraception should be used during the period of taking the medication.