Menstrual bleeding has an individual duration and volume of blood loss. But in the medical community, a framework has been defined that makes it possible to distinguish pathology from the norm.
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Regular abundant menstruation can lead to iron deficiency anemia, which will affect the condition of internal organs, hair and nails. Methods of treatment depend on the causes and severity of the pathology.
1. What periods are considered abundant?
The duration of the normal monthly cycle is in the range of 21-35 days.
During menstruation, it takes from 3 to 7 days, while the volume of blood extracted usually does not exceed 80 ml for the entire period of bleeding.
There is often a pattern between the total cycle length and the length of the menstrual period: with a short cycle, bleeding lasts a minimum number of days.
Abundant menstruation may be different in nature.
Menorrhagia, or hypermenorrhea, is a rhythmic menstruation that lasts more than 7 days, and blood loss is 80 ml or more.
There may be a large number of blood clots in the discharge, and anemia of varying degrees in the analysis.
If the cycle lasts less than 21 days and is accompanied by regular heavy bleeding, then this is called polymenorrhea.
With an irregular menstrual cycle, bleeding may occur, which is called metrorrhagia, or menometrhagia.
The intervals between them are different in time, the volume of blood loss can vary from scanty discharge to massive bleeding.
2. Causes of bleeding in adolescents
In adolescents, abundant menstruation occurs in the first three years after menarche and indicates inconsistency in the work of hormonal systems and the maintenance of homeostasis.
They can be ovulatory and anovulatory. The second type is much more common and is caused by atresia or persistence of the ovarian follicle.
The concentration of estradiol menorrhagia in a teenager may be hyper-, hypoestrogenic or normoestrogenic.
Various factors can lead to a cycle violation:
- 1 Psychological stress.
- 2 Acute psychogenic situation.
- 3 Alimentary failure.
- 4 Overweight.
- 5 Hypovitaminosis.
- 6 Adverse ecological situation.
At the hormonal level, severe bleeding is accompanied by a persistent decrease in the blood of LH (luteinizing hormone) and FSH (follicle-stimulating hormone) or, conversely, with an increase in the concentration of LH. Sometimes hormone levels change chaotically.
Hypoestrogenic type of menorrhagia occurs most often. It usually occurs in adolescents of a fragile physique, with a lack of body mass, whose sexual development may lag a little behind the age norm.
Normal estrogenic bleeding occurs in girls 13-16 years old, with a harmonious physique.
Hyperestrogenic menorrhagias are characteristic of the beginning of the formation of a cycle or age of 16-17 years. External sexual characteristics in girls of this type are sufficiently developed.
When examining adolescents with hypermenorrhea, it is necessary to exclude endometrial pathology, which may be the cause of large blood loss.
3.1. Inflammatory processes
Inflammation of the endometrium is often non-specific in nature and is a consequence of the spread of infection by the ascending path from the vagina through the cervical canal.
It leads to an increase in blood flow, swelling, changes in the thickness of the endometrium. All this changes the process of separation of the mucous layer from the muscle.
Mediators of inflammation, waste products of bacteria violate the local blood clotting, which leads to prolonged menstruation with profuse bleeding.
With menorrhagia associated with inflammation, the woman has additional symptoms in the form of abdominal pain, fever, impairment of general well-being. They need to be differentiated from signs of premenstrual syndrome.
In this disease, the endometrium grows through the basement membrane and penetrates into the muscle layer, where it should not normally be.
Cavities lined by mucous membrane cells can form. They function under the influence of hormonal background; they also cause desquamation and separation of the upper layer.
Menstruation for endometriosis lasts several days, and at the end, instead of a spotting brown discharge, copious, dark brown or reddish appear.
Abundant menstruation with endometriosis is also associated with impaired separation of the mucous membrane, uterine motility and hormonal imbalance.
3.3. Uterine myoma
The increase in blood loss during menstruation with myoma is associated with 2 factors: the size and location of the nodes and concomitant endometrial hyperplasia.
Increasing the thickness of the mucous membrane (endometrial hyperplasia) leads to the fact that it lasts longer, it takes more time to complete this process. Bleeding is usually significant.
Large nodes change the shape of the uterus and the location of muscle fibers. This leads to disruption of the process of separation of the endometrium. Weak contractions of the myometrium do not help rapid emptying of the uterus and stop bleeding.
To a greater extent, the menstrual cycle is affected by nodes that grow inside the cavity. Less affected by subserous foci.
In polycystic ovary syndrome (abbreviated as PCOS), cycles become anovulatory.
Maturation of the follicle occurs, but there is no release of the egg. The absence of the corpus luteum, concomitant hyperandrogenism lead to disruptions of the menstrual cycle, irregular and abundant menstruation.
3.5. Intrauterine device
Contraceptives installed in the uterine cavity (IUD), create a zone of aseptic inflammation, which prevents the implantation of the embryo. The state of the endometrium changes, the contractility of the uterus increases.
These changes also affect the menstrual cycle. If before the installation of the uterine helix, the monthly periods had an average duration, then after the manipulation they become abundant, with clots lasting more than 7 days.
Sometimes, on the background of the IUD, endometritis can develop, then the symptoms of menorrhagia aggravate.
3.6. Aborted pregnancy
In medicine, there is the concept of biochemical pregnancy, which the woman usually does not suspect. It is a consequence of a violation of implantation and interruption of it at a very early date.
Conception in this case can only be determined by a blood test for HCG and progesterone. Their levels increase, but may remain at the upper limit of normal, and after the onset of menstruation they decrease.
A biochemical pregnancy ends in a miscarriage at a time when it is still impossible to discern the fertilized egg in the uterus by ultrasound.
In this case, a woman may have a slight delay, after which stronger monthly periods begin.
This condition does not require special correction. Most women and do not realize that they had a terminated pregnancy.
3.7. Hormonal changes after childbirth
Normally, after childbirth, bleeding (lochia) lasts up to 2 weeks, after 10-14 days they become mucous and acquire a yellowish, yellowish-gray color. They do not have an unpleasant smell.
If the bleeding persists for too long, there is no tendency to reduce it, the stomach hurts, you should immediately consult a doctor. Most often this is due to complications:
- 1 Endometritis.
- 2 Preservation of parts of the placenta and clots in the uterus.
- 3 Placental polyp.
- 4 Violation of tissue regeneration.
In some women, abundant menstruation is observed in the first months after birth.
During breastfeeding, periods are usually absent due to the influence of prolactin. As a rule, the first cycle ends with heavy bleeding.
The likelihood of menorrhagia increases in patients who have given birth through cesarean section and who have postpartum complications.
Normally, after 2-3 months, menstrual flow should become habitual in duration and intensity.
3.8. Diseases of other systems and organs
Increased blood loss during menstruation may be associated with endocrine, cardiovascular and other diseases.
- 1 Often these failures occur when thyroid dysfunctionglands. An increase in the menstrual cycle can be observed both with its hyperfunction and hypofunction.
- 2 Obesity is an endocrine pathology., which is accompanied by cycle violations. This is due to hormonal imbalance, increased estrogen levels and hyperinsulinemia.
- 3 Abundant periods can be associatedand with oncopathology. Prolactin-producing tumors disrupt the menstrual cycle and lead to menorrhagia.
- 4 Severe renal failure leads to developmentso-called uremic coagulopathy and menorrhagia.
- 5 Blood Coagulation Disordersmay be both hereditary and acquired.
Blood clotting may be affected by:
- 1 Treatment drugs coagulability reducing (aspirin, heparins).
- 2 Lack of vitamin K, calciumin food or a violation of their absorption in the intestines.
- 3 Protein deficiency and liver failurein which peptide synthesis suffers. This causes a lack of fibrinogen and other proteins that are responsible for blood clotting.
- 4 Congenital Coagulation Diseases (villerbrand's disease, thrombocytopenic purpura, etc.) are manifested not only by strong menstruation, but also by a tendency to gingival bleeding, nasal bleeding, bruising and bruising.
4. The influence of external factors
The hypothalamus-pituitary-ovaries system obeys the cerebral cortex.
Psychological and emotional stress leads to the development of stress hormones, which affects the menstrual cycle.
Therefore, the duration of bleeding may vary. Changes in the cycle can cause:
- 1 Climate change.
- 2 Change of time zones.
- 3 Stress at work.
- 4 Psychological tension in the family.
- 5 Heavy physical labor.
- 6 Lack of sleep and rest.
The increase in the duration of bleeding and the volume of secretions can occur under the influence of a lack of vitamins and microelements, which occurs when exhausting diets, vegans.
Some women notice an increase in bleeding during travel, which is associated with acclimatization.
The external factors include the action of certain drugs. Women for the normalization of the menstrual cycle in the second phase of the cycle is sometimes prescribed Duphaston. After completing the course of treatment, periods may be somewhat stronger.
5. Causes during menopause
In women after 45 years (pre-menopausal age), the duration of menstruation may also vary.
Some patients notice that the discharge becomes very abundant, the gaskets last only a few hours.
The causes of such deviations are most often the following pathologies:
- 1 Endometrial hyperplasia, polyps.
- 2 Myoma (leiomyoma).
- 3 Endometriosis.
- 4 Carcinoma (cancer).
The most common anatomical causes of menstrual disorders in premenopausal women are uterine polyps and submucosal fibroids.
Transvaginal ultrasound and endometrial biopsy are not sufficiently informative, the percentage of detected anomalies is higher when using sonogesteroscopy with saline.
The essence of the method is that a sterile isotonic solution is introduced into the uterus with continuous visualization of the endometrial surface using a transvaginal ultrasound transducer.
The study is more informative for detecting uterine fibroids (sensitivity 87%, specificity 92%) than for endometrial polyps.
It must be remembered that after 40-45 years, cycles without ovulation are increasingly being observed, when the follicle can exist without maturation for a long time.
6. Treatment methods
Affect the menstrual cycle in different ways. If the cause of the bleeding is established, the treatment is prescribed depending on it.
- 1 In case of inflammatory processes, a course of antibiotics is prescribed in accordance with the sensitivity of the detected flora. After this, a period of rehabilitation is usually required.
- 2 If the cause of heavy menstruation is the IUD, then it is removed.
- 3 Fibroids in young women who want to preserve reproductive function are treated in non-invasive ways: uterine artery embolization, FUS ablation. Hormonal treatment has a short-term effect. Submucosal nodes are removed by vaginal access.
