Types, symptoms, risk factors, and causes

Von Willebrand’s disease is a hereditary blood-clotting disorder. It is the most common bleeding condition that a person can inherit.

However, a person might also acquire it as a result of other medical conditions, such as lymphomas, leukemias, and autoimmune disorders such as lupus, as well as by taking certain medications.

People with von Willebrand’s disease either lack, or have ineffective supplies of, a substance in the blood called von Willebrand factor (vWF). This promotes clotting.

People with the condition will have difficulty forming blood clots. For example, if they cut themselves, it will take longer to stop bleeding.

It occurs in up to 1 percent of people in the United States. No cure is available, but treatment can help people with the condition lead otherwise healthy lives.

In this article, we look at the different types of von Willebrand’s disease, their symptoms, and ways to manage them.

There are four main types of von Willebrand’s disease.

Type 1

Type 1 is the most common. About 60–80 percent of people with von Willebrand’s disease have type 1.

Type 1 is characterized by low levels of vWF. Clotting factor VIII, another essential blood-clotting protein, may also be affected. The severity of type 1 can range from mild to severe, but it mostly presents as mild.

Type 2

Several subtypes might occur in type 2 von Willebrand’s disease, but a doctor will generally diagnose type 2 when the vWF does not work properly, rather than there being a lack of it.

Different gene mutations can cause type 2, and each will require different treatment. Knowing the type 2 subtype can help a doctor shape treatment in a way that works best for the individual.

Type 2 is present in around 15–30 percent of people who have von Willebrand’s disease.

Type 3

In type 3, the individual typically has little to no vWF at all. This is the rarest and most severe form of von Willebrand’s disease.

Around 5–10 percent of people with the condition have type 3.

Acquired

While the more common types of von Willebrand’s disease are inherited, it is also possible to develop the condition from an autoimmune disease such as lupus or cancer, or as a result of taking some medications.

This is called acquired von Willebrand’s disease.

Signs and symptoms may be mild and difficult to observe, or they may occur in a range of ways. It is difficult for doctors to diagnose milder forms of von Willebrand’s disease.

When symptoms do appear, they tend to include bruising and extended or excessive bleeding. Bleeding might occur around the mucous membranes, including the gastrointestinal tract.

Symptoms of bleeding include:

• nosebleeds, which may be prolonged, recurring, or both
• bleeding from the gums
• longer, heavier menstrual bleeding
• excessive bleeding from a cut
• excessive bleeding after a tooth extraction or other dental work
• bruising, sometimes with lumps forming under the skin

Sometimes, a doctor will only discover the condition after the person has undergone a surgical procedure, had dental work, or experienced serious trauma.

Women may notice the following signs when menstruating:

• blood clots that are at least 1 inch in diameter
• soaking through at least two tampons or pads in 2 hours
• a need for double sanitary protection to control bleeding
• menstruation that continues for over a week
• symptoms of anemia, including fatigue, pallor, and drowsiness

In rare and severe cases, the bleeding can damage internal organs. When internal organ damage occurs as a result of this condition, it can be fatal.

When injury occurs in a blood vessel, small fragments inside a type of blood cell called platelets normally clump together to plug the wound and stem the bleeding.

vWF, which carries clotting factor VIII, helps platelets stick together to form a clot. Clotting factor VIII is either missing or faulty in people with the most common form of hemophilia.

Family history is the most common risk factor for von Willebrand’s disease. That said, the genetic content needed for each type to develop will differ.

For example, in types 1 and 2, only one gene is necessary to cause the condition. Also, the biological parents will likely have von Willebrand’s disease themselves.

In type 3, both parents need to pass on genes, and they will most likely be carrying the disease without actually having it.

Acquired von Willebrand’s disease can happen later in life, so advanced age is a factor.

Early diagnosis and treatment significantly increase the chances of living a normal and active life with von Willebrand’s disease.

Some people with type 1 or type 2 may not experience major bleeding problems. Therefore, they may not receive a diagnosis until they have surgery or a serious injury.

The diagnosis of type 3 usually occurs at an early age, because major bleeding will probably occur at some time during infancy or childhood.

A doctor will look at the person’s medical history, carry out a physical exam, and run some diagnostic tests.

When assessing medical history, the doctor may ask whether the person has ever experienced the following symptoms:

• excessive bleeding after surgery or a dental procedure
• unexpected or easy bruising, or bruising with a lump underneath
• blood in the feces
• bleeding in the joints or muscles
• bleeding after taking medications, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners
• abnormal blood platelet counts
• unexplainable nosebleeds that last for longer than 10 minutes, even after placing pressure on the nose
• frequent nosebleeds
• heavy menstrual bleeding for longer than a week, with clots
• kidney, liver, blood, or bone marrow disease

The physical exam will check for bruising and signs of recent bleeding.

Blood tests can assess:

• vWF levels
• the structure of vWF and its multimers, or protein complexes, as well as how its molecules break down, to determine the type of von Willebrand’s disease
• ristocetin cofactor activity, to reveal how well vWF works and whether it is adequately clotting the blood
• factor VIII clotting activity, to establish levels of factor VIII
• platelet function
• bleeding time, to see how long it takes for a small wound to stop bleeding

It may take 2–3 weeks for the test results to come back, and some tests may need repeating to confirm a diagnosis. The doctor may refer the individual to a hematologist, a doctor who specializes in diseases of the blood.

No cure is currently available for von Willebrand’s disease, but some options can prevent or stop bleeding episodes. Treatment tends to take the form of medication.

Symptoms are normally mild, and treatment for people with milder symptoms is only necessary during surgery, dental work, or after an accident or injury.

Management methods depend on the type and severity of the condition, as well as the person’s response to therapy.

Medications can:

• release more vWF and factor VIII into the bloodstream
• control heavy menstruation
• prevent the breakdown of blood clots
• replace missing vWF

Desmopressin (DDAVP) is a synthetic hormone that a person can take by injection or through a nasal spray (Stimate). It is similar to vasopressin, which is a natural hormone that controls bleeding by making the body release more of the vWF already present in the linings of blood vessels. This raises factor VIII levels.

A doctor will usually prescribe this for those with types 1 and 2. They may use the nasal spray at the beginning of a menstrual period or before minor surgery.

