Concluded Case

secondary Amenorrheoa

A female of 30 yrs came with complaints of secondary Amenorrheoa since 3 months.... Her upt was negative and her abdominal usg was normal and her hb was 13.1...her tft was normal.... She was prescribed meprate 10 t.d.s for 5 days... After that also she didn't had her menses.. And again she was prescribes primolut n 5 t.d.s for 5 days and gynovit b.d.... How to proceed this case further....

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Vijaya shanthi , Endometrium should be primed by estrogen followed by progesterone. In this case of secondary amenorrhea, you've given progesterone. Only a estrogen primed endometrium , progesterone will act . Withdrawal of progesterone is followed by bleeding. Thus is known as progesterone challenge test. When there is no progesterone Withdrawal bleeding, then give estrogen tab progynova 2 MG twice daily for 5 days followed by tab crina NCR 15 MG once daily for 5 days. Wait for 10 days after stopping the drug. She will have estrogen + progesterone Withdrawal bleeding now. Do a TVS scan and see for endometrial thickness. If there is no Withdrawal bleeding after giving estrogen and progesterone, then she needs evaluation.

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Vijaya shanthi , Endometrium should be primed by estrogen followed by progesterone. In this case of secondary amenorrhea, you've given progesterone. Only a estrogen primed endometrium , progesterone will act . Withdrawal of progesterone is followed by bleeding. Thus is known as progesterone challenge test. When there is no progesterone Withdrawal bleeding, then give estrogen tab progynova 2 MG twice daily for 5 days followed by tab crina NCR 15 MG once daily for 5 days. Wait for 10 days after stopping the drug. She will have estrogen + progesterone Withdrawal bleeding now. Do a TVS scan and see for endometrial thickness. If there is no Withdrawal bleeding after giving estrogen and progesterone, then she needs evaluation.

Valuable opinion
1

Don't give too much hormones, wait 10 to 14 days for withdrawal bleeding after last dose . Also get investigations for other causes like PCOD etc

Thanks Dr.Dinesh Gupta, Dr.Sandeep Ghodeker, Dr. Pushker Bhomia, Dr. Vijaya shanthi S
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NEED'S .. HORMONAL STUDY .. GYNECOLOGICAL EXAMINATION WITH EXPERTS OPINION .. HORMONAL TREATMENT ..

Thank you doctor
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HEALTHY DIETavoid junk food Regular Exercise Must Meditation n Yoga must to releive anxiety. Sound sleep is essential. Fertility is controled by Kaph & MC by Vata. So Acc to Charak Til tail is best for all Vata. Til tail abhyang If obess reduce wt by KOLKULATHHADI CHURN Udvartan & Oral Arogyavardhini & Medohar/Triphala Guggul. Takradhara with musta, amalaki churn to regulate Hypothalamo-Pituitary Axis. TO REGULATE MC 1-Kumariasav+Ashokarishta 2-Evecare Syp 3-Rajpravartini vati 4-brihat Shatawari ghrut. TO INDUCE OVULATION can use Trivang bhasma pushpadhanva ras Nashtapushpantak. In PROLACTIN INCREASED LEVEL Musalikhadiradi kashay ela, tvak,musta? Guduchi, amalaki, Nagkesar. ANULOMAN IS MOST IMP- CAN USE Gandharvhastadi kashay/ triphala/ abhayarishta.

Progesterone level. Ovulation study. SHBG

Valuable opinion
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SUGGESTIVE. OF SECONDARY. AMENORRHOEA NEEDS FURTHER. EVALUATION. AFTER HORMONAL. WITHDRAWL AND REPEAT. U S G URINE. CULTURE. AND. SENSITIVITY

Consult gynaecologist & Endocrinologist

Thank you doctor
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P cod

But her usg is normal
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If progesterone challenge test negative then two probable diagnosis either Hypoestrogenemia or asherman syndrome. To differentiate between these two estrogen challenge test should be done. If estrogen challenge test positive, hypoestrogenimia will be confirmed. To rule out causes of hypoestrogenimia either ovarian cause or pituitary cause, further harmonal study should be done like s. LH, S. FSH, S. prolactin, S. AMH

Check her TSH and serum prolactin.Increased tsh or increased prolactin levels may be the cause of sec amenorrhoea.

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