- 4 Endometriosis is treated with hormonal and surgical means. The effect of drug therapy is temporary.
- 5 Diseases of the thyroid gland, prolactinemia require the attention of an endocrinologist. In hyperthyroidism, the menstrual cycle is often normalized only after surgical treatment.
6.1. Bleeding stop
You can affect blood loss during menstruation with the help of drugs:
- 1 Etamzilat sodium (Ditsinon) in the first days it is used as an injection into a vein or muscle, after which you can switch to pills. For women, whom heavy menstruation is disturbed regularly, you can start taking Ditsinona at home, 3-4 tablets per day 5 days before they start.
- 2 Vikasol is a drug analogue of vitamin K. The solution is injected intramuscularly in 1 ml up to 6 times per day. In tablets of 15 mg administered 4 times a day.
- 3 Aminocaproic acid use in the conditions of a hospital. To stop the bleeding, it is administered intravenously. The daily dose is 5-30 grams and depends on body weight.
- 4 Tranexamic acid apply both inside and intravenously. Dose and frequency of administration is calculated individually.
Non-steroidal anti-inflammatory drugs are used in girls during the period of menstruation to stop bleeding. They are able to reduce blood loss by 30-38% due to inhibition of prostaglandin synthesis.
Ibuprofen is prescribed 400 mg 4-6 times a day on menstruation days.
6.2. Hormonal drugs
For long-term therapy using progestins (mini-pili) orally from 5 to 26 day of the cycle. In the pharmacy network, they are represented by drugs:
For women who do not plan pregnancy, an intrauterine system Mirena is installed, which contains levonorgestrel.
This substance significantly reduces blood loss, so the helix is not only contraceptive, but also a therapeutic agent.
Teenagers with the purpose of hemostasis with strong periods have to take hormonal drugs from the group of combined oral contraceptives.
They are prescribed if there is no effect from the use of other drugs, and in the absence of contraindications.
Different schemes are used, but the following is more common:
- 1 1-4 days - 4 tablets per day.
- 2 5-7 days - 3 tablets.
- 3 8 day - 2 tablets.
- 4 In the following days - 1 tablet to the end of the package.
After that, for 3 cycles, it is recommended to use monophasic oral contraceptives to normalize the condition.
7. Surgical treatment
Surgical correction methods are also used to reduce blood loss. Interventions are carried out using a hysteroscope in a hospital or outpatient setting.
Before the operation, Danazol is prescribed to reduce the thickness of the endometrium.
Under the control of a hysteroscope, surgical removal or laser ablation of the endometrium is performed. This procedure is performed under general anesthesia and requires hospitalization.
On an outpatient basis, the following treatment methods are used:
- 1 Cryodestruction.
- 2 Radio frequency ablation.
- 3 Microwave ablation.
- 4 Laser therapy.
With the ineffectiveness of these treatments, older women may offer hysterectomy.
Folk remedies for the treatment of heavy periods should be used only in consultation with your doctor. It is known about some influence of nettle on the blood coagulation system, but the effect of it is cumulative and develops within a few days.
With repeated bleeding, it is necessary to consult a doctor in order to exclude the pathology of the reproductive system. A full examination will help prescribe treatment in time and prevent the development of complications.
The main causes of heavy periods
Doctors say that the normal amount of bleeding in the first two or three days is 100-150 ml. If the amount of excreted fluid is significantly exceeded, then it is necessary to consult a doctor, because too heavy periods can cause anemia. Along with this, other symptoms appear in girls and women, for example:
- severe pain
- dizziness and nausea
- loss of consciousness
All these symptoms correspond to physiological abnormalities such as metrorrhagia.
Metrorrhagia is a phenomenon that is accompanied by very abundant secretions during menstruation. This is a violation in the monthly cycle, which does not affect its duration. But there are women who have it all the time, and do not carry any pathogenic effects - for them this is the norm.
In adolescents, for example, a large amount of discharge is also the norm, as is the uneven duration of the cycle. This is due to the hormonal imbalance of the young growing organism.
But, if this is not your norm, and you are not a teenager, then remember: metrorrhagia is not a diagnosis, but a symptom of a certain disease, therefore, when it appears, you should immediately consult a doctor.
The natural causes of a large amount of discharge include:
- severe stress
- too harsh intense exercise
- climate change
- misuse of hormones and contraception
- teenage cycle setting
- postpartum condition.
These reasons are not dangerous, but require you to listen to the body. If you do not have these reasons, and copious discharge does not go through the first menstruation, then medical intervention is necessary.
As for the causes that mean pathological diseases, then they include:
- Imbalance of hormones - a sharp change in the amount of hormones in a normally functioning organism.
- Intrauterine contraceptive spirals. This is, firstly, an outdated method of contraception, and, secondly, very dangerous, as it provokes blood loss. To secure the life of a woman, the spiral must be removed.
- Endometritis - profuse menstruation with clots, accompanied by severe abdominal pain. At the same time, the inflamed uterine membrane greatly increases in size and leaves the body unevenly and for a long time.
- Bad coagulation - a violation of blood clotting due to poor nutrition, malfunction of the liver or heredity.
- Inflammation of the pelvic organs - an infection followed by inflammation of the ovaries, uterus or fallopian tubes. The main symptoms here are fever, heavy discharge and severe abdominal pain.
- Complicated childbirth, abortion, miscarriage.
- Impaired uterine tone - the uterus is reduced unevenly. It happens that a lot of blood is released, and sometimes it happens that the discharge does not go out for a long time, coagulates and then large clots appear.
- Adenomyosis - endometrial tissues germinate in the uterus, and there they continue to develop and reject - to menstruate. This leads to rupture of the muscles of the uterus and the release of a large number of secretions. In this case there is a very strong pain.
- Benign tumors - uterine myoma, endometrial polyps. In such pathologies, severe pains are present, and a large number of clots are observed with regulators.
These reasons are very serious, here you need to urgently consult a doctor and begin treatment. These pathologies lead to anemia, infertility and other terrible consequences.
Causes of long frequent and heavy periods during menopause
As a rule, every woman after 50 years has a menopause, or, as it is also called, menopause. It is characterized by a decrease in the performance of the ovaries, a violation of the cycle, followed by its termination.
With menopause, long and copious menstruation is not the norm. But, not all women know about it.
Long bloody discharge may be far from menstruation. And, for example, uterine bleeding. So how to stop the copious periods? Contact a specialist! Only he will assign you the right advice and treatment.
The causes of bleeding may be different. The most frequent of them are:
- Endometritis. Intensive menstruation with endometriosis is also accompanied by severe pain.
- Uterine fibroids.
- Hormonal imbalance in menopause.
- Disorders of the thyroid gland.
- Endometrial polyps.
Therefore, when the appearance of heavy periods, you should consult with a specialist.
What to do?
To understand how to deal with such menstruation, you need to understand the root cause of its occurrence. If these reasons are not pathogenic, then you can treat yourself, otherwise you need to go to the doctor.
To understand whether they are pathogenic or not, you can by certain criteria. Independently treat heavy bleeding during menstruation is possible if:
- You have such symptoms for the first time.
- There was no delay.
- No dark clots or pus
- You have a normal state of health.
- No pregnancy.
- No gynecological pathologies, which were known to be known.
In this case, you can do without consulting a doctor. With heavy periods with clots, you need to limit physical activity, eat regularly and properly, get enough sleep. You can also take vitamins C and P - Askorutin, or drink herbal teas or tinctures of herbs.
You can not prescribe medication alone. Consultation with your doctor is necessary!
What medications help, if monthly abundant?
If the symptoms described above appeared for the first time, then you can take such drugs that will help minimize discomfort and stop pain:
- Calcium preparations
- Vitamin B12,
- Folic acid,
Severe pain relieves such drugs as:
Recall: if the drugs do not help or become worse - you need to consult a doctor.
Prolonged periods - symptoms of diseases such as uterine fibroids or other organs, fibromas or polyps. Only surgical intervention will help here. These are complex pathological diagnoses requiring a complete examination with further surgical intervention.
If you have found a uterine myoma in a woman over the age of 50, then it is simply removed, but in young girls of childbearing age, hysterectomy is performed only in the most difficult cases. Therefore, very abundant periods in young girls - not a sentence. It is possible medical treatment.
Opinion of doctors
For any health problems you can not self-medicate. Especially when it does not help. Need to contact highly qualified specialists.
Thus, you know exactly what to do with heavy periods. The reasons for their appearance and the features of treatment are also clear. Physical health and hormonal balance - the fundamental regular and proper menstrual cycle. For any physiological or physical changes, consult a physician. Passion for self-treatment can lead to complex pathological diseases.
What is considered pathology?
The cycle duration is on average 28 days, but the duration may vary individually. Directly for periods of 4-7 days. If the discharge is observed more than the maximum term, pathology should be suspected.
Menstruation may be accompanied by minor painful sensations, but should not disrupt the usual rhythm of life. If painful periods are forced to take time off from work, spend time lying in bed, then this is also a reason to consult a doctor.
The amount of blood loss is crucial. It should not lead to the development of anemia, signs of which are dizziness, tachycardia, darkening of the eyes, shortness of breath. How to determine is abundant menstruation or bleeding: you need to calculate the frequency with which the pads change. If a tampon or sanitary pad overflows within an hour, this is not the norm.
Detachable endometrium may be in the form of small cords or clots. But sometimes bleeding occurs with the release of large dark clots and a small amount of light blood. This condition also has its reasons.
Why does the discharge pattern change?
The causes of heavy periods can be different - from minor functional disorders to severe pathologies.
Pathology of the uterus
In severe myomatosis, an increase in the internal area of the uterus, a change in its shape. Therefore, the endometrium is separated longer, it is more, and hence the bleeding is more abundant. Endometriosis is a pathological proliferation of the endometrium. It grows into the muscle layer of the uterus. The separation is accompanied by pain, profuse blood loss. Both pathologies develop against the background of hyperestrogenia, which contributes to endometrial hyperplasia. Intermenstrual bleeding is also characteristic of this condition.
Causes of heavy periods with clots may be in the change in the shape of the uterus. In the presence of intrauterine adhesions that interfere with the normal outflow of blood, it lingers inside, manages to curl up and comes out in the form of clots.
It is worth guarding when there are heavy periods with clots after 45 years. Especially if the woman has already entered a period of menopause, and menstruation was absent for a long time. The cause of such changes can be cancer.