If DDAVP is not sufficient, the doctor might prescribe doses of concentrated blood-clotting factors containing vWF and factor VIII for all three types of von Willebrand’s disease.

Oral contraceptives, specifically birth control pills containing estrogen, can help women with heavy periods.

Clot-stabilizing medications delay the breakdown of clotting factors. A doctor may call these antifibrinolytic drugs. They help keep a clot in place once it forms, especially during surgery or dental work.

A doctor may also apply fibrin sealant to a wound to stop the bleeding. This is a glue-like substance.

vWF and factor VIII levels tend to rise during pregnancy, but bleeding complications might occur during delivery. Bleeding may be heavier and last longer after giving birth.

Women who have a type of von Willebrand’s disease should consult a hematologist and specialized obstetrician when they become pregnant.

They will likely carry out blood tests during the final trimester of pregnancy.

Share on PinterestSome medicines affect blood clotting. Speak to a doctor before taking some OTC medications.

To prevent bleeding episodes, people who have any type of von Willebrand’s disease should check with a physician before taking medications.

They should also avoid over-the-counter (OTC) medications that may affect blood clotting, such as aspirin, ibuprofen, and other NSAIDs.

It may also be worth a person informing healthcare professionals such as dentists about their condition, as well as sports coaches or people who oversee physical activity.

People with severe symptoms should also wear a medical ID necklace or bracelet.

To minimize common health risks, people with the condition should eat a healthful, balanced diet and exercise regularly. Normally, von Willebrand’s disease does not interfere with daily activities, but doctors may recommend that children with the condition avoid contact sports, such as football and hockey.

Von Willebrand’s disease is the most common type of heritable bleeding disorder. Type 1 is the most prevalent, affecting around 60–80 percent of all people with the condition.

Symptoms may be mild or severe, and they may include nosebleeds, excessive bleeding from a cut, and bruising more easily.

Though no cure is currently available for von Willebrand’s disease, treatments tend to include taking medications that prevent the breakdown of blood clots and applying a glue-like substance called fibrin sealant to bleeding wounds.

Q:

What is the difference between von Willebrand’s disease and hemophilia?

A:

While von Willebrand’s disease and hemophilia are both genetic and cause problems with blood clotting, they are distinctly different conditions.

Von Willebrand’s disease is usually milder than hemophilia and is more common. It affects males and females equally, while hemophilia almost always affects males.

Hemophilia causes low levels of clotting factors that are different than the vWF involved in von Willebrand’s disease.

Karen Gill, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Menorrhagia: Symptoms, Causes, Treatments

Overview

What is menorrhagia?

Menorrhagia is a common disorder in women. Menorrhagia is the medical term for menstrual bleeding lasting for longer than 7 days. About 1 in every 20 women has menorrhagia.

Some of the bleeding can be very heavy, meaning you would change your tampon or pad after less than 2 hours. It can also mean you pass clots the size of a quarter or even larger.

Menorrhagia can lead to anemia if not treated. Also, the heavy bleeding can affect sleep, cause lower abdominal pain and make enjoyable activities a burden.

If you are experiencing weakness and a disruption to everyday life due to heavy bleeding, you should ask your doctor for treatment options.

Symptoms and Causes

What are the signs and symptoms of menorrhagia?

Signs of menorrhagia include:

• Soaking 1 or more tampons or pads every hour for many consecutive hours
• Doubling up on pads
• Changing pads or tampons during the night
• Long-lasting menstrual periods (longer than 7 days)
• Blood clots the size of a quarter or larger
• Bleeding that is keeping you from doing normal activities
• Constant pain in lower part of stomach
• Lacking energy
• Shortness of breath

What causes menorrhagia?

Menorrhagia can be caused by uterine problems, hormone problems or other illnesses. Other causes include:

• Growths or tumors of the uterus that are not cancer
• Cancer of the cervix or uterus
• Particular types of birth control
• Pregnancy-related problems (miscarriage or ectopic pregnancy, when the fertilized egg implants outside the uterus)
• Bleeding disorders
• Liver, kidney or thyroid disease
• Pelvic inflammatory disease (and infection of the female reproductive organs)
• Taking certain drugs, such as aspirin
• The menopause transition, also referred to as perimenopause
• Childbirth
• Fibroids or polyps in the lining or muscle of the womb

Diagnosis and Tests

How is menorrhagia diagnosed?

Menorrhagia is diagnosed by your doctor through a series of questions about your medical history and menstrual cycles. Usually for women with menorrhagia bleeding lasts for more than 7 days and more blood is lost (80 milliliters compared to 60 milliliters).

Your doctor may ask for information about:

• Your age when you got your first period
• Length of your menstrual cycle
• Number of days your period lasts
• Number of days your period is heavy
• Quality of life during your period
• Family members with a history of heavy menstrual bleeding
• Stress you are facing
• Weight problems
• Current medications

Physical tests or exams done to diagnose menorrhagia may include:

• Pelvic exam
• Blood test to check thyroid, check for anemia and how the blood clots
• Pap test to check cells from cervix for changes
• Endometrial biopsy to check uterine tissue for cancer or abnormalities
• Ultrasound to check function of blood vessels, tissues and organs

Sometimes additional tests are still required to understand the cause of bleeding, including:

• Sonohysterogram to check for problems in the lining of the uterus
• Hysteroscopy to check for polyps, fibroids or other problems
• Dilation and curettage (“D&C”). This test can also treat the cause of the bleeding. During this test, the lining of the uterus is scraped and examined under sedation.

Management and Treatment

How is menorrhagia treated?

Treatment for menorrhagia depends on how serious the bleeding is, the cause of the bleeding, your health, age, and medical history. Also, treatment depends on your response to certain medicines and your wants and needs. You may not want to have a period at all, or just want to reduce the amount of bleeding. In addition, your decision to get pregnant or not will affect what treatment you choose. If you do not have anemia, you can choose to not have treatment.

