Progesterone and estrogen trials should be done in patients with amenorrhea

Amenorrhea is a common cause of female infertility and can be caused by a variety of factors. Therefore, the cause of the disease should be identified first and the site of the disease should be found before symptomatic treatment can be taken. Patients with amenorrhea should undergo progesterone and estrogen tests.

Progesterone test

1. Test methods

Administer 20 mg of progesterone intramuscularly every day for 3 to 5 consecutive days; or administer 5 to 10 mg of medroxyprogesterone every day for 5 to 7 consecutive days. The test is positive if withdrawal bleeding occurs 3 to 7 days after stopping the drug.

2. Results Analysis

A positive progesterone test indicates that the endometrium is functional, which can rule out uterine amenorrhea. The ovaries have the function of secreting estrogen, and the endometrium can only respond to progesterone after being affected by a certain level of estrogen. The shedding and bleeding indicate that amenorrhea is not caused by a lack of estrogen, but by a lack of progesterone caused by various anovulations.

A negative progesterone test suggests the following possibilities: First, the ovarian function is low and there is no appropriate estrogen effect on the endometrium; second, the ovarian function is normal, but the endometrium is defective or damaged and cannot respond to estrogen, which means that uterine amenorrhea is not ruled out; third, pregnancy is not ruled out.

Estrogen test

1. Test methods

Patients with amenorrhea who have a negative progestin test should take 1 mg of diethylstilbestrol or 10 μg of ethinyl estradiol or other estrogens with equivalent biological effects orally every day for 20 consecutive days. During the last 3 to 5 days, add 20 mg of progesterone intramuscularly every day. Observe for withdrawal bleeding 3 to 7 days after stopping the drug.

2. Results Analysis

If there is withdrawal bleeding in the estrogen test, it means that the endometrium responds to the effects of estrogen and progesterone, and can undergo normal growth and shedding changes. The cause of amenorrhea should be in the ovaries or higher. Further measurement of sex hormone levels should be performed to confirm the diagnosis.

No bleeding in the estrogen test suggests that the disease may be in the uterus, that is, uterine amenorrhea