Abortion and childbirth, the presence of the Navy
If there were complications during the birth of the child or in the postpartum period, for example, bleeding or inflammation, the first periods after childbirth can be very abundant. After cesarean section, such changes in the nature of the discharge are also a consequence of trauma to the uterus. During breastfeeding, menstruation is absent for a long time. But at the initial stage of recovery cycle monthly can last longer than usual.
The change in the duration and intensity of menstruation is observed after intrauterine manipulation:
Also, do not forget about the possibility of spontaneous abortion. Sometimes a woman does not know about her pregnancy. Often this situation is observed with an irregular cycle. Then a delay of several days is perceived as the norm. But the fetus does not attach in the uterus, after a short delay, more pronounced than usual bleeding begins.
The presence of an intrauterine device increases the likelihood of changes in blood loss. Only in the case of the use of the Mirena intrauterine system with progestogens with endometriosis and myoma, the volume of lost blood will decrease, and the number of critical days will decrease.
The use of drugs that thin the blood can make menstrual bleeding longer. This applies to Aspirin, a group of antiplatelet agents and anticoagulants, which are used in the treatment of thrombosis and blood clotting pathologies.
Medical abortion is carried out with the help of drugs that lead to the death of the ovum and its natural rejection. Sometimes with an incomplete medabort there are abundant periods. This condition must be monitored with an ultrasound scan, and if complications develop, medical care will be required.
Abundant periods after the course of Duphaston are a consequence of the effect of the drug on the endometrium. Under the influence of the hormone in it increases the growth of blood vessels. A looser mucous membrane during menstruation is actively rejected.
In the period of formation of the monthly cycle in adolescents, bleeding different in nature may alternate. The same can be said about women who are on the verge of menopause.
Diseases and hypovitaminosis
Pathologies of the endocrine organs, blood coagulation systems, including congenital ones, can affect the volume of blood loss during menstruation. Lack of vitamins C, K, P, as well as calcium, violates the process of blood coagulation, which threatens to deteriorate during menstruation.
There is also evidence of the nature of nutrition. A diet with a predominance of lactic acid products - kefir, cottage cheese, yogurt - leads to an increase in the synthesis of substances in the liver that thin the blood. Consequence - deterioration of its coagulability.
Hemostatic agents belong to different groups. The choice of a particular remedy may depend on the cause of heavy menstruation.
It is a vitamin preparation whose action is aimed at strengthening the walls of blood vessels. But the effect develops gradually, not earlier than after 3 weeks of regular intake. Therefore, it is used for prophylactic purposes, as well as after intrauterine manipulations. The analogue is the drug Rutaskorbin.
Vitamin preparation, a source of vitamin K. This is a component of prothrombin - a protein that provides blood clotting. For the appointment of a drug, you need to bring the diagnosis and prove that the cause of bleeding is just a vitamin deficiency.
- Hemostatic tablets Ditsinon (Etamzilat)
It speeds up blood clotting, but does not affect blood clots and does not constrict blood vessels. It is allowed to use it for metrorrhages, profuse bleeding in women with an intrauterine device. But the drug is prohibited for use in pregnant women and nursing. Despite the fact that etamzilat does not increase the likelihood of blood clots, it is not used for thrombosis. The drug increases clotting due to the thrombocyte link, therefore, in patients with thrombocytopenia, the effect of therapy will not manifest. In mild cases, Ditsinon can be used in pill form, in case of severe blood loss, treatment is started with intravenous injections, then transferred to intramuscular and intramuscular tablets.
In the form of tablets used in cases of bleeding associated with the activation of fibrinolysis - the dissolution of the clot, which was formed at the site of the bleeding vessel.
Additional effects of the drug are: analgesic, anti-inflammatory, anti-allergic and anti-infective.
Tranexamic acid is used for heavy menstruation and uterine bleeding. But it can cause thrombosis. Therefore, in case of pathologies of the coagulation system, the presence of thrombosis in the past, its use is not recommended.
For symptomatic therapy using iron supplements, folic acid, vitamin C. They are necessary for the restoration of blood, treatment of anemia. Iron and ascorbic acid are antagonists - in the presence of vitamin C, ferrum is absorbed more actively. Folic acid affects the division of new red blood cells, the formation of high-grade hemoglobin.
With heavy and prolonged menstruation, the use of herbs can help reduce the amount of blood loss, improve blood clotting, fill the deficit of certain substances. But they are not a panacea, herbal remedies are mild, and it is impossible to calculate the exact dosage: the amount of active substances varies greatly depending on the period of collection, the conditions of drying and storage of substances. Herbal preparations may slightly reduce the severity of symptoms, but they will not cure endometriosis, myoma and endometrial hyperplasia, or dissect intrauterine adhesions.
To reduce blood loss, traditional medicine proposes to use nettle. It is used to make a decoction, an infusion, which begins to be taken several days before the onset of menstruation.
Corn stigmas have a hemostatic effect. Of them prepare a decoction, which is taken several times during the day.
Extract of water pepper is sold in the pharmacy in the form of an alcohol solution. He is able to reduce the duration and severity of bleeding. Take it as prescribed by a doctor with a slight increase in blood loss, as well as after abortion, diagnostic curettage. The duration of admission is determined individually.
Yarrow has a similar effect as nettle. For medical use it is better to buy ready-made pharmacy raw materials, which are collected in compliance with all the requirements of sanitation, and the concentration of useful substances is maximum. Apply yarrow in the form of decoctions and water infusions.
Viburnum extract, decoction of shepherd's purse and peppermint is used as a binder and hemostatic agent.
Some healers suggest using self-made herbal remedies for douching. Such treatment can be very harmful. Reverse current along with menstrual blood can cause an infection that will lead to the development of inflammation.
To prevent and eliminate heavy bleeding, you need to change the way of life. At the time should completely abandon alcoholic beverages, coffee and strong tea. Those who are actively involved in sports need to abandon training or reduce their intensity on critical days. The same rule applies to weight lifting.
Increase the amount of blood loss hot baths, sauna, bath, any thermal procedures. This also includes active insolation, many warming up physiotherapy.
If the bleeding has become pathological, emergency medical care is needed. Reducing drugs in this case is not prescribed. Scraping is the only way to stop the bleeding - the mechanical removal of blood clots that prevent the uterus from contracting. In severe cases, transfusion of blood, plasma or its components may be required in the development of pathological signs of blood loss.
In adolescence, curettage of the uterus does not apply. For girls, there is a way to stop bleeding with medication. Combined oral contraceptives have hemostatic properties. But they are not taken in the usual way - 1 tablet per day, but according to a special system, several tablets per reception at short intervals.
What periods are considered strong
The menstrual cycle for each particular woman is individual, but in accordance with medical standards, its duration should be within 21-35 days. Monthly discharge should be at least 3 days and no longer than a week. The normal volume of menstrual blood released during this period is 80 ml, but it can vary between 50-150 ml.
If blood loss for the entire period of menstruation has exceeded 150 ml, such regulations are considered abundant.A woman cannot independently measure the volume of blood secreted during menstruation, so for a self-assessment of this parameter, it is customary to pay attention to the number of sanitary pads that the woman changed per day. Normally, there should be no more than 4 of them, but if there are more than 5, then they will be diagnosed with abundant bleeding.
When is not a pathology
Abundant bleeding during menstruation is not a pathology in such cases:
- with a genetic predisposition, in which case abundant regulula appear in a woman in each cycle throughout the reproductive age, and there is no additional discomforting symptoms and deterioration of the woman’s general condition,
- a teenager during puberty for 1-2 years after the first menstruation normalizes hormonal levels. Abundant regulations in this case are the result of hormonal changes in the body, and they may well be replaced by scarce regulations or their prolonged delay,
- menstruation can go on intensively and during the period of premenopause, at this time the attenuation of the reproductive function of the ovaries begins, as a result of which there can be various menstrual irregularities, including abundant or meager blood loss.
Symptoms of pathological menorrhagia
Symptoms of hypermenorrhea caused by pathologies will primarily depend on the type of disease.
It is necessary to pay attention to the color and consistency of regul, and not just to their number. Pathological symptom are bright scarlet discharge with large clots, as well as the need to change hygiene products more often than every hour and a half.
There are several other symptoms of pathological menstruation:
- intense pain in the lower abdomen,
- general weakness, dizziness, headache, bruises all over the body, there are frequent nasal bleeding, gums are bleeding, a woman often faints,
- during inflammatory processes in the uterus, against the background of abundant blood loss, body temperature rises.
If you have at least one of the listed symptoms, then abundant menstruation is caused by pathology, and you should consult with a gynecologist.
It should be remembered that menorrhagia is of two types: primary, which occurs with the first menstrual period in adolescence, and secondary or acquired, it can occur at any age, but provided that before that a woman had normal menstrual flow.
Why changes the intensity of discharge
Consider the most common causes of very heavy periods:
- hormonal imbalance. If the menstruation cycle passes normally, then endometrium rejection occurs in the uterus under the influence of estrogen and progesterone. If the hormones change, then the endometrium can grow rapidly, because of this, during the menstrual period, they start to go too abundantly. Such hormonal jumps are typical for girls at puberty, when the cycle is only set, and for women on the eve of menopause, when ovarian functions begin to fade,
- malfunction of the ovaries. When the ovulatory phase is absent in the menstrual cycle, an insufficient amount of progesterone is produced. Such hormonal disorders cause severe menstrual and uterine bleeding,
- benign tumor in the uterus (myoma). This type of neoplasm is characteristic of women of reproductive age. One of the signs of fibroids is copious menstruation,
- polyps in the uterus. This benign focal growth of the endometrium occurs in women from 25 to 40 years old during periods of high hormonal activity. With polyps, a lot of blood is released during the regulation,
- adenomyosis. This is a pathology in which cells of the inner mucous layer of the uterus germinate in its walls. A characteristic sign of the disease is painful regulala, which proceed too intensively and can pass into uterine bleeding,
- intrauterine device. Many women who establish this contraceptive method for the first time, note that during monthly discharges they have become more abundant. A similar condition is allowed during the first three months after installation, when the body becomes accustomed to the IUD, but if abundant reedlets occur on the 4th month or pass into uterine bleeding, the helix needs to be urgently removed,
- extrauterine development of the fetus. Abundant blood loss during menstruation can be triggered by implantation of a fertilized egg in the fallopian tube,
- malignant tumors. In the initial stages, cancerous tumors may not manifest themselves, in later periods there may be very intense bleeding during the regulation, with pain and discomfort in the lower abdomen,
- with problematic blood clotting often abnormal uterine bleeding occurs. One example of such diseases is Willebrand's hereditary pathology,
- taking certain medications. Some anticoagulants or anti-inflammatory drugs may cause increased menstrual flow,
- infections and inflammatory processes in the reproductive organs,
- stressful states, psycho-emotional disorders,
- excessive physical activity associated not only with sports, but also with work,
- exhausting diets, fasting, avitaminosis.