Common treatments include:

• Iron supplements to put more iron into your blood
• Ibuprofen to reduce pain and amount of bleeding
• Birth control to make periods more regular and reduce bleeding (pills, vaginal ring, patch)
• Intrauterine contraception (IUD) to make periods more regular and reduce bleeding
• Hormone therapy to reduce bleeding
• Desmopressin nasal spray to stop bleeding for certain bleeding disorders
• Antifibrinolytic medicines to reduce bleeding
• Dilation and curettage to reduce bleeding by removing the top layer of uterus lining
• Operative hysteroscopy to remove fibroids and polyps and remove lining of uterus
• Endometrial ablation or resection to remove all or part of the lining of the uterus
• Hysterectomy to surgically remove the uterus and you will stop having your period

How is menorrhagia managed?

To manage menorrhagia, some women stay home on days when they are bleeding heavily. Others leave the house if they know a bathroom will be nearby. Also, it is a good practice to keep pads and/or tampons in your purse or at work. Wearing dark pants or skirts can help if you are worried about stains on light-colored clothing. Additionally, you can use a waterproof sheet on your mattress to prevent stains.

Prevention

How is menorrhagia prevented?

Menorrhagia cannot be prevented. However, talking with your doctor to get diagnosed and treated can prevent other health issues in the future.

Outlook / Prognosis

What is the prognosis for living with menorrhagia?

If left untreated, menorrhagia can interfere with daily life. In addition, it can cause anemia and leave you feeling tired and weak. Other health problems can also arise if the bleeding problem is not resolved. With proper treatment and doctor assistance, menorrhagia can be managed and not cause a disruption to your life.

Living With

When do you call the doctor if you suspect menorrhagia?

You should call the doctor if you are passing clots the size of a quarter or larger. You should also call the doctor if you need to change your tampon or pad after less than 2 hours due to heavy bleeding.

Why Is My Period Lasting So Long? – Health Essentials from Cleveland Clinic

There’s really no such thing as a “normal” period. Sure there are general guidelines, but every woman is unique and different. Some women have unpredictable cycles, while others experience regular, clockwork menstruation. It’s important to note that there is likely nothing is wrong with you if your period is a little longer or shorter than others. It’s also perfectly fine if your period varies a bit from month to month.

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But what’s the deal if you suddenly feel like your period is lasting forever? Yep, it’s annoying. But is it cause for concern? Gynecologist Erin Higgins, MD, offers advice on what might be causing your period to overstay its welcome and how to manage it.

What’s normal?

You probably learned in high school that a woman’s period occurs every 21 to 35 days (with most women’s cycles occurring every 28 days).

The average period is two to seven days in length, so bleeding for eight days or more is considered long. In general, periods on the longer end of normal (five to seven days) aren’t something to worry about. So although aggravating, it’s unlikely due to an underlying problem.

Periods lasting for eight days or more should be investigated, says Dr. Higgins. Heavy periods (requiring multiple pad or tampon changes a day) or infrequent periods (occurring less than every 5 weeks) should also be evaluated. A change in cycle characteristics (such as a noticeable difference in frequency, heaviness or spotting between periods) is also a reason to seek medical care.

The source of the issue

Long periods can be the result of a variety of factors such as health conditions, your age and your lifestyle.  

Underlying health conditions that can cause long periods include uterine fibroids, endometrial (uterine) polyps, adenomyosis, or more rarely, a precancerous or cancerous lesion of the uterus. A long period can also result from hormonal imbalances (like hypothyroidism) or a bleeding disorder.

Many women struggle with long and heavy periods for years without knowing there are ways to manage and improve their symptoms. I encourage all patients to seek out medical care if they have questions about their menstrual cycle or other gynecologic issues.

The first step to managing long periods due to a specific condition is to treat it. This can include things like removing an endometrial polyp or correcting hypothyroidism. Hormonal contraceptives (things like the pill, the patch or a hormonal IUD) are commonly used to help regulate abnormal cycles resulting from a wide variety of causes. Most of these methods take three to six months before you’ll notice some improvement.

The effects of birth control and menopause

Various
forms of birth control can affect the frequency and duration of your period.
The birth control pill tends to produce a regular period that occurs every
month and lasts for three to five days. A hormonal IUD usually results in a
lighter period (less bleeding) or no
period at all. Most women experience spotting for the first few
months after getting the IUD.

A copper IUD (such as Paragard®) may have no effect on bleeding patterns or may cause heavier and longer periods for some women. Progestin-only methods like the injection, medroxyprogesterone acetate (such as Depo-Provera®), and the implant, etonogestrel (such as Nexplanon®) are associated with irregular spotting as well, but most women report lighter and shorter periods.

Periods can become longer and more irregular as women approach menopause. It’s important to discuss cycle characteristics with your doctor, especially women over the age of 45, as the risk of endometrial hyperplasia (a precancerous change) and endometrial cancer increases with age.

Long Periods: Is Prolonged Menstrual Bleeding Cause for Concern?

Doctors use the term “menorrhagia” to describe a period that is dangerously heavy or long-lasting. According to the Mayo Clinic, menorrhagia means more than just having a period that drags on longer than you’d like; it means you are losing so much blood through your menses that you can’t maintain your usual activities.

What Is the Normal Duration for a Menstrual Period?

Women vary greatly in the range of their cycles. This includes how long they go between periods (typically anywhere from 21 to 35 days).

It also includes how long a period lasts. Generally, a period should last six days or less and start heavier and get lighter. “But every woman is different,” Dr. Thielen says.

What’s more important is whether the length of your period has changed, she stresses. “If you regularly bleed for eight or nine days, that’s not concerning. But if you previously had a five-day flow and now you’re going eight or nine, that should be evaluated,” she says. Even women in perimenopause, whose periods may be all over the place, are wise to get examined.

Depending on the circumstances, long menstruation might be a mild condition that can be easily controlled, or one that indicates a more serious underlying health issue.

RELATED: 5 Simple Yoga Moves for Endometriosis and Pelvic Pain Relief

Is It Normal for a Period to Not Stop?

For some women it may seem as if the bleeding literally doesn’t stop, continuing through the entire month. But this isn’t usually the case.

Since the time between cycles is counted from the first day of your period, a woman who has a 24-day cycle with eight days of bleeding will experience only 16 days period-free. It may seem like you’re always having your period even though you’re within a standard timetable.

RELATED: Why You Shouldn’t Miss Your Ob-Gyn Wellness Visit Due to the Pandemic

What Causes Prolonged Menstrual Bleeding?

