A competent doctor can cure everything

As I had seen in the future, a small amount of bleeding occurred for Na Kyung.

The color was brown, and the amount was just enough to leave a mark.

This naturally became the main topic of interest in the morning study.

As I opened my mouth after displaying the presentation materials on the screen, everyone perked up their ears.

“Since admission, we have administered Yulinju and performed acupuncture and herbal injections daily. So far, we have seen improvements in facial flushing. nighttime sleep, reduction of cold sweats, and improvement in skin dryness, but….”

“This is the first time there has been vaginal bleeding, right?”

“Yes, that’s correct.”

Professor Bu Yeo-jung wrapped up my presentation and threw a question to everyone.

“So, what do you think this means?”

First-year resident Lee Yi-won raised her hand high.

Her unusually proactive demeanor drew a bit of curiosity from everyone.

“Alright. Yang, please share your thoughts.”

“First, we need to determine whether this bleeding is menstrual. Menstruation refers to ‘spontaneous bleeding that occurs at regular intervals due to hormonal changes in the endometrium. However, the bleeding in Na Kyung lacks regularity, and the amount is also insufficient for normal menstruation. Therefore, it seems to be AUB (Abnormal Uterine Bleeding) rather than menstruation.”

“That’s right. Lee Yi-won is quite insightful. So?”

“If we rule out the causes of AUB based on the test results, we are left with either Ovulatory (ovulation disorder) or Endometrial (endometrial) factors.”

This aligned with my thought process.

I followed Lee Yi-won’s reasoning with interest.

“The number one cause of bleeding in menopausal women is atrophic endometritis or atrophic vaginitis, excluding bleeding due to hormone therapy. And the characteristic of such atrophic bleeding is that it is minimal.”

Professor Bu Yeo-jung elegantly swept her long, flowing hair aside and asked.

“Atrophic bleeding, huh? Then what should the treatment be?”

“We should temporarily halt the treatment aimed at restoring ovarian function and follow the processes of Seoryu (hemostasis), Jingwon (removal of the cause), and Bogu (prevention of recurrence).”

“Is that your conclusion?”

“…Yes, Professor.”

Lee Yi-won hesitated for a moment before giving a definitive answer.

Seoryu (hemostasis), Jingwon (removal of the cause), and Bogu (prevention of recurrence) are principles in traditional Korean medicine for treating abnormal uterine bleeding in women.

Professor Bu Yeo-jung turned her head towards me without affirming or denying.

“What do you think, the attending physician, Seon-Joon?”

“There is a possibility of atrophic bleeding due to menopause, but it could also be caused by an ovulation disorder. Therefore, we cannot be certain with just this clue,”

“What should we do then? What other clues do we need?”

“First, we need to distinguish whether this bleeding is ovulatory or anovulatory.”

Suddenly, the associate professor raised his hand to interrupt me.

“Ah, let’s exclude checking for ovulation via ultrasound. We can’t just observe the ovaries with daily ultrasounds for someone like this patient who has an irregular menstrual cycle. Is there no other clue besides ultrasound?”

I heard Lee Yi-won mumbling in confusion beside me.

“Excluding ultrasound?”

But I didn’t hesitate and moved to the next slide of the presentation.

The progress chart of patient Jo Na Kyung appeared on the screen.

“So, every day when I interviewed the patient, I checked for ‘ovulation signs. Ovulation signs include the patient’s own awareness of premenstrual symptoms, changes in cervical mucus, breast tenderness, abdominal bloating, and menstrual cramps. Jo Na Kyung recently expressed that she felt bloated and that her discharge had changed to resemble egg whites.”

The mucus secreted from the cervix varies in color, viscosity, and amount according to the ovarian cycle.

During the ovulation period, the amount of mucus increases, becoming sticky and transparent. This is referred to as ‘ovulatory mucus’.

“Additionally, since I took over as the attending physician, I had the patient measure her BBT (Basal Body Temperature) every morning. This is the graph.”

As I turned to the next slide, a graph appeared.

“Oh my… When did you prepare that?”

I heard a third-year resident softly exclaim in surprise.

BBT is the body temperature measured after 6-8 hours of sufficient sleep without any activity.

‘I instructed the patient to measure her temperature with an oral thermometer under her tongue as soon as she woke up.”

A woman’s BBT shows a low temperature of around 36.5°C before ovulation and a high temperature of over 37.0°C after ovulation.

After ovulation, a structure called the ‘corpus luteum’ forms in the ovary, which secretes progesterone, raising the body temperature.

“Although the period for collecting data wasn’t very long, we could still observe changes in BBT. If you look at the graph, you can see that the BBT recently showed a brief high temperature phase. However, this high temperature phase did not last and ended shortly.”

“What does that mean?”

“If estrogen drops sharply just before ovulation, it can cause a small amount of bleeding. known as ovulatory bleeding. The short duration of the high temperature phase indicates.

“luteal phase deficiency.”

“This bleeding is ovulatory bleeding?”

“Yes. In summary, it appears that ovulation occurred in patient Jo Na Kyung, but the corpus luteum could not be maintained, preventing her from entering a normal menstrual cycle. However, the fact that ovulation occurred is a positive sign, so if we continue the current treatment, we should see good results soon.”

“One person says we should stop the current treatment, while another says we should continue because it’s going well… Who do you think is right?”