Accurately establish the causes and factors provoking heavy discharge during menstruation, can only be a gynecologist after a series of diagnostic activities, so do not self-medicate, so as not to harm health, and immediately seek medical help.
What to do during heavy periods
The method of treatment of heavy periods will depend on the reason that provoked them. The course is assigned individually and can include both medications and folk remedies. In some cases, lifestyle changes may be sufficient to correct the cycle, and in certain diseases, surgery may be necessary.
To make menstruation less plentiful, the doctor first prescribes hemostatic drugs. The choice of a particular drug depends on the factor that triggered the increased secretions. Most often, drug therapy includes such drugs:
- Askorutin. This is a vitamin preparation, its action is aimed at strengthening the walls of blood vessels. Ascorutin produces a cumulative effect, they can stop abundant blood loss only with regular intake of at least 3 weeks, so the remedy is more often recommended for the prevention of uterine bleeding and after surgical intrauterine interventions. Analogue of the drug - Rutaskorbin,
- Vikasol. The drug, which is a source of vitamin K, the main component for the protein that regulates blood coagulation. It is prescribed if, after diagnosis, it has been established that the cause of abundant regulating lies in deficiency in the body of vitamin K,
- Ditsinon. Analogue etamzilat. These are hemostatic pills that promote rapid blood clotting, but do not constrict the blood vessels and do not provoke the formation of blood clots. The drug can be used for heavy bleeding and intense menstruation, but it is contraindicated in pregnant women and nursing mothers. The effect of the drug in patients with thrombocytopenia may be absent. If the situation is severe, the drug is started to be injected intravenously, after relief of the condition they are transferred to intramuscular injections, and then to the tablet form,
- Tranexam. The tablets help to stop the intense regulations that are caused by the activation of fibrinolysis (the process by which the clot forming at the site of the bleeding vessel dissolves). Tranexam also has analgesic, anti-inflammatory, anti-allergic and anti-infective effects. A side effect is the formation of blood clots, so the drug is not prescribed for thrombosis in history and if there are problems with blood clotting.
To eliminate the accompanying symptoms can be prescribed iron supplements and vitamin therapy.
If the monthly medical treatment is going strongly, it can be supplemented with folk remedies. They are not a substitute for the main therapy, but only enhance its effect, therefore, the reception of any herbal remedies and home infusions must be negotiated with your doctor.
On this topic:
So that menstruations go with normal intensity, the following drugs can be prepared at home:
- a few days before the start of menstruation, you need to take a decoction or infusion of nettle,
- stopping bleeding will help decoction of corn stigmas, you need to drink it throughout the day,
- significantly reduces the intensity and duration of the regulation of the alcohol solution based on the extract of water pepper. You can buy it at any pharmacy. Take as prescribed by a doctor with moderately increased intensity regulator, as well as after surgical interventions. The course of treatment is selected individually
- a good hemostatic effect shows a decoction or infusion of yarrow, with the same purpose, extract of viburnum and peppermint decoction with a shepherd's bag is used,
- reduce the monthly help decoction of red raspberry leaves, which is taken in half a glass three times a day. This drug is contraindicated in patients with diseases of the liver, liver, ulcers and gout,
- To reduce the intensity of menstrual flow, you can drink a decoction of cherry leaves or acorn infusion. These recipes are very popular and can be found in any herbalist.
Some popular reference books have recipes decoction for douching. They are not recommended to be used independently, because such procedures can spread the infection and provoke the development of inflammatory processes in the reproductive organs.
What menstruation is considered abundant
It is considered normal for menstruation, occurring after a period of 21-35 days, and for each particular woman they are approximately in an equal number of days (for example, after 25-28). Their duration should not be less than 2 days and more than 1 week. And the volume of blood secreted for the entire menstruation is not less than 40 ml, not more than 150 ml (the normal average value is 80 ml).
Menstruation is considered abundant if more than 150 ml of blood is secreted. For convenience, women usually focus not on the amount of discharge, but on the number of pads per day. If everything is fine with the monthly, then it takes about 4 pads per day.
When menorrhagia is not a pathology
Abundant periods (menorrhagia) are not a symptom of the disease in the following cases:
- If there is a genetic predisposition, in which menstruation is abundant throughout the reproductive period, there are no severe adverse symptoms, the woman is healthy.
- Menorrhagia can occur in girls at the very beginning of puberty, when the cycle has not yet been established (during the first 2 years). The reason is fluctuations in the ratio of sex hormones produced in the ovaries.
- The intensity of menstruation deviates from the norm during premenopause, with heavy menstruation alternating with scanty periods.
Symptoms of pathological heavy menstruation
Depending on the type of pathology, the blood may be bright scarlet or contain blood clots. It is required to change the gaskets every 1-1.5 hours. Related signs are:
- severe aching pain in the lower abdomen,
- weakness, headache, dizziness, sometimes a woman bruises on her body, bleeding from the nose and gums, fainting,
- if heavy periods are associated with inflammation in the uterus, the bleeding is accompanied by fever.
There are two types of menorrhagia: primary (at the first menstruation in adolescents) and secondary (occurring in adulthood).
During life in the body of a woman's natural hormones change many times. In adolescence, during puberty, during pregnancy, after childbirth, during menopause, all physiological processes are associated with sex hormones. The natural ratio is violated if a woman has endocrine diseases (deviations in the work of the pancreas and thyroid glands, adrenal glands, pituitary gland).
The cause of deviations from the norm can be the use of hormonal contraception or treatment, for example, of certain pathologies in the mammary glands with the help of hormones. In this case, the woman's menstrual cycle is disturbed, painful and abundant periods appear.
Diseases of the uterus and ovaries
Uterine myoma - benign outgrowths in the muscles of the uterus, both outside and inside it. They change the structure of the endometrium (internal mucous membrane). When it is rejected, causing the appearance of menstruation, a large number of vessels are injured, which is the reason for the increase in the intensity of bleeding.
Polyps. They can occur both in the uterus and in the cervix. Grow from endometrial cells. Represent a benign neoplasm in the form of a tubercle filled with blood. A thin leg connects it with the surface of the uterus. Polyps reach several centimeters in diameter. They are easily injured and bleed. There may be several. Menstruation is accompanied by severe bleeding. If such polyps are not removed, they are able to degenerate into cancer. Abundant periods are in this case an important symptom warning of the need for a serious examination.
Adenomyosis of the uterus. It happens that the mucous membrane grows into the wall of the uterus under it. Sometimes this pathology is even congenital. It is mainly manifested in women aged about 30 years. The reason - all the same hormonal imbalance or injury of the uterus during childbirth, abortion, scraping. If such a disease is associated with hormonal abnormalities, then, as a rule, with the onset of menopause, it passes on its own. A concomitant pathology is endometriosis, in which the epithelium of the uterus grows into tubes, ovaries, vagina, peritoneum. The detachment of the endometrium with this painful, accompanied by abundant blood loss.
Ovarian dysfunction. This is a violation of the ovaries, insufficient production of sex hormones, estrogen and progesterone. Ovarian function depends on the state of the pituitary gland, where hormones such as prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) are formed. If the production does not meet the norm (for example, with age-related changes during menopause or with a pituitary tumor), then the woman has various deviations in the menstrual cycle. Monthly come with a small, then with a long break. Discharge is scarce and frequent or abundant and long (lasting more than 10 days). At the same time, there is no ovulation, that is, a ripe egg can not leave the protective capsule (follicle), respectively, a woman can not become pregnant, since the fertilization of the egg is impossible.
With this disease usually exacerbated the symptoms of premenstrual syndrome: headaches, tearful mood. Menstruation is accompanied by pain. Bleeding may occur in the intervals between them. In some cases, on the contrary, abundant periods come after a break of 6 months.
Addition: Timely diagnosis of ovarian dysfunction is of great importance, since this condition may be the cause of the appearance of other diseases of the genital organs or a sign of ectopic pregnancy. Disruption of the ovaries sometimes leads to the appearance of breast tumors.
Malignant Diseases cavity or cervix. When unusual monthly high intensity appears, a visit to the doctor plays an important role in preserving the health and life of a woman.
Inflammatory and infectious diseases of the organs of the urogenital system can also lead to the appearance of heavy periods. Anatomical connection provokes the rapid spread of inflammation to the uterus and ovaries, as a result of which their functioning may be disrupted. Abundant periods are with endometritis (inflammation of the mucous in the uterus). Inflammation of the fallopian tubes and ovaries (salpingo-oophoritis) leads to overgrowth of tubes. This condition leads to ectopic pregnancy. This can lead to rupture of the pipe with dangerous abundant uterine bleeding.
Abundant incessant menstruation may indicate blood diseases, impaired blood clotting. The cause is often the disease of the thyroid gland (hypothyroidism), pancreas (diabetes) and other endocrine organs.
Note: An important reason for the occurrence of heavy bleeding during menstruation is excessive exercise (for example, when playing sports or ballet), as well as emotional stress. The duration of menstruation in women is affected by abrupt climate change.
Causes of heavy menstruation after childbirth
Sometimes the first periods after childbirth are very abundant. The time of their occurrence depends on how long and often the woman breastfeeds the baby. The cause of intense menstruation is most often the restructuring of the body, the return of the hormonal composition to normal levels. Hormones also affect the muscle tone of the uterus.In a healthy woman, if there were no complications during childbirth, the normal nature of the menstrual cycle, including the volume of menstrual blood, is restored in 2-3 months.
After a cesarean section with complaints of heavy monthly periods, the doctor clarifies the reason for which this method of delivery was used. If a cesarean section was made due to the presence of uterine fibroids, removed during childbirth, then abundant menstruation may indicate a recurrence of the disease.
If abdominal pains, back pains and fever appear together with the menses, this may indicate infection and the onset of postpartum inflammation. The same explanation can be given to the appearance of heavy periods after an abortion or a cleaning of the uterus.
