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Abstract: The patient had normal menstruation in the past. After the abortion and uterine evacuation surgery, her menstrual flow decreased and her menstruation was irregular. After treatment, the patient’s menstruation returned to normal and the ultrasound examination showed that the endometrium was normal.
Basic information】Female, 29 years old
Type of disease】Secondary amenorrhea
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】February 2022
Treatment plan】Surgical treatment (hysteroscopic separation of uterine adhesions) + oral medication (estradiol valerate tablets, didrogestrel tablets) + intravenous infusion (cefuroxime sodium for injection, metronidazole injection)
Treatment period】3 days of hospitalization, 3 months of postoperative follow-up
Treatment effect] The patient’s menstruation returned to normal and the treatment was effective.
I. Initial consultation
The patient had normal menstruation for 5-6 days each time with an interval of 30-32 days, with medium volume and no dysmenorrhea. The patient had one abortion in June 2021, and the abortion was incomplete, and then she underwent an operation to remove the uterus. After the operation, her menstrual flow was reduced by nearly half, and her menstrual flow was irregular, with 3-4 days each time and 30-45 days interval. In the last 6 months, the patient started dieting and vigorous exercise to lose weight, and lost from 134 kg to 108 kg, her body shape changed significantly. her last menstrual period was on October 20, 2021, after which there was no menstrual flow, and she did not consult the doctor after self-testing negative urine HCG on December 28. she visited the outpatient clinic on February 13 after nearly 4 months of menopause, and was found to have negative blood HCG, and ultrasound indicated thin endometrium and interrupted endometrial continuity. She was diagnosed with secondary amenorrhea and uterine adhesions and was admitted to hospital.
Treatment history
The patient was admitted to the hospital to improve sex hormone six, coagulation function, liver and kidney function, and leucorrhea examination, etc. There were no obvious contraindications to surgery. The patient expressed her understanding and willingness to cooperate with the treatment. On February 14, a hysteroscopic operation was performed, during which the endometrium was seen to be thin and reduced in size, and the adhesions on the lateral wall of the uterine cavity and the uterine fundus were tightly adherent. After the operation, the patient was given cefuroxime sodium for injection and metronidazole injection as intravenous anti-inflammatory treatment to prevent the occurrence of infection, and was instructed to take hormones to adjust her menstrual cycle.
III. Treatment results
The patient recovered well after the operation and was discharged after 3 days of hospitalization. The patient was advised to take hormonal drugs continuously for 3-6 months and was recommended to have a follow-up examination 3 months after the operation. The follow-up ultrasound indicated that the endometrium had returned to normal, indicating that the treatment plan was correctly chosen and the treatment effect was ideal.
IV. Notes
We are glad that the patient’s menstruation came smoothly after treatment, but we suggest that the patient must take hormones to adjust the menstrual cycle for 3-6 months as prescribed by the doctor. Patients should also be aware that when there is a significant weight loss, there is a high probability that menstrual disorders will occur, so weight loss should be planned. To accentuate the weight loss effect, localized fat loss is also an option. In order to resume menstruation, patients should restore their weight appropriately and increase their nutrition. The sudden occurrence of amenorrhea and prolonged menstrual disorders will have a certain impact on the psychology. When the mood is too anxious and depressed, it will also affect the menstruation in turn, so patients should pay attention to maintain a good state of mind, which is more important for restoring menstruation.
V. Personal insight
In this case, the endometrial lining was damaged due to uterine surgery, and menstrual changes occurred as a result of uterine adhesions. At the same time, the patient underwent significant changes in lifestyle habits, such as dieting and weight loss, and strenuous exercise, which can affect the change in sex hormone levels, thus leading to secondary amenorrhea. Therefore, for this type of secondary amenorrhea, surgical removal of the uterine adhesions along with hormonal regulation of the menstrual cycle is required to achieve good results.