The professor asked, looking around at the residents gathered in the meeting room.

Lee Yi-won suspected atrophic conditions solely because of the high likelihood of post- menopausal bleeding.

I spoke of ovulatory bleeding based on signs of ovulation and BBT.

Everyone glanced at each other’s faces.

Though no one said it outright, it was clear who they thought was right.

The associate professor threw an additional question at me.

“I knew you were checking for ovulation signs and BBT through the chart. You understood what I said before. But the patient might not have had any ovulation response for months. In that case, we need indicators to confirm whether the treatment is effective. What were you planning to do?”

“In that case, I was also monitoring the MRS (Menopause Rating Scale).”

“Excellent.”

The professor nodded in satisfaction.

The MRS is an indicator that rates the severity of menopausal symptoms on an 11-item scale from 0 to 4.

The primary treatment goal for this patient is to restore ovulation, but I thought it would be good to also monitor the accompanying menopausal symptoms.

“After today’s rounds, let’s send patient Jo Na Kyung down to our outpatient clinic. We need to check the thickness of the ovaries and endometrium via ultrasound.”

It seemed the professor thought it was necessary to confirm via ultrasound at this point.

As the study ended and we left the meeting room, the residents whispered among themselves.

“Wow! The professor actually used the word ‘excellent.”

“Tomorrow, the sun might rise in the west.”

At that moment, Lee Yi-won hesitated and approached me.

“Doctor. So… since the professor mentioned indicators in the last study, have you been checking for ovulation signs. BBT, and MRS continuously? How did you think of that? I mean, if you’re curious about ovulation, you could just observe it with an ultrasound.”

“You need to have a regular menstrual cycle to decide when to do an ultrasound, but since this patient doesn’t have a cycle, I thought other indicators would be necessary. The more evidence you have, the better.”

At my words, Lee Yi-won stammered in a subdued voice.

“Ah… I don’t think I could have done that if I were the attending physician.”

“Professor Bu Yeo-jung must have told you.”

“That’s probably true. After scolding me a lot.”

Lee Yi-won laughed self-deprecatingly and left with a strange remark.

“I need to study more.”

Why the sudden talk about studying?

I stared blankly at her bobbed hair as she walked away briskly.

Jo Na Kyung visited Professor Bu Yeo-jung’s outpatient examination room for an ultrasound.

Her heart raced just like when she had the early menopause test at the obstetrics and gynecology clinic last time.

But this time, it was a thrilling tension accompanied by hope.

“Hmm.”

Professor Bu Yeo-jung carefully observed the ultrasound and captured the screen at a certain point.

A gray conical image froze against a black background.

Na Kyung found herself staring intently at the screen without realizing it.

“Miss, I’m sure you’re curious about what this means, right? Let’s move to the consultation room first.”

Seeing Na Kyung, the associate professor smiled and finished the examination.

As they moved to the consultation room, the screen they had seen earlier appeared on the computer.

The associate professor pointed at the monitor with a pen.

“The oval-shaped pouch you see on the screen is the ovary. And do you see the black circle inside? That’s the follicle. It’s where the egg develops. At this size, the follicle has grown and is about to ovulate. However, the post-ovulation process has failed. The endometrium has also thickened to some extent.”

“Professor, then, does that mean…?”

“Yes, the ovary has started functioning again.”

“Congratulations, miss. You’ve passed a significant hurdle. Of course, there’s still a long way to go. We need to monitor for three more regular menstrual cycles after menstruation.”

The mention of a long way to go didn’t register in Na Kyung’s ears.

Before she knew it, she was covering her mouth with her hand, on the verge of tears.

“Thank you. Thank you…!”

“Hmm. It seems there’s someone else who should be thanked.”

“Ah!”

At the associate professor’s words, Na Kyung gasped softly.

“It seems starting treatment early worked in your favor.”

“Meeting that doctor was truly a stroke of luck for me.”

Thinking back, it was just a trivial occasion that led to their conversation.

What if she hadn’t spoken with Seon-Joon that day?

Just thinking about it made Na Kyung dizzy.

“I don’t think you need to stay hospitalized any longer. You can be discharged and come to the outpatient clinic.

“Yes, understood!”

Even though her illness wasn’t completely cured, Na Kyung was already beaming with joy.

Seeing her, the associate professor gave her another warning.

“Since your ovarian function is weaker than others, you need to maintain a regular and healthy lifestyle. It may also be more difficult for you to conceive, so please come back for a consultation before attempting to get pregnant. You also need to be careful to avoid miscarriage after becoming pregnant.”

“Miscarriage? So, do I have to just lie down if I get pregnant?”

“I’m not saying to be that cautious. In traditional medicine, there’s a treatment called An-tae that prevents miscarriage. You can take herbal medicine for An-tae.”

“Oh, I see. It seems it’s okay to take herbal medicine during pregnancy.”

“Of course. Many patients with threatened miscarriage visit our traditional obstetrics and gynecology clinic. In traditional medicine, we refer to miscarriage as Taedongbul-an.
and have been providing treatments to prevent it for hundreds of years. Don’t worry; a traditional doctor will prescribe it safely.”

Hearing the professor’s explanation, Na Kyung felt relieved.

She thought it would be good to be managed by a reliable traditional doctor for her menstruation, pregnancy, and childbirth, given her weak ovarian function,

And she felt fortunate to have found such a trustworthy traditional doctor.