Lochia, or postnatal discharge, which accompany the recovery processes in the uterus for 6 weeks, is sometimes considered abundant. Usually they are scanty and smearing, without an unpleasant smell, they stop on their own until the end of breastfeeding. If they are abundant, bright red, accompanied by pain in the abdomen, this may indicate injuries to the uterus during labor or incomplete removal of the placenta. At the same time in the blood are clots.
Treatment of menorrhagia
What to do with heavy periods? First of all, you should consult with your doctor to make sure that the cause is not trauma, illness or ectopic pregnancy. If the reason is physiological, then you can try to reduce the bleeding by putting a cold heating pad on the area of the uterus, as well as drink such hemostatic home remedies as chamomile or nettle tincture.
It is not recommended to take drugs to increase blood clotting yourself, as they can provoke the formation of blood clots in the vessels. From popular councils we can mention the following:
- drink a decoction of cherry leaves several times a day (1 tablespoon per 1 cup of water),
- an infusion of acorns (grind and insist 1 tablespoon. in 1 cup boiling water),
- decoction of a mixture of yarrow and chamomile (150 g), horsetail (100 g), shepherd's bag and chestnut (50 g). Boil the mixture in 1 glass of water, drink 3 weeks, after a 5-day break, repeat.
In case of diseases caused by hormonal disorders, hormone-containing pills are prescribed or an intrauterine device is inserted with a drug that reduces the thickness of the endometrium. In inflammatory diseases, antibiotics and physiotherapy are used. Vitamin C supplementation and iron supplements often help. If the treatment does not help, surgery is performed.
Why does hypermenorrhea occur?
In order to determine the exact reason why a girl or woman has a strong monthly period, as a rule, they conduct a comprehensive examination, including a variety of modern diagnostic techniques. Quite often, limited to only standard gynecological examination is not necessary. Consider the most common causes of heavy periods:
- Violation of hormonal background. In a normal menstrual cycle, estrogen and progesterone regulate the growth of the uterine mucosa (endometrium), which is rejected in the menstruation process. If there is an imbalance of these hormones, then there is an increased proliferation of the endometrium, which leads to more heavy menstruation and the development of uterine bleeding. Most often, hormonal imbalances are observed in young girls during the first menstrual periods, when the menstrual cycle has not yet been established, and in women of menopause.
- Functional failure of the ovaries. If during the menstrual cycle there is no ovulation phase, this leads to insufficient production of the hormone progesterone. Naturally, the resulting hormonal imbalance provokes menorrhagia and uterine bleeding.
- Uterine fibroids - a benign tumor that can develop in women of reproductive age. Often uterine fibroids contributes to the appearance of strong menstrual and uterine bleeding.
- Uterine polyps are benign growths of the mucous membrane (endometrium). Most often found in women aged 25-40 years, when there is a high hormonal activity.
- Adenomyosis - internal endometriosis, in which there is proliferation of the mucous membrane in the thickness of the muscle layer of the uterus. This pathological process often provokes severe painful uterine bleeding during critical days and is characteristic of middle-aged women who already have children.
- Intrauterine device. Menorrhagia is considered to be a fairly common side effect when using this non-hormonal contraceptive. If it is determined that the intrauterine device is the cause of the development of strong periods, then it is necessary to remove it as soon as possible.
- Ectopic pregnancy. There are frequent cases when the cause of hypermenorrhea is the implantation (implantation) of a fertilized egg into the fallopian tube instead of the uterus.
- Malignant neoplasms of internal genital organs. There is evidence that cancer of the ovaries or uterus can cause very heavy periods.
- Problems with blood clotting. For example, hereditary Willebrand disease usually leads to abnormal uterine bleeding during the menstrual cycle.
- Medications. It is reliably known that some drugs, such as anti-inflammatory drugs and anticoagulants, can provoke heavy menstruation.
- Infectious and inflammatory diseases of internal genital organs.
- Psychological stress, strong emotional reactions.
- Heavy physical exertion, which can be associated with both professional sports and work activities.
- Strict diet, which does not correspond to the needs of the female body.
If you do not determine the true reason why there are very strong abundant periods, then menstrual irregularities and uterine bleeding will recur, even after a medical course of treatment.
Hypermenorrhea risk factors
According to clinical statistics, the main responsibility for the development of menorrhagia or hypermenorrhea lies on hormonal imbalance. In a normal menstrual cycle, the release of a ripe egg from the ovary stimulates the production of progesterone, one of the many functions of which is to maintain the regularity of menstruation.
If ovulation does not occur, then a lack of the hormone progesterone causes abundant prolonged menstruation. Most often, anovulatory cycles that are not accompanied by the release of a mature egg from the ovary occur among two age groups:
- Teenage girls, who have recently begun menstruation. Many young representatives of the beautiful half of humanity are very prone to anovulatory cycles during the first year after the first menstruation (menarche).
- Mature women approaching menopause. Ladies aged 40 to 50 years due to physiological characteristics are especially at high risk for hormonal disorders.
If you don’t reliably know how to reduce the monthly (critical days), which are also very abundant, then first consult with your gynecologist before taking any action.
When do I need to see a doctor?
To date, there is a tendency not to seek once again for the help of specialists, which is at least rash and arrogant. A lot of girls and women are sure that they know what to do when there is a lot of uterine bleeding during menstruation. However, it is strongly recommended not to self-medicate and to consult a specialist as soon as possible. Even if you manage to reduce your period at home, without removing the cause of the menstrual cycle, it is likely that everything will happen again.
No matter how hard you try, you cannot manage to reduce heavy bleeding during your period, which means you should hurry to see your gynecologist.
Why it is not necessary to delay with visiting the doctor?
Without going to a doctor in time for long-term menorrhagia, you risk getting a number of fairly serious complications that can further aggravate the current situation. If hypermenorrhea recurs and other pathological symptoms appear, it is a reason to sound the alarm. What can you expect if you continue to neglect the help of specialists:
- Iron-deficiency anemia. In most cases, there will be mild anemia of mild to moderate severity, which will manifest as pallor of the skin, weakness, increased fatigue, headaches, dizziness, shortness of breath, palpitations, etc.
- Severe abdominal pain. Along with abundant and prolonged periods, women may experience very painful sensations on critical days (dysmenorrhea).
First aid for hypermenorrhea
What should be done if there are very heavy periods? First of all, you should calm down and stop being nervous, since the expressed psycho-emotional excitability only contributes to the strengthening of uterine bleeding. It is better to lie down on the bed so that the legs are in a higher position. It is recommended to apply cold (ice, chilled products, etc.) on the area below the abdomen.
How can you reduce the monthly if they have already begun and are in full swing? One of the fastest and most effective hemostatic agents is Dicionon. Despite the fact that this drug is available in pharmacies without a prescription, it is necessary to take it only with the approval of the attending physician, who determines the dosage and frequency of use. It should be noted that Ditsinon should be used only in case of heavy bleeding during the menstrual cycle.
Another popular hemostatic drug is Vikasol. However, it is worth noting that its action is more systemic and the effect of the reception does not occur as quickly as from Ditsinona.
Monthly with clots
What does the presence of dark blood clots? This means that the blood that is collected in the uterine cavity, manages to clot, therefore, comes out in this form.
If there are heavy periods with clots, what to do? It is necessary to consult a doctor. Large blood clots in menstruation suggest that a woman may have polyps, an impaired uterine wall tone due to fibroids or endometriosis, and other diseases.
Causes of heavy monthly
Why girls have abundant periods, and even with large blood clots? In some women, this feature is inherited, is a family disease. But there are other reasons that can cause abundant periods:
- Diseases in which blood clotting is impaired or a woman has taken anticoagulants, i.e. drugs that affect clotting.
- Lack of vitamins that are necessary for blood clotting (K, P, C).
- Various diseases of the thyroid gland, pelvic organs, heart, liver and kidneys.
- Pathological intrauterine processes or anomalies of the uterus: endometriosis, fibroma, metroendometritis, etc.
- Intrauterine device, which gave such an undesirable side effect.
- Constant stress, change of residence (climate change), overwork, or too much physical exertion.
- Abortions or childbirth, especially if they were complicated.
- Hormonal instability, which is often observed in adolescents or in women in the period before the onset of menopause.
Abundant periods in adolescents
Often abundant periods are in adolescents. They occur quite often, in 37% of cases. In girls 13-16 years of age, unstable hormones, disturbed the balance between the amount of estrogen and progesterone. But there are other reasons because of which girls may have heavy periods with clots:
- enlarged thyroid gland
- poor blood clotting,
- genital tract infections
- lack of vitamins
- stressful situations, mental overload, mental trauma,
- Infectious diseases can also affect (sore throat, flu).
If a child has such violations, you should immediately consult a doctor. The doctor must find out the cause of the deviation and prescribe treatment. If the girl does not complete the course of therapy, the probability is high that she will later develop polycystic ovary (diagnosed in 30% of patients).
Abundant periods in women after 45 years
In women aged 45 to 55 years, the premenopausal period begins. At this age, a woman gradually loses the ability to conceive, after a while her menstruation can completely stop. During this period, for most women, critical days are irregular, menstruation may disappear for several months, and discharge becomes less. But some things may be different: first, heavy bleeding, then become scarce, and after a while they become strong again. This is due to failures in all body systems.
If there are abundant periods after 45 years, what to do? It is advisable to go to a gynecologist and be examined. Not necessarily the cause of their appearance may be some kind of pathology, but it is better to make sure that all is well. In addition to normal age-related changes, heavy menstruation may occur due to the following diseases:
- myoma (benign tumor),
- polycystic disease (copious periods after a delay),
- polyps (benign neoplasms).
Abundant periods after childbirth or cesarean section
After giving birth to a woman, the intensity of the period can change; her body has also changed: the cervical canal has become wider and shorter, the uterine cavity has increased. Such changes are considered normal. But sometimes they indicate pathological processes, for example, a violation of the contractile activity of the uterus due to the fact that there was its overdistension (large fruit, polyhydramnios), endometrosis, etc.
Abundant menstruation after cesarean may appear due to the fact that there is a suture on the uterus, and this affected its contractile abilities, since the scar consists of connective tissue, and it cannot contract. If there is a sharp pain, monthly bright red color, then this may indicate a divergence of the suture, it is necessary to immediately go to the hospital.
What to do if there are heavy periods, do you need to go to the doctor? If you have copious periods after childbirth or cesarean, you must visit a doctor in the following cases:
- Menstruation lasts a week or longer.
