In clinical practice, we often encounter patients with dysfunctional uterine bleeding who need to stop bleeding, or patients with menstrual disorders who need artificial cycle therapy. At this point, in the face of the dazzling array of hormonal drugs, how do you tell which one to use? Let’s start with hormonal contraceptives. 1, compounded short-acting oral contraceptives are combined estrogen + progestin, with ovarian suppression, of which all estrogen is ethinyl estradiol. Ethinylestradiol is a synthetic high-efficiency estrogen with high activity and strong effect. However, there are different types of progestogens with diverse effects, making each contraceptive unique in its own way. However, it should be noted that ethinyl estradiol may increase the risk of thrombophilia, causing changes in the coagulation system and side effects such as nausea, breast swelling and vomiting. Therefore, it is necessary to exclude contraindications to the use of the drug. (1) Mafolone (deprenyl + ethinyl estradiol) Mafolone is a third-generation contraceptive pill and is inexpensive. It is often used in patients with severe anemia and dysfunctional uterine bleeding. It inhibits the secretion of estrogen from the ovaries by suppressing the secretion of gonadotropins by the pituitary gland, resulting in a rapid reduction or cessation of bleeding due to atrophy of the endometrium. Momofolone has high estrogen and progesterone activity, so it is effective in stopping bleeding; after stopping the drug, it can induce a transient enhancement of feedback regulation of the ovarian-pituitary-hypothalamus axis (HPO axis). However, because of its ovarian suppressive effect, it may aggravate the suppression of hypothalamus-pituitary gland in patients with poor HPO. Therefore, it is only used clinically to stop bleeding in patients with fertility. Application: To stop hemorrhage in patients with severe anemia during the reproductive period. Dosage: 1 tablet po q8 h (or q6 h), usually 1-3 days after the drug is used, the bleeding stops or decreases significantly. If there is no breakthrough bleeding after dose reduction, continue to reduce the dose: 1 tablet po qd × 3d, and maintain for 21 days if there is still no bleeding. (2) Da-Ying-35 (cyproterone acetate + ethinyl estradiol) The unique hypoandrogenic effect of cyproterone acetate in Da-Ying makes it an essential drug for patients with polycystic ovaries. It inhibits the secretion of gonadotropins (LH) through negative feedback on the hypothalamic-pituitary-gonadal axis, resulting in lower testosterone levels and reduced androgen production; it also inhibits androgen activity by competitively binding to androgen receptors at the prostate target cell level. It is mostly used in clinical practice to improve acne and hirsutism caused by hyperandrogenemia in patients with polycystic ovaries. Application: Patients with hyperandrogenemia of polycystic ovaries. Dosage: Start taking 1 tablet daily on the 5th day of menstruation and stop after 21 days, usually after 2-3 days of withdrawal bleeding. Start the next box on the 5th day of bleeding (bleeding may not be over by then). (3) Eusemide (Drospirenone + Ethinyl estradiol) Eusemide is a fourth-generation contraceptive, with the progestin drospirenone, which has an anti-aldosterone effect and is effective in reducing sodium retention caused by estrogen. It seems to have a “weight loss” effect. However, it is also more expensive. Applications: Women who are concerned about their appearance and need to adjust their menstrual cycle. Dosage: Take 1 tablet daily for 21 days. After 7 days of discontinuation, the next box of pills is started, during which withdrawal bleeding usually occurs. Bleeding usually starts 2-3 days after the last pill of the cycle and may not be over by the time the next pill is started. 2. Other estrogen combinations (1) Clomid (estradiol valerate + cyproterone acetate) is very similar to the pill and also comes in 21 tablets. The major difference is that the first 11 tablets of Clenbuterol are estrogen-only preparations – estradiol valerate – and the last 10 tablets are a combination of estrogen and progestin. It simulates the endocrine changes of the ovaries during the natural menstrual cycle, without suppressing FSH, ovulation or ovarian function. Therefore, for patients with already poor ovarian function, such as women who need to adjust their menstruation after pubertal uterine bleeding, or patients with premature ovarian failure or low estrogenic amenorrhea, artificial cycles are more effective in regulating menstruation. Applications: Adjustment of menstrual cycle in women with pubertal meritorious hemorrhage or in patients with perimenopausal syndrome (with uterus and low estrogen); low estrogenic amenorrhea. Dosage: 1 tablet daily for 21 days without interruption: 11 tablets of estradiol valerate and 10 tablets of estrogen-progestin combination. Take for 21 days. Start the next box after 7 days of discontinuation. (2) Fentanyl (estradiol + dydrogesterone) Fentanyl consists of 28 tablets, the first 14 of which are mono-estrogenic – estradiol – and the second 14 of which are progestogenic – dydrogesterone – and are similar to Clomid in that they can be used as estrogenic sequential therapy to simulate an artificial cycle. In addition, the estrogen in Fentanyl is 17β-estradiol, which does not require biotransformation to exert estrogenic effects and has better vaginal absorption than oral administration. Therefore, it can be used for intravaginal administration, such as estrogen supplementation in patients with thin endometrium in assisted reproduction. Application: Patients with thin endometrium in assisted reproduction techniques. Dosage: For ovulation monitoring when follicle diameter ≥ 14 mm and endometrium < 7 mm, estradiol tablets are administered intravaginally at bedtime at 0.5 mg/d until ovulation when it is changed to 0.5 mg/qod and discontinued 2 weeks after ovulation. HRT: 1 oral tablet daily for 28 days; 1 oral estradiol tablet (1/2 mg) daily for the first 14 days and 1 oral estrogen-progestin combination tablet (containing estradiol 1/2 mg and detrofloxacin 10 mg) daily for the last 14 days. At the end of one course of 28 days, the next course of treatment will be started on day 29. It is important to note that Fentanyl is available in estradiol 1 mg and 2 mg sizes.