While irregular menstrual periods can be bothersome, many are caused by hormonal changes, which are common and rarely mean something serious. Younger girls just entering puberty and older women approaching menopause are most likely to experience these hormonally based prolonged or irregular periods.

Usually, a changing level of estrogen is to blame. Estrogen helps build up the uterine lining, called the endometrium, which if it is fertilized will support a pregnancy. If no pregnancy happens that month, the lining is shed as a menstrual period. Doctors use the term dysfunctional uterine bleeding (DUB) when a hormone imbalance is the cause of the bleeding.

In some cases, birth control can impact the frequency, duration, and flow levels of menstrual periods. The copper IUD may cause extra bleeding, Thielen says. And while birth control pills usually shorten your periods, it’s possible some can have the opposite effect. Changing the type of birth control you use may help with this issue. But if you are on birth control pills you should not stop taking them or alter your birth control strategy without speaking to your physician.

What Underlying Conditions May Cause Prolonged Menstrual Bleeding?

A visit with your gynecologist or other healthcare professional is the first step in determining the cause of your prolonged menstrual bleeding. Your doctor will make a diagnosis after performing a series of tests.

Depending on your age and other symptoms, your doctor may test your blood for pregnancy, hormone levels, and thyroid function. Other diagnostic tests may include Pap smears, endometrial biopsies, ultrasounds, and other procedures.

Medical conditions that could be the cause of abnormal menstrual bleeding include:

• Uterine fibroids These noncancerous growths emerge inside the uterine walls. They can range in size from one tiny speck to several bulky masses. Also called leiomyoma, uterine fibroids can lead to heavy bleeding and periods that last longer than a week.
• Uterine polyps These small, noncancerous growths appear on (not inside) the wall of the uterus. Polyps are usually round or oval shaped.
• Endometriosis This disorder has tissue similar to the tissue that normally lines the inside of your uterus grows outside your uterus. In addition to excessive bleeding, endometriosis can cause significant pain.
• Endometrial hyperplasia This is a condition in which the lining of the uterus, called the endometrium, becomes too thick. An excess level of the hormone estrogen is often to blame.
• Polycystic ovary syndrome (PCOS) PCOS is a hormonal disorder that often entails excess levels of the male hormone androgen.
• Thyroid disease Unhealthy levels of your thyroid hormone can cause periods to be long, heavy, light, or irregular.
• Intrauterine device (IUD) Especially in the first year, a copper IUD can cause heavier menstrual bleeding.
• Pelvic inflammatory disease (PID) PID is an infection in the female reproductive organs that is often transmitted during sex.
• Bleeding disorders When the blood does not clot properly, it can cause heavy menstrual bleeding.
• Endometrial cancer Though rare, this cancer of the uterine lining is the most serious cause of prolonged menstrual bleeding.

What Treatments Are Available for Prolonged Menstrual Bleeding?

Many causes of prolonged bleeding can be treated with birth control pills of estrogen and progesterone. This not only provides contraception, it can regulate hormone production and so treat bleeding caused by hormones. “Birth control pills generally decrease the overall amount of flow and so should lessen the length of your period,” Thielen says.

In some cases, such as for endometrial hyperplasia, the hormone progestin may be prescribed alone.

Other medicines may also be used. Lysteda (tranexamic acid) is a prescription drug that treats heavy menstrual bleeding. It comes in a tablet and is taken each month at the start of the menstrual period.

Prolonged bleeding caused by uterine fibroids can be treated with medication or with minimally invasive procedures such as endometrial ablation or laparoscopic surgery (known as a myomectomy). In severe cases an abdominal myomectomy or a hysterectomy may be recommended.

Are There Any Complications From Having a Long Menstrual Period?

Often, the biggest problem from having a long menstrual period is the way it impacts your quality of life. If this is the case, don’t be shy about exploring ways to change your cycle with your doctor.

“It’s okay to treat something simply because it’s a bother. Women don’t have to live that way,” Thielen says

And since blood is rich in iron, women who bleed a lot are at risk of anemia, she says.

How Can Birth Control or Menopause Affect the Duration of Your Period?

Birth control pills generally help with prolonged menstrual bleeding, but on occasion may cause it. IUDs, especially copper IUDs, sometimes cause prolonged bleeding, especially in the first year after insertion.

Women in perimenopause, the years leading up to menopause, frequently find their periods changing. Still, even if you’re perimenopausal, you want your doctor to check things out. “Long or irregular bleeding may just be from perimenopause. But it is also often our first clue of endometrial cancer or cervical cancer,” she says.

When Should You See a Healthcare Professional for a Long Menstrual Period?

If you have a long period for only one month, there’s probably no need to worry. But “if you notice a change for two or three cycles, that’s the time to seek out your doctor,” Thielen says.

Any significant bleeding (as opposed to spotting) between periods without an explanation such as a recently placed IUD should be evaluated. And a woman past menopause should have no bleeding at all and so should see her doctor immediately if she does.

Which Healthcare Professionals Can Help?

Several different types of medical professionals can help with prolonged periods. These include:

• Primary care physician
• Gynecologist
• Nurse practitioner
• Physician assistant

Is My Bleeding Normal? – Your Period

In order to decide whether the bleeding you are experiencing is normal or abnormal, a good starting point is understanding the range of normal bleeding. Learning how to track your periods, get an idea of how much blood loss is occurring, and knowing what to do if your period changes, are all important parts of maintaining menstrual health.

What is a normal period?

There is a range of normal bleeding – some women have short, light periods and others have longer, heavy periods.

Normal menstrual bleeding has the following features:

• Your period lasts for 3-8 days
• Your period comes every 21-35 days (measured from the first day of one period to the first day of the next)
• The total blood loss over the course of the period is around 2-3 tablespoons (30-50 mL)

How much bleeding is too much?

Heavy menstrual bleeding (HMB) is characterized by experiencing any of the following:

• Bleeding that lasts more than 7 days.
• Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.
• Needing to wear more than one pad at a time to control menstrual flow.
• Needing to change pads or tampons during the night.
• Menstrual flow with blood clots that are as big as a quarter or larger.

You can learn about the causes of HMB here.

If you are concerned about your menstrual bleeding, or other bleeding tendencies, you can use the self-administered bleeding assessment tool  (Self-BAT) available at the Let’s Talk Period website (www.letstalkperiod.ca). This tool is designed to evaluate menstrual and other bleeding tendencies and tell you if you should be screened for a bleeding disorder.