- The blood is bright scarlet (it is possible that this is bleeding, and not critical days).
- It is often necessary to change the pads (every 2 hours or more), normally you can do this no more than 4-5 times a day.
- If you have to get up at night and at least 1-2 times to change the pads, although the sleeping woman should have less discharge.
- There are epithelial clots in the blood, i.e. there were parts of the placenta that needed to be removed.
But even if you have just the first menstruation after childbirth is very abundant, and you are worried about this, you can visit the doctor and be examined. Stress exacerbates the situation, and it can also be a sign of pathology, and the sooner it is discovered, the better.
Abundant menstruation after cleansing, abortion or miscarriage
If a woman has an abortion or miscarriage, her body has experienced severe stress, in addition to a thorough hormonal adjustment. According to statistics, about 12% of women after a termination of pregnancy breaks the menstrual cycle, there may be heavy periods after an abortion. If it was a medical abortion, then uterine bleeding appears very often. To avoid serious complications, it is better to immediately seek help from a doctor.
After curettage, the woman may have bleeding similar to the menstrual flow. So it should be, you should not be afraid. After a few days, the discharge changes color (turns brown) and gradually fades out. And the real menstruation should begin in 26-35 days (it depends on the length of the cycle), it also passes as usual. But if there were abundant periods after cleansing, i.e. a woman has to change the gaskets every 2-3 hours, you need to consult a doctor. Unpleasant feeling in the abdomen, fever may indicate inflammation.
Treatment of heavy menstruation
We found out the main reasons that explain why abundant periods appear, and it remains to find out what to do. Do not self-medicate. If the patient has this pathology, it is necessary to immediately contact a gynecologist, who must establish why there were heavy periods, and then prescribe treatment.
It is difficult to give exact recommendations, since it is important not to get rid of the consequences of the disease, which manifested itself in this way, but of the cause itself.
- For example, if the hormonal balance is disturbed, the doctor may recommend taking oral contraceptives. These drugs should help with heavy periods, their volume will gradually decrease by 40%. A woman should take them for a long time (at least 3-6 months).
- The doctor, in order to avoid the appearance of anemia, may advise taking iron preparations.
- How to stop heavy periods? Patients are often helped by anti-inflammatory drugs (NSAIDs), which reduce the duration of menstruation and reduce blood loss by about 40%.
- What other hemostats are recommended for heavy periods? To reduce blood loss, vitamins are prescribed: ascorbic acid, rutin and others.
- An intrauterine device with levonorgestrel can help stop abundant periods.
What if very heavy periods? In this case, medications can help. With heavy menstrual periods, the doctor may prescribe hemostatic pills: vikasol, aminocaproic acid, dicine, calcium preparations, transseks. But you should not take hemostatic drugs with heavy periods, because in this case, it is important not only to remove the symptom of the disease, but to cure the underlying disease.
If all these methods did not help, the woman developed physiological disorders, persistent severe anemia, and surgical treatment is prescribed. The doctor will remove tumor formation and pathological endometrium. If after this heavy bleeding has not stopped, doctors remove the uterus. Most often, such an operation is assigned to women after 40, who no longer plan to have children, very rarely - to young women, in especially severe cases.
What to do if periods go very plentiful? Do not self-medicate, but visit a gynecologist, undergo an examination and then a course of treatment. It is also important to normalize the regime of the day, eat well and properly, do not forget about proper rest. You can go to the physiotherapy. Over time, the amount of menstruation should become normal. But just in case it is worth at least 2 times a year to visit a gynecologist for a routine examination.
Causes of heavy periods
Isolated episodes of heavy periods can occur in perfectly healthy women without serious pathological causes. Excessive psycho-emotional stress, contrasting changes in climatic living conditions, physical overloads (including in the gym) can lead to an increase in menstrual blood loss.
Abundant periods can be the result of incorrect hormone therapy or hormonal contraception.
The physiological reasons for the appearance of heavy periods also include natural hormonal fluctuations that occur during puberty (puberty) or during menopausal changes in the body.
To understand why there are abundant periods, it is necessary to understand the essence of the processes that ensure the normal menstrual function of the body.
The menstrual cycle is a regularly repeated chain of successive events occurring in the central nervous system (pituitary-hypothalamus), ovaries, fallopian tubes, and uterus. Each link of this chain is responsible for a specific function. The hypothalamus controls the production of hormones in the pituitary gland. They are synthesized cyclically: in the first phase of the cycle (follicular) the follicle-stimulating (FSH) hormone is released, and in the second (luteal) hormone - luteinizing (LH).
In the ovaries under the control of the pituitary hormones, hormones are also synthesized: estrogens in the follicular phase and progesterone progesterone - in the luteal phase. Under the control of estrogen, important changes occur in the structure of the ovary: a follicle is formed that contains a developing egg cell. When the egg cell becomes sexually mature, the follicle is destroyed, releasing it outside the ovary for potential fertilization (ovulation), and a temporary hormone glandular structure, the yellow body, begins to form at the site of the destroyed follicle, it synthesizes progesterone. Before the beginning of the next menstruation, the corpus luteum collapses, and in the case of fertilization continues to function, ensuring the safety of pregnancy.
Cyclic structural changes also occur in the epithelium lining the uterine cavity, and ovarian hormones “direct” this process.
In parallel with the maturation of the egg with the participation of estrogen, the endometrium “prepares” for a potential pregnancy: when it expands, it becomes more loose and thick, and germinates with new vessels. If the pregnancy did not take place, all the changes that have occurred should be eliminated, which happens in the second phase, when using the progestogen the endometrium gradually begins to be torn away, exposing the underlying blood vessels, and the menstrual flow is formed. To get rid of the accumulated contents, the uterus is reduced, throwing blood and fragments of the destroyed epithelium out.
After the entire rejected endometrium, together with the blood, is evacuated from the uterine cavity (menstruation period), all the listed processes are repeated again.
If at any of the stages of the formation of a normal menstrual cycle fails, the menstrual function is disturbed. All the causes of heavy monthly can be divided into two large groups:
1. Associated with hormonal dysfunction. An excess of estrogen leads to a too large growth of the endometrium.
2. Non-hormonal causes. They are based on pathological formations of the uterine cavity (fibroids, adenomyosis, polyps), as well as extragenital ailments (diseases of the liver and hematopoietic system, endocrine pathologies).
Often with abundant menstruation increases not only the menstrual blood loss, but also its duration.
Abundant periods after childbirth and cesarean
If after birth went heavy monthly, it is not always associated with serious pathology. The menstrual function of the ovaries during pregnancy for a long time is in a modified state, and it takes time to recover and return to the previous physiological norm. In addition, the muscular wall of the uterus (myometrium), which is “tired” from excessive load during labor, must also restore strength and return to the previous tone.
As a rule, if the woman in labor is healthy, and the childbirth has passed without complications, after 2-3 cycles after the first heavy periods, menstruation becomes normal. Therefore, if after childbirth for the first time abundant periods in the absence of other alarming symptoms, you should not panic.
Breastfeeding plays a significant role in restoring normal menstrual function after childbirth. Non-lactating women should expect their first menstruation two months (or a little later) after delivery. In lactating, the first menstruation occurs later (after the end of lactation) due to the competing action of the hormone prolactin, it stimulates the secretion of breast milk, but inhibits the synthesis of estrogen.
Since during a cesarean section, the surgeon simulates a normal generic process, the reasons for the appearance of heavy periods after surgery differ little from those during natural childbirth. However, it is necessary to consider the reasons for choosing the surgical method of delivery, and whether they can provoke menstrual irregularities.
Abundant periods after childbirth correlate with a temporary normal phenomenon, if they are not accompanied by pain, fever, deterioration of health. Abundant painful periods indicate an inflammatory process.
You should also pay attention to the intensity of blood loss and the composition of the menstrual flow. Despite the abundant blood loss, the amount of separated blood should gradually decrease on its own, as a result, the bleeding stops altogether. As part of the menstrual flow should not be a lot of blood clots and pathological impurities in the form of pus and mucus.
It should be noted that not all bleeding after childbirth correlates with menstruation. After delivery in the uterine cavity after rejection of the fetal membranes and the placenta, an extensive wound surface forms with exposed bleeding vessels. For six weeks after giving birth, enhanced regeneration processes take place in the uterine cavity, and postpartum bleeding (lochia), which are not menstruating, expires from the uterus.
For postpartum uterine secretions should be monitored. Physiological are Lochia, which are:
- change quantitatively: after birth, they can be abundant, and then subside,
- self-terminate no later than six weeks after delivery,
- change their color over time from bright red to almost transparent,
- not accompanied by pain or significant fever,
- do not contain blood clots or pus.
Sometimes patients can hear complaints about "heavy periods during pregnancy." Such complaints are incorrect, as it is impossible to consider menstruation bleeding during pregnancy. As a rule, “abundant menstruation during pregnancy” as a complaint serves as an alarming signal, since they can signify the beginning of its premature termination, and in later periods, abundant bleeding indicates a placental that has exfoliated prematurely.
Abundant periods with clots
There is a direct relationship between the amount of blood lost and the consistency of menstrual flow. Often, abundant periods are accompanied by discharge of dark blood clots. Their presence is due to the fact that accumulated in the uterine cavity, menstrual blood has time to curl up and out in the form of clots.
Why are heavy periods with large clots? There are several significant pathological causes:
- The presence of obstacles to the free evacuation of menstrual blood from the uterine cavity. Most often these are myoma nodes, if they grow inside the uterine cavity and deform it. Also, blood clots in the uterus can form due to endometrial polyps and cervical canal.
- Violation of the uterine wall tone. To the contents of the uterus in the process of menstruation was evacuated in a timely manner and completely, the uterine wall is rhythmically reduced. Violation of the mechanism of contraction leads to untimely evacuation of blood, so she manages to curl up and go out in the form of clots. Such violations may occur due to the presence of fibroids, which grows deep into the uterine wall, or the focus of endometriosis. After childbirth, abundant menstrual periods with clots indicate violations of the processes of involution (recovery) of the uterus, when the tone of the uterine muscles is not restored correctly.
- Hormonal dysfunction. Abundant periods due to hormonal causes are more often observed in anovulatory cycles, when the egg does not complete the maturation process. In the absence of ovulation, the follicle is not destroyed, but continues to persist, producing estrogens. An excess of estrogen causes excessive proliferation of the endometrium. As a result, during the period of menstruation in the uterus is a lot of blood with clots.
