There are many patients who come to the clinic with low menstrual flow. They are worried that their menstrual flow is getting lower and lower, and that they will go through menopause soon. They ask for medication to increase their menstrual flow. It is important to understand the causes of low menstrual flow before deciding whether to treat it and how to treat it. Let me first talk about normal menstruation, which is the cyclical shedding and bleeding of the endometrium that occurs once a month, week after week, along with the cyclical changes of the ovaries. Regular menstruation is an important sign of the maturity of female reproductive function. Normal menstrual blood is dark red in color and contains, in addition to blood, endometrial debris, cervical mucus and shed vaginal epithelial cells. Menstrual blood contains prostaglandins (PG) and large amounts of fibrinolytic enzymes, the latter of which causes menstrual blood to be non-clotting and clots to appear only when there is a lot of blood. We consider the 1st day of bleeding as the beginning of the menstrual cycle, and the interval between the 1st day of two menstrual periods is called 1 menstrual cycle. Normal is 21 to 35 days, with an average of 28 days. The duration of menstruation is the period, which is normally 2 to 8 days, with an average of 4 to 6 days. Assessment of menstrual volume The volume of menstruation is the total amount of blood lost during one menstrual period. It can be roughly estimated as follows: a daily sanitary napkin with a wet surface can be considered as a menstrual flow greater than 5 ml, and vice versa. Causes of menorrhagia The cause of menorrhagia can be due to insufficient ovarian estrogen secretion, anovulation, or the endometrium not responding to normal amounts of hormones due to surgical trauma, inflammation, adhesions and other factors. The flow chart is as follows: To summarize, although hypomenorrhea may appear as a clinical manifestation of ovarian aging, it is not a sign of ovarian aging. We start by taking a medical history according to the flow chart above, focusing on the exclusion of tuberculosis, whether or not she has taken oral contraceptives, whether or not she has been under stress at work and mentally recently, and whether or not she has a history of scraping. The key points are 1. If you have never been pregnant, endometrial tuberculosis should be ruled out and regular anti-tuberculosis treatment should be given after diagnosis. 2, history of scraping to exclude the cervical or uterine cavity adhesions, can do hysteroscopy and treatment. 3, suspected endometrial damage can be checked in the luteal phase ultrasound endometrial thickness, normal, no need for treatment, observation can be; non-treatment, it is recommended to eat some blood-boosting herbs. 4. For those with fertility requirements, blood should be drawn on the 2nd to 5th day of menstruation to check hormones E2, FSH, LH and AMH; follicle monitoring and endometrial thickness should be performed on the 11th day of menstruation. Follicle stimulation therapy is given for anovulation, and endometrial thinning can be treated with estrogen supplementation and combined with follicle stimulation. 5. Ovarian reserve test shows abnormalities (negative ultrasound suggesting AFC <5-7 follicles or AMH <0.5-1.1ng/ml). Be alert to low ovarian reserve function. Many women are misinformed that menstruation can detoxify the body, which is pure nonsense! The actual hospital check is clear that there is no abnormality, just a small amount of menstruation without any discomfort can not be treated, relaxed mood, balanced nutrition, eat more soy products, appropriate exercise, the amount of less than the amount of good, at least not anemic, but also save sanitary napkins, is to save money.