How can I tell how much blood I am losing?

Measuring the amount of blood lost via menstruation is not that easy, since it is hard to tell how much blood has been absorbed by a pad or tampon. Different products have different absorbencies, and each woman has a different perspective on when a tampon or pad needs to be changed. Using a menstrual cup is one way of getting an accurate measurement of blood loss. Alternatively, you can use this ‘Pictorial Blood Assessment Chart‘ which helps identify whether your blood loss is excessive.

What if my period changes?

Changes in your period can be a sign of a problem, and most changes are worth seeing a doctor about. Some changes that should be investigated include:

• Your period stops for more than 90 days (and you are not pregnant or on extended regimen birth control)
• Periods that become irregular when you usually have regular periods
• Bleeding for longer than normal, for example your period normally lasts 5 days and is suddenly 9 or 10 days long
• Bleeding between periods, particularly if you are not on any birth control
• Pain during your period where you have not usually had pain
• Your bleeding has become very heavy, soaking through more than one pad or tampon per hour or staining night clothes

Menstrual cycle: What’s normal, what’s not

Menstrual cycle: What’s normal, what’s not

Your menstrual cycle can say a lot about your health. Understand how to start tracking your menstrual cycle and what to do about irregularities.

By Mayo Clinic Staff

Do you know when your last menstrual period began or how long it lasted? If not, it might be time to start paying attention.

Tracking your menstrual cycles can help you understand what’s normal for you, time ovulation and identify important changes — such as a missed period or unpredictable menstrual bleeding. While menstrual cycle irregularities usually aren’t serious, sometimes they can signal health problems.

What’s the menstrual cycle?

The menstrual cycle is the monthly series of changes a woman’s body goes through in preparation for the possibility of pregnancy. Each month, one of the ovaries releases an egg — a process called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn’t fertilized, the lining of the uterus sheds through the vagina. This is a menstrual period.

What’s normal?

The menstrual cycle, which is counted from the first day of one period to the first day of the next, isn’t the same for every woman. Menstrual flow might occur every 21 to 35 days and last two to seven days. For the first few years after menstruation begins, long cycles are common. However, menstrual cycles tend to shorten and become more regular as you age.

Your menstrual cycle might be regular — about the same length every month — or somewhat irregular, and your period might be light or heavy, painful or pain-free, long or short, and still be considered normal. Within a broad range, “normal” is what’s normal for you.

Keep in mind that use of certain types of contraception, such as extended-cycle birth control pills and intrauterine devices (IUDs), will alter your menstrual cycle. Talk to your health care provider about what to expect.

When you get close to menopause, your cycle might become irregular again. However, because the risk of uterine cancer increases as you age, discuss any irregular bleeding around menopause with your health care provider.

How can I track my menstrual cycle?

To find out what’s normal for you, start keeping a record of your menstrual cycle on a calendar. Begin by tracking your start date every month for several months in a row to identify the regularity of your periods.

If you’re concerned about your periods, then also make note of the following every month:

• End date. How long does your period typically last? Is it longer or shorter than usual?
• Flow. Record the heaviness of your flow. Does it seem lighter or heavier than usual? How often do you need to change your sanitary protection? Have you passed any blood clots?
• Abnormal bleeding. Are you bleeding in between periods?
• Pain. Describe any pain associated with your period. Does the pain feel worse than usual?
• Other changes. Have you experienced any changes in mood or behavior? Did anything new happen around the time of change in your periods?

What causes menstrual cycle irregularities?

Menstrual cycle irregularities can have many different causes, including:

• Pregnancy or breast-feeding. A missed period can be an early sign of pregnancy. Breast-feeding typically delays the return of menstruation after pregnancy.
• Eating disorders, extreme weight loss or excessive exercising. Eating disorders — such as anorexia nervosa — extreme weight loss and increased physical activity can disrupt menstruation.
• Polycystic ovary syndrome (PCOS). Women with this common endocrine system disorder may have irregular periods as well as enlarged ovaries that contain small collections of fluid — called follicles — located in each ovary as seen during an ultrasound exam.
• Premature ovarian failure. Premature ovarian failure refers to the loss of normal ovarian function before age 40. Women who have premature ovarian failure — also known as primary ovarian insufficiency — might have irregular or occasional periods for years.
• Pelvic inflammatory disease (PID). This infection of the reproductive organs can cause irregular menstrual bleeding.
• Uterine fibroids. Uterine fibroids are noncancerous growths of the uterus. They can cause heavy menstrual periods and prolonged menstrual periods.

What can I do to prevent menstrual irregularities?

For some women, use of birth control pills can help regulate menstrual cycles. Treatment for any underlying problems, such as an eating disorder, also might help. However, some menstrual irregularities can’t be prevented.

In addition, consult your health care provider if:

• Your periods suddenly stop for more than 90 days — and you’re not pregnant
• Your periods become erratic after having been regular
• You bleed for more than seven days
• You bleed more heavily than usual or soak through more than one pad or tampon every hour or two
• Your periods are less than 21 days or more than 35 days apart
• You bleed between periods
• You develop severe pain during your period
• You suddenly get a fever and feel sick after using tampons

If you have questions or concerns about your menstrual cycle, talk to your health care provider.

June 13, 2019

Show references

1. Kaunitz A, et al. Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. https://www.uptodate.com/contents/search. Accessed March 22, 2019.
2. Welt C, et al. Evaluation of the menstrual cycle and timing of ovulation. https://www.uptodate.com/contents/search. Accessed March 22, 2019.
3. Barrett KE, et al. Reproductive development & function of the female reproductive system. In: Ganong’s Review of Medical Physiology. 26th ed. New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Accessed March 22, 2019.
4. Hammer GD, et al. Disorders of the female reproductive tract. In: Pathophysiology of Disease: An Introduction to Clinical Medicine. 8th ed. New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Accessed March 22, 2019.
5. Melmed S, et al. Physiology and pathology of the female reproductive axis. In: Williams Textbook of Endocrinology. 13th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed March 22, 2019.