Much less often the presence of clots in the menstrual blood is explained by blood diseases, namely coagulation disorders. If the clotting time is shortened, the blood clots before it leaves the uterus.
Abundant first monthly
Abundant first menstruation is leading among the reasons for adolescent girls seeking help (up to 37%). If we take into account the well-known fact that patients often cope with abundant menstruation independently, we can confidently assert that the first abundant periods accompany puberty in most girls, and only the part that suffers from severe hormonal disorders is asked for help.
The period of formation of menstrual function in adolescents is often accompanied by abundant menstruation. Often they come out of time. Sometimes abundant periods last two years. The hormonal imbalance of this period is associated with imperfect connections between all links of the chain regulating the menstrual cycle. If the fragile relationship between the central nervous system (the pituitary gland - the hypothalamus) and the ovaries is interrupted, each link begins to function in isolation, and the normal proportion of sex hormones is disrupted.
Among the most frequent causes of heavy menstruation in girls are psycho-traumatic situations, frequent emotional distress, excessive physical exertion, nutritional disorders (both weight deficit and obesity). The menstrual function of puberty is significantly influenced by the state of the endocrine system.
More often than other reasons (80%), abundant first menstrual periods provoke deviations in the psycho-emotional sphere. As a rule, among patients with abundant menstruation most emotionally labile, hyper-responsible girls (most often honors pupils), students in high-level schools (gymnasiums, lyceums) or prestigious universities are the most Constant stress on the central nervous system provokes dysfunction of the structures (hypophysis-hypothalamus) responsible for the proper functioning of the ovaries.
The risk group for menstrual disorders also includes girls with impaired sexual and general physical development.
Clinical manifestations of menstrual adolescent disorders depend on which link of hormonal regulation "suffered". According to the peculiarities of menstrual dysfunction, the first menstrual periods can be divided into several types:
- Abundant periods on the background of normal menstrual rhythm. As a rule, bleeding lasts longer than seven days, blood loss is increased (over 80 ml), and a small amount of clots is present in the blood. Increased blood loss often provokes the symptoms of anemia.
- Abundant first menstruation with a shortened intermenstrual period (usually not more than 21 days).
- Monthly, have lost a certain rhythm, when the bleeding happens sooner or later.
Therapy at the first heavy menstruation is required only if after a preliminary examination it turns out that hormonal dysfunction cannot be compensated for itself. In this case, resort to hormone therapy, which helps restore proper hormonal balance. Most of the girls respond well to the therapy being conducted, and already a year later they have not seen heavy periods.
Fortunately, such situations are rarely observed, and to successfully overcome the violations that have occurred, the body can be helped with the help of simple measures:
- elimination of excessive neuropsychic loads,
- correct physical activity (swimming pool, gymnastics, active rest),
- balanced vitamin-saturated nutrition,
- fight obesity,
- psychotherapy (if necessary).
More attention should be paid to the first painful heavy periods. Often the presence of pronounced pain during menstruation in adolescents indicate malformations of the genitals or endometriosis.
Very heavy monthly
Appeared instead of the next menstruation very abundant bleeding may be uterine bleeding, which coincided in terms with regular menstrual and therefore called cyclic. To distinguish very heavy menstruation from uterine bleeding, one should remember about the criteria for normal periods, namely their duration and the amount of blood loss. Abundant periods are characterized by increased blood loss, but their duration practically does not exceed a week, and then the intensity of menstrual bleeding is significantly reduced, and there are only minor, lasting no longer than three days, spotting.
Cyclic bleeding correspond to the period of the next menstruation, but lasts much longer, and the amount of blood lost can even be visually more often defined as “very large”. Often there are blood clots. Sometimes cyclic bleeding is similar to heavy brown menses, that is, there is a small but prolonged blood loss.
In contrast to the usual heavy menstruation, uterine bleeding rarely has a tendency to spontaneous termination, so women often show signs of anemia: dizziness, weakness, nausea.
Very heavy periods can trigger:
- Inflammatory process (metroendometrit). In addition to menstrual dysfunction, symptoms inherent in the infectious process appear: intense pain, severe fever, and a sharp deterioration in health.
- Uterine fibroids, especially interstitial, and adenomyosis. Their presence in the uterine wall disrupts the proper functioning of the uterine muscles and increases the surface of the rejected endometrium.
- Hormonally ovarian tumors.
- Non-gynecological causes: endocrine pathologies, diseases of the liver, heart and blood vessels.
Abundant periods - what to do
Universal advice for women with heavy periods can not be given. Each specific situation of excessive menstrual blood loss has its own causes and clinical features. It is also not always possible without a qualified specialist to distinguish profuse menstruation from cyclic uterine bleeding.
However, sometimes abundant periods are innocuous reasons, and you can try to deal with them yourself. This can be done if an abundant menstruation has happened for the first time, and you know exactly its cause. This can be a sharp change in climatic conditions when you come to a country with an unusual climate for you. Также обильные менструации могут провоцироваться избыточной физической нагрузкой, сильным стрессом или неправильным приемом гормональных препаратов.
Если менструальное кровотечение не нарастает, не сопровождается слишком большой кровопотерей (особенно со сгустками), а общее самочувствие остается хорошим, можно попробовать остановить его самостоятельно. First you need to limit physical activity. Something cold can be put on the stomach in the projection area of the uterus - a heating pad or a simple bottle with ice or very cold water, a bag of frozen food and the like. In order to avoid injury to the skin, any natural fiber fabric (towel, sheet) should be put on the belly beforehand. To increase the tone of the vascular wall and reduce the clotting time, use decoctions of herbs: nettle, chamomile, shepherd's bag.
Eat foods rich in iron and vitamin C, drink fruit "sour" juices (they have more vitamin C), give up alcohol and coffee.
There is a huge amount of hemostatic drugs, however, it is very difficult for a woman to choose a suitable one, since all of them are unequal in terms of the mechanism of action and must be selected individually according to the reasons for heavy menstruation.
If the decrease in the intensity of bleeding can be observed visually (the number of gaskets used decreases), no clots or pus in the blood, no pain, and the state of health is still good, your independent activities can be extended by one to two days. As a rule, during this period of menstruation is completed, and your efforts can be considered successful.
It should be remembered that abundant brown menses on the background of a delay accompanied by spastic pain may indicate intermittent uterine as well as ectopic pregnancy.
Unfortunately, women often do not pay attention to their menstrual function, ignoring the first symptoms of trouble. If abundant menstruation is permanent, a visit to a specialist is inevitable, but it is better to contact him in time, and not after a long period of self-treatment.
If during three consecutive cycles you have an abundant period of time (as you think), you should undergo a detailed examination, and then treatment.
Drugs for heavy periods
To stop excessive menstrual bleeding, it is not enough to choose the right situational medications, it is also necessary to exclude the possibility of recurrence of heavy menstruation. Therefore, any therapeutic scheme involves the diagnosis of the cause of menstrual dysfunction.
Initially, abundant menstruation is stopped with medication. More often used symptomatic means of different groups:
- Means that enhance the uterine muscles: oxytocin, methioergometrine, shepherd's bag extract, tincture of water pepper.
- Antihemorrhagic and hemostatic agents: aminocaproic acid, calcium preparations (chloride and gluconate), dicine (etamzilat), vikasol.
The drug tranlesku with heavy monthly in recent times used more often than others. In addition to the hemostatic effect, it has an anti-inflammatory effect, as well as relieves moderate pain and reduces allergic manifestations. It is also effective for trunks with heavy periods with metroendometritis and salpingoophoritis.
- To eliminate anemia, use vitamin B12, folic acid, iron-containing drugs (ferroplex, totem and others).
- Antispasmodic and analgesic drugs (no-shpa, papaverine, ketorol and the like) are prescribed in case of menstrual pain.
When the danger from increasing menstrual bleeding is eliminated, the patient is examined to determine the true cause of heavy menstruation.
Initially conducted a detailed conversation with the patient. It is important to find out how the period of formation of the menstrual function proceeded, how the menstruations passed before, and what changes have occurred recently. Sometimes a woman when answering questions clearly indicates a situation that has provoked heavy periods, such as abortion or severe stress.
At the end of the conversation, a gynecological examination is carried out. It allows you to detect changes in size, texture and location of the genitals, as well as their pain in the case of inflammation.
Laboratory diagnosis includes the study of hormonal function and the diagnosis of anemia.
Ultrasound scanning helps assess the condition of the endometrium and the ovaries. It also diagnoses fibroids, polyps, endometriosis and ovarian mass.
After the cause of abundant menstruation is established, proceed to its removal. Hormonal dysfunction is corrected by hormone therapy. Cyclic oral contraceptives are often used to suppress excessive estrogen production (urinestan, duphaston, and the like). The hormonal agent is chosen individually based on the results of laboratory research.
Cervical and uterine polyps must be removed surgically, and the treatment of fibroids is individualized, taking into account the peculiarities of its structure, location and growth.
A small number of cases of abundant monthly unexplained origin requires a more aggressive diagnostic and therapeutic intervention - complete mechanical removal (curettage) of the entire endometrium. The procedure has a double meaning: it quickly eliminates profuse bleeding and allows detailed examination of the removed endometrium in the histological laboratory.
Abundant menstruation: how to determine?
Menstruation is assessed according to the following criteria:
- Duration (not longer than 7 days)
- profusion of discharge (in normal menstruation, only the first 2 to 3 days differ in profusion),
- the amount of blood loss (total volume per day does not exceed 120, maximum 150 ml),
- intervals between menstruations (at least 21 days),
- menstruation soreness (normal mild discomfort or mild pain is normal),
- intermenstrual bleeding (in the normal menstrual cycle, they are absent).
Based on the listed symptoms, you can independently determine whether there is an abundant menstruation. Abundant menstruation is a syndrome that can be observed in many gynecological and not only diseases. Therefore, this condition does not apply to diseases, but requires the identification of the causes of heavy periods. Abundant periods are characterized (they are also called menorrhagia or hyperpolymenorrheas) with the following features:
- menstruation lasts a week and longer
- spotting significant, with large clots,
- a large volume of blood lost, 150 ml or more, requires replacement of pads or hygienic tampons every hour, including at night,
- shortening of the menstrual cycle (less than 3 weeks),
- the appearance of bleeding not only in the days of menstruation,
- the occurrence of significant pain in menstrual days,
- the entire period of bleeding is characterized by profusion,
- the occurrence of menstruation or other bleeding in a year and later after the onset of menopause.