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What It Means If Your Period Lasts For More Than A Week

By: Suzannah Weiss, Bustle
December 1, 2017

I learned in middle school health class that your period should last between two and seven days. But I very quickly learned this was just the ideal situation for most people — not what everyone actually experiences. My first period lasted nine days. So, how long should your period last? And if it lasts more than a week, how do you know if there’s a cause for concern or if you just have a longer-than-average period?

It is possible that a long period is just normal for you, as long as you’re not experiencing any troublesome symptoms. However, all the blood loss resulting from long periods can lead to anemia, Salli Tazuke, MD, Co-Medical Director with CCRM San Francisco, tells Bustle. If you’ve always had a long period, there’s probably nothing wrong, but you should get a blood count to make sure you’re not anemic. Getting enough iron from supplements or foods like spinach, red meat, and poultry can help prevent anemia.

If this is new for you, though, you should talk to your doctor. There could be an underlying issue. The reason your period lasts more than a week depends on whether it has always been that long or has suddenly gotten longer, says Tazuke. Here’s what it could be in each situation.

If It’s New:

1. Pregnancy

If it only happens once, a long period could be a result of an early miscarriage or a tubal pregnancy, which occurs outside the uterus, says Tazuke. See a doctor to rule out these possibilities.

2. A Missed Period

If you miss a period, your next one may be longer than usual because your uterine lining has spent a long time building up, says Tazuke. The causes of a missed period include stress, sleep disturbances, and changes in weight.

3. Blood-Thinning Medications

Medications intended to avoid blood clotting can also affect your menstrual blood, says Tazuke. Pain relievers like Aspirin, Advil, and Motrin can also have this effect on some people.

If It’s Always Been That Way:

1. Excessive Bleeding

Some people are genetically more prone to bleeding, says Tazuke. If this is the case with you, you might also notice that you bruise or bleed easily on other parts of your body. This requires treatment, so see a doctor about it.

In Either Situation:

1. Uterine Fibroids

Fibroids are benign tumors on the uterus made of muscle cells and connective tissue. Seventy to 80 percent of women get fibroids before age 50, and most don’t even notice them. One sign of fibroids is a heavy or long-lasting period, says Tazuke. Others include frequent urination, an enlarged abdomen, and pain during sex. Most fibroids don’t have to be treated, but if you have some of these symptoms and they’re bothering you, you can go to a doctor for an ultrasound to see if you have fibroids, and they can be treated with pain relievers, hormonal medication, or, in severe cases, surgery.

2. Polyps

Polyps are another kind of uterine growth that can cause long or heavy periods, says Tazuke. They come from overgrowth of the uterus’s lining, and they’re sometimes cancerous but usually benign. Postmenopausal people are most likely to get them, though it’s possible for younger people to as well. Like fibroids, these don’t always require treatment, but they can be treated with hormonal medications or surgical removal.

3. Ovarian Cysts

Ovarian cysts are growths on the ovaries that most women have at some point. Sometimes they cause pain or rupture, and sometimes they go away before you even feel them. They don’t always affect your period, but they may go along with hormonal changes that can throw off your period. Ovarian cysts could also be a sign of polycystic ovary syndrome (PCOS), whose symptoms include missed periods, making the next period long.

So, your long periods could mean a huge number of things. Most of them aren’t serious, but see your doctor just to make sure everything’s OK and to prevent anemia.

90,000 Fighting Coronavirus May Be Complicated By Longer Incubation Period | World Events – Estimates and Forecasts from Germany and Europe | DW

The incubation period of the SARS-CoV-2 coronavirus, that is, the period from infection to the onset of symptoms, is usually 2 to 14 days. The World Health Organization (WHO), the German Robert Koch Institute and the Ministry of Health of the Federal Republic of Germany continue to proceed from this period. Accordingly, those suspected of being infected are quarantined for two weeks.

The average incubation period of SARS-CoV-2 was three days

Most often, the first symptoms appear after three days. This was found out by the leading epidemiologist of China Zhong Nanshan, the head of the national group of experts on the fight against lung diseases. His team investigated 1,099 SARS-CoV-2 cases in 552 hospitals in China.

Zhong Nanshan

However, these are preliminary results that require further study, says Zhong Nanshan, who discovered the SARS coronavirus in 2003 during the SARS outbreak.

In rare cases, the incubation period for a new coronavirus can be up to 24 days, according to the study, which was published on the medRxiv medical research platform on February 9, 2020. It, in particular, says that “the average incubation period of SARS-CoV-2 was three days (its limits are from 0 to 24 days).”

Individual cases or improper control?

A few days ago, a report by the government of the Chinese province of Hubei, the epicenter of the spread of the new virus, became a sensation, in which it was noted that a 70-year-old man began to show symptoms of SARS-CoV-2 only 27 days after infection.

Checking the temperature of residents of Wuhan, the epicenter of the coronavirus epidemic

However, such isolated cases are significant only to a limited extent, according to the German expert, virologist Christian Drosten from the Berlin clinic “Charite”. “A common source of error in a seemingly very long incubation period is subtle intermediate effects,” explained Drosten.

He sees no reason to change previous estimates of the incubation period for the new coronavirus.In his opinion, only strictly controlled conditions make it possible to exclude the possibility that the victims were exposed to the pathogen several times in a row.

Different people respond to coronavirus at different rates

According to Thomas Pietschmann, molecular virology specialist at Twincore, the Center for Experimental and Clinical Infection Research, it is not surprising that different patients respond differently to pathogens.And, therefore, the length of the incubation period varies greatly from patient to patient.

Jonas Schmidt-Chanazit

“Viruses have different properties regarding how they spread in the host’s body and at the same time suppress his immunity. And such processes lead to the fact that it takes longer or that, on the contrary, the virus is recognized earlier and his symptoms are showing up, “Pitschman pointed out in an interview with DW.

It is gradually becoming clear that in some cases the incubation period lasts significantly longer, continues Professor Jonas Schmidt-Chanasit from the German Center for Infectious Research.But the vast majority of those infected with the coronavirus showed symptoms within a week.

After China, the most cases of the new coronavirus were detected in South Korea

“It was a hitherto unknown virus, we learned about it only two months ago, and now we have more patients and more cases that can be studied. And with this, more and more data show that in some cases – this is worth emphasizing again – the incubation period can be longer, even over a month.But most patients fall ill within a week, this is the bulk. And we work on this basis, “Schmidt-Chanazit DW said.

What does a longer incubation period for coronavirus mean?

For example, if many Chinese workers and employees return from a two-week forced leave to their factories and enterprises, this may, under certain circumstances, lead to a second wave of the spread of infection.

Therefore, Japanese Minister of Health Katsunobu Kato urged all passengers and crew of the Diamond Prinzess cruise ship to stay at home for another two weeks after a two-week quarantine on board. Since the two Australians were found to have the virus only at home, although nothing was found on Diamond Prinzess.

Incomprehensible ways of infection

In addition to concerns about the longer incubation period of SARS-CoV-2, the World Health Organization (WHO) is also concerned about the often incomprehensible ways of infection and those cases of infections where there is no clear epidemiological link, admitted on Twitter WHO Director General Tedros Adan Ghebreyus.

According to him, many people have contracted the new coronavirus, although they have not been to China and have not communicated with anyone who has been diagnosed with it. This confirms the currently widespread assumption that SARS-CoV-2 can be spread by people who have no symptoms of infection at all or such symptoms are mild.

See also:

• Coronavirus in Germany: SARS-CoV-2 epidemic

  The German government introduces emergency measures against the epidemic

  Until February 25, Germany had “only” 16 cases of SARS-Co-2 coronavirus infection …But after a few days, not a single region remained in the country that was not affected by the epidemic, the count went to thousands. The epidemiological situation in the south and west of the country is especially unfavorable. German Health Minister Jens Spahn announced a program of massive financial support for medical institutions.

• Coronavirus in Germany: SARS-CoV-2 epidemic

  Closed schools and kindergartens

  Schools and kindergartens, bars and clubs, restaurants and cinemas, universities and vocational schools are now closed throughout the country, as in this picture from North Rhine-Westphalia.Only pharmacies and grocery stores remain open. Throughout Germany, severe restrictions have been imposed on leaving home and people-to-people contact. Public life froze.

• Coronavirus in Germany: SARS-CoV-2 epidemic

  The original source of infection often remains unknown

  A feature of the pulmonary disease COVID-19 caused by a new coronavirus from China, according to some experts, is that its chain of transmission sometimes occurs very difficult to trace.So, it is still not clear where the spouses from the Heinsberg district, who are currently undergoing treatment at the University Hospital of Dusseldorf (pictured), could have contracted the coronavirus.

• Coronavirus in Germany: SARS-CoV-2 epidemic

  One of the SARS-CoV-2 cases is a doctor

  Two coronavirus patients from Baden-Württemberg, a 25-year-old man from the suburbs of Göppingen and his 24-year-old companion were likely infected with SARS-CoV-2 while traveling to Milan.The third case is the girl’s father, a 60-year-old head of the pathology department at the university hospital in Tübingen. The doctor’s colleagues are now suspended from providing care to patients and are being monitored.

• Coronavirus in Germany: SARS-CoV-2 epidemic

  Protective masks on the faces of passers-by

  Experts warn that conventional thin masks do not provide 100% protection against coronavirus and recommend more expensive and uncomfortable FFP3 masks. Many residents of metropolitan areas such as Berlin or Hamburg, due to the threat of COVD-19 infection, began to wear protective masks when in crowded places or on public transport.

• Coronavirus in Germany: SARS-CoV-2 epidemic

  Development of a vaccine against coronavirus

  The study of coronavirus and the development of a vaccine against it are carried out in several medical and research centers in Germany, including the Robert Koch Institute (RKI) and the Institute of Virology at the Charite Clinic in Berlin, the Institute of Virology at the University of Marburg and some others. However, as RKI told DW, many issues related to the coronavirus have not been clarified so far.

• Coronavirus in Germany: SARS-CoV-2 epidemic

  Forecast for the spread of the virus in Germany

  The Robert Koch Institute predicts a further increase in the number of cases of coronavirus in Germany, but hopes for a slight slowdown in the spread of the epidemic due to the restrictive measures taken by the authorities. In the long term, German virologists believe, COVID-19 can get sick from 60 to 70 percent of German residents.

  Author: Elena Gunkel

90,000 Recommendations for the use of antiviral drugs

Pandemic influenza (h2N1) 2009.Short message No. 8

August 21, 2009 | Geneva –
WHO is now issuing guidance on the use of antiviral drugs in the treatment of patients infected with the h2N1 pandemic influenza virus.

This guideline has been developed as a result of a consensus reached by an international group of experts who reviewed all available research results on the safety and efficacy of these drugs. Particular importance is attached to the use of oseltamivir and zanamivir in order to prevent the development of serious illness and death, reduce the need for hospitalization and shorten the length of hospital stay.

The pandemic virus is currently susceptible to both of these drugs (known as neuraminidase inhibitors), but resistant to a second class of antiviral drugs (M2 inhibitors).

Around the world, most patients infected with the pandemic virus show typical flu symptoms and recover completely within one week, even without any medication. Healthy patients with uncomplicated disease do not need antiviral treatment.

In a personalized patient approach, treatment decisions need to be made based on clinical judgment and knowledge of the presence of the virus in specific communities.

In areas where the virus is circulating in communities, physicians must assume that a pandemic virus is the cause of the illness when treating patients with influenza-like illness. Treatment decisions should not wait for laboratory confirmation of h2N1 infection.

These recommendations are supported by reports from all outbreak locations that the h2N1 virus is rapidly becoming the predominant strain.

Immediately start treatment for serious cases

Evidence reviewed by a panel of experts indicates that oseltamivir, when properly administered, can significantly reduce the risk of pneumonia (one of the leading causes of death from both pandemic and seasonal influenza) and reduce the need for hospitalization.

For patients who develop severe illness from the outset or begin to deteriorate, WHO recommends starting treatment with oseltamivir as early as possible. Research shows that early treatment, preferably within 48 hours of symptom onset, is significantly associated with better clinical outcomes. Patients with severe or worsening disease should be treated at a later date. If oseltamivir is not available or if it cannot be used for any reason, zanamivir may be given.

This recommendation applies to all patient groups, including pregnant women, and to all age groups, including young children and infants.

For patients with comorbid conditions that increase the risk of more severe illness, WHO recommends treatment with oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after the onset of symptoms, without waiting for laboratory test results.