Abundant menstruation in adolescence
Menorrhagia in adolescents is quite common and reaches 37%. As a rule, heavy menstruation is observed in the first 3 years after menarche, but another situation is possible when the first menses are abundant.
The main role in the occurrence of menorrhagia in adolescent girls are:
- chronic and acute infectious diseases
- improper diet leading to the development of hypovitaminosis
- mental injury
- intellectual overload.
Infectious diseases (angina, flu, rheumatism and others), stress and other factors disrupt the work of the hypothalamic-pituitary system, which, in turn, affects folliculogenesis and the synthesis of hormones in the ovaries. Due to the above, estrogens are produced monotonously, maintaining the same level and for a long time. Progesterone is produced in insufficient quantities, there is a shortage of it, as a result of which the mucous membrane of the uterus does not pass the stage of secretory transformation (the second phase of the cycle), and hyperplasia.
Abundant menstruation occurs due to stagnation of blood and plethora, dilation of capillaries, necrotization of individual sections of the endometrium and its uneven rejection. In addition, prolonged menstruation also contributes to the reduction of contractility of the uterus in case of its underdevelopment (hypoplasia). Abundant periods in the pubertal period may vary in intensity and duration, and the clinical picture depends on the degree of blood loss.
Menorrhagia in adolescents quickly leads to:
- anemisation - weakness, fatigue, decreased appetite, pallor of the skin and mucous membranes, increased heart rate
- coagulation disorder - reduced platelet count and prothrombin index.
Abundant menstruation in premenopausal age
Premenopausal age is the period that lasts from 45 to 55 years, when the female body loses its ability to conceive and smoothly moves into the phase of the end of menstruation.
If after the last menstruation 12 months have passed, which were characterized by the absence of bleeding, this period of time is called menopause.
The next stage will be postmenopause, when the production of sex hormones sharply decreases and any bleeding from the genital tract is considered as pathology.
What happens with menstruation during premenopause? The hypothalamic-pituitary-ovarian system undergoes processes of involution, or, roughly speaking, aging, which leads to disruptions of its functioning. Cyclic secretion of gonadotropins, the maturation of follicles and the production of sex hormones in the ovaries is impaired.
As a result, relative hyperestrogenemia develops (estrogens are known to be produced in the first phase of the cycle) against the background of absolute hyperprogesteronemia (due to luteal insufficiency with the inferiority of the corpus luteum). All this leads to disruption of the processes of proliferation (phase 1) and secretory transformation (phase 2 of the cycle) of the endometrium and the appearance of hyperplasia of the uterine lining.
- A woman in premenopause notices that her periods have become more abundant and longer.
- In addition, in the premenopause, in addition to menorrhagia (cyclical bleeding), acyclic bleeding or metrorrhagia may also occur, which are associated with a violation of uterine contractility.
- Various tumors and tumor-like formations (fibroids, polyps, endometrial foci) alter the structure of the uterine wall, replacing the part of the muscle layer with connective tissue or endometrioid. As a result, the uterus, both during menstruation and outside, is not able to adequately contract, which causes heavy bleeding during menstruation or after the action of various factors (coitus, physical overstrain, stresses).
A practical example: I had a patient of about 48 years old, who for several years suffered from heavy menstruation, which, of course, led to the development of anemia. After an ultrasound of the pelvic organs was diagnosed: “Glandular hyperplasia of the endometrium. Suspicion of endometrial polyp. The patient was recommended to be consulted at the regional hospital, where she was prescribed and underwent therapeutic and diagnostic hysteroscopy followed by curettage of the uterus. But after the surgical treatment, the situation has not changed. Hemoglobin remained in the range of 90-100 g / l, despite the intake of iron-containing drugs, and the monthly were distinguished by the abundance of secretions. Six months after the second consultation with the regional gynecologists, the woman was asked to remove the uterus. After amputation of the uterus, a histological study of the drug was carried out and the conclusion was made: Multiple myomatous nodes of small size (0.5-1 cm) on the background of common adenomyosis. Adenomatous polyp (5 cm) of the uterus. Within 6 months after surgery, hemoglobin reached normal values, and menstruation stopped immediately after the uterus was removed. It becomes clear that an endometrial polyp of such dimensions could not be removed by hysteroscopy, and even if it was cut, concomitant endometriosis of the uterus and myomatous nodes would serve as a supporting factor for menorrhagia.
After childbirth, the nature of menstruation changes, they become somewhat more intense and longer. This is due to the anatomical transformations of both the uterus itself and its cervix. After giving birth, the cervical canal shortens and becomes wider, which explains the increase in menstrual flow. In addition, the uterus itself, and, consequently, its cavity become larger than before pregnancy, the area of the uterine mucosa increases, which automatically leads to an increase in bleeding during menstruation.
But in some cases, menstruation after childbirth becomes too abundant and long. This is due to the occurrence of complications in the process of childbirth, as a result of which the contractile activity of the uterus is disturbed due to its overstretching (large fetus, polyhydramnios or multiple pregnancy, twins) or abnormalities of labor forces (discoordination, weakness of contractions, clinically narrow pelvis).
These factors affect the involution of the uterus in the postpartum period and provoke heavy menstruation. Also on the occurrence of menorrhagia after childbirth is influenced by how pregnancy proceeded.
- Malnutrition, low hemoglobin, stress and various complications of pregnancy can not affect the formation of the menstrual cycle and the nature of menstruation.
- After cesarean section, a suture remains on the uterus, which also plays a role in its contractility. Therefore, the monthly after abdominal delivery become abundant, since the uterine scar is mostly represented by connective tissue that is not able to contract.
Menorrhagia after abortion and intrauterine interventions
As you know, pregnancy causes the strongest hormonal adjustment, and its interruption, both in the form of medical abortion (consequences) and in the form of a miscarriage, is a stress for the body, which cannot but affect the hormonal balance.
It should immediately make a reservation that any intrauterine intervention (hysteroscopy or curettage for the purpose of diagnosis or removal of the ovum / residue) is accompanied by the appearance of bleeding in the postoperative period, which women often take for menstruation.
- Norm - menstruation is normal after intrauterine manipulation begins on average in a month, and bleeding after curettage of the uterus lasts 3 - 7 days, maximum 10. Such discharge is usually moderate and even scanty, painless or causes little discomfort.
- Abundant periods - in case of abundant periods after abortion / curettage or hysteroscopy, consult a doctor immediately. Most likely the cause of the development of menorrhagia is inflammation of the uterus.
In this case, the monthly will be:
- copious, dark red or "dirty", like meat slop and accompanied by an unpleasant smell.
- a woman will be bothered by pain in the lower abdomen
- fever and symptoms of intoxication (weakness, lack of appetite, dyspeptic symptoms).
If the diagnosis of endometritis is not confirmed, this indicates a malfunction in the hypothalamic-pituitary-ovarian system, which disappear after the appointment of oral combined contraceptives for a period of 3, a maximum of 6 months.
Anticoagulants and antiplatelet agents
First of all, such drugs include blood thinners - anticoagulants and antiplatelet agents.
- Anticoagulants (heparin, fenilin, syncumar) or prevent blood clots (direct anticoagulants), or inhibit the secretion of blood coagulation factors (indirect effects).
- Antiplatelet agents (aspirin, trental, chimes) inhibit platelet aggregation and adhesion (sticking), making the blood more fluid. It is enough to cancel or at least reduce the dosage of the listed drugs, as menstruation becomes moderate and short-lived.
- Combined oral contraceptives
In the second place, the occurrence of menorrhagia causes the use of hormonal drugs. Often, abundant menstruation occurs against the background of the use of combined oral contraceptives, which is associated either with an incorrectly chosen drug (most often it is high-dosage COC: rigevidon, regulon), or in violation of the regimen (delayed menstruation or not taken in time pill).
- Hormonal drugs after intercourse
Very often, the cause of menorrhagia is the abuse of fire-contraceptive devices (postinor, escagel). Since such hormonal pills contain huge doses of progestogen - levonorgestrel, taking them causes frustration in the menstrual cycle, which leads not only to the occurrence of massive menstrual bleeding, but often requires prolonged treatment to restore the cycle and ovulation.
In some cases, women note that menstruation has become more abundant and longer while receiving duphaston, and postmenstrual daub has also appeared. A similar effect from taking duphaston is possible, which is associated with the reinstallation of the hormonal background and the "addiction" of the body to the ingestion of the progestogen from the outside. Не стоит пугаться, через 2, максимум 3 месяца месячные возвращаются к исходным параметрам.
Если месячные очень обильные – что делать? В любом случае следует обратиться к гинекологу. Only a doctor after a thorough history, clarification of complaints, gynecological examination and additional examination methods can find out the cause of menorrhagia, select an adequate treatment and check its effectiveness.
Therapy of heavy menstruation depends on the factors that led to the development of menorrhagia, concomitant diseases, the use of certain drugs or the use of contraceptive methods, as well as the severity of clinical signs and the patient's age.
- If a pathology of the blood, liver or thyroid gland is detected, corrective therapy of the underlying disease is prescribed.
- If the cause of hypermenorrhea is the IUD, it is removed.
- When taking certain drugs, a different treatment regimen with these drugs is selected or their treatment is canceled.
There are 2 directions in the treatment of heavy menstruation: conservative and surgical.
As symptomatic hemostasis, hemostatic medications are used for heavy menstruation.
- Ditsinon - it can be Ditsinon injections and tablets, tranexamic and aminocaproic acid.
- Vitamins - vikasol (vitamin K, which contributes to the formation of prothrombin by the liver), vitamins that reduce the penetration of the vascular wall (C and P, or a complex drug - ascorutin).
- Infusions of medicinal herbs, reducing menstrual flow (nettle, corn silk, yarrow, shepherd's purse, meadow geranium and others). Infusions should be taken on ½ - 1 glass three times a day for 2 - 3 before the onset of menstruation and the entire period of discharge.
- NSAIDs have proven themselves in the treatment of heavy menstruation nonsteroidal anti-inflammatory drugs (ibuprofen, indomethacin, naproxen). Acceptance of these drugs reduces blood loss by up to 40% and reduces the duration of menstruation.
- Treatment of anemia - anti-anemic therapy is carried out in parallel, iron-containing drugs are prescribed for this purpose (see iron preparations for anemia).