Given that pregnant women are at increased risk, WHO recommends providing them with antiviral treatment as soon as possible after symptoms appear.

At the same time, the presence of concomitant health disorders does not allow to reliably predict all or even most cases of the development of a serious illness. Globally, about 40% of severe illness now occurs in previously healthy children and adults, usually under the age of 50.

Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually 5 or 6 days after the onset of symptoms.

Clinical deterioration is characterized by the development of primary viral pneumonia, which destroys lung tissue and is not sensitive to antibiotics, and functional failure of many organs, including the heart, kidneys and liver. Intensive care units are needed to manage these patients, where other therapies are used in addition to antiviral drugs.

Physicians, patients and home carers should be alert to warning signals that the disease is more severe and take urgent action, which should include treatment with oseltamivir.

In cases of severe or worsening illness, doctors may prescribe higher doses of oseltamivir and use it for a longer period of time than usual.

Use of antiviral drugs in children

After the recent publication of two clinical reviews [1,2], some questions have arisen about the advisability of prescribing antiviral drugs to children.

The data used for these two clinical reviews have been taken into account by WHO and its expert group in the development of this guideline and are fully reflected in the guidelines.

WHO recommends immediate antiviral treatment for children with severe or worsening illness and children at risk of developing more severe or complicated illness. This recommendation applies to all children under the age of five, as this age group is at an increased risk of developing a more severe illness.

All other healthy children over the age of five need antiviral treatment only in cases of protracted or worsening illness.

Signs of danger in all patients

Physicians, patients, and home caregivers should be vigilant for signs of danger that may signal the development of a more severe illness. Given that disease progression can be very rapid, medical attention should be sought when individuals with confirmed or suspected h2N1 infection develop any of the following danger signs:

• shortness of breath during physical activity or at rest;
• shortness of breath;
• blue in the face;
• Bloody or stained sputum;
• chest pain;
• change in mental state;
• high fever for more than 3 days;
• low blood pressure.

In children, signs of danger include rapid or labored breathing, decreased activity, difficulty waking up, and decreased or no desire to play.

90,000 Influenza

Seasonal influenza is an acute respiratory infection caused by influenza viruses that circulate throughout the world.

Pathogen

There are 4 types of seasonal influenza viruses – types A, B, C and D. Influenza A and B viruses circulate and cause seasonal
epidemic disease.

Influenza A viruses are subdivided into subtypes according to
combinations of hemagglutinin (HA) and neuraminidase (NA),
proteins on the surface of the virus. Viruses are currently circulating among humans
influenza subtypes A (h2N1) and A (h4N2). A (h2N1) is also denoted as A (h2N1) pdm09 as it caused
pandemic in 2009 and subsequently replaced by the seasonal influenza A (h2N1) virus circulating until 2009
of the year. Only influenza type A viruses are known to cause pandemics.

Influenza B viruses are not subdivided but can be subdivided
on line.Currently circulating influenza B viruses belong to
lines B / Yamagata and B / Victoria.

Influenza C virus is detected less frequently and usually leads to mild
infections. Therefore, it does not pose a problem to the public.
health care.

Group D viruses , mainly infect large
cattle. They do not reportedly infect people or cause them
diseases.

Signs and Symptoms

Seasonal flu is characterized by a sudden onset of high fever, cough (usually dry), headache, muscle and joint pain, severe malaise, sore throat, and runny nose.The cough can be severe and last 2 weeks or more. For most people, the temperature will return to normal and symptoms resolve within a week without any medical attention. But influenza can cause serious illness and death, especially in high-risk people (see below).

The disease can be mild or severe and even fatal. Hospitalizations and deaths occur mainly in high-risk groups. Annual influenza epidemics are estimated to cause 3–5 million cases of severe illness and 290,000–650,000 respiratory deaths.

In industrialized countries, most influenza-related deaths occur in people aged 65 and over (1). Epidemics can lead to high rates of absence from work / school and lost productivity. During peak periods of illness, clinics and hospitals can be overcrowded.

The impact of seasonal influenza epidemics in developing countries is not well known, but research has shown that 99% of deaths of children under 5 years of age with influenza-related lower respiratory tract infections occur in developing countries (2).

Epidemiology

People get the flu at any age, but there are populations at increased risk of .

• Pregnant women, children under 59 months of age, the elderly, people with chronic health conditions (such as chronic heart, lung and kidney diseases, metabolic disorders, neurological development disorders, diseases liver and blood) and people with weakened immune systems (as a result of HIV / AIDS, chemotherapy or steroid treatment, as well as in connection with malignant neoplasms).
• Health care workers are at high risk of contracting influenza virus through contact with patients and can facilitate further transmission of infection, especially to people at risk.

Transmission of seasonal influenza infection occurs easily and quickly, especially in crowded areas, including schools and boarding schools. When an infected person coughs or sneezes, small droplets containing the virus (infectious droplets) are released into the air and can spread up to one meter and infect nearby people who inhale them.The infection can also be spread through hands that are contaminated with influenza viruses. To prevent transmission of infection when coughing, cover your mouth and nose with a tissue and wash your hands regularly.

In temperate areas seasonal epidemics of occur mainly during the winter season, while in tropical areas influenza viruses circulate year round, resulting in less regular epidemics. Seasonal epidemics and disease burden

The period from infection to disease development, known as incubation period, lasts about 2 days, but can range from 1 to 4 days.

Diagnostics

In most cases, human influenza is clinically diagnosed. However, during periods of low activity of influenza viruses and in the absence of epidemics, infection with other respiratory viruses, such as rhinovirus, respiratory syncytial virus, parainfluenza virus and adenovirus, can also proceed as an influenza-like illness, making it difficult to clinically differentiate influenza from other pathogens.

A definitive diagnosis requires the collection of appropriate respiratory specimens and a laboratory diagnostic test.The first critical step for laboratory detection of influenza viral infections is the proper collection, storage and transport of respiratory specimens. Typically, laboratory confirmation of influenza viruses in throat, nasal and nasopharyngeal secretions or tracheal aspirates or washes is done by direct antigen detection, virus isolation, or detection of influenza-specific RNA by reverse transcriptase polymerase chain reaction (RT-PCR). There are a number of laboratory method guidelines published and updated by WHO (3).

In clinics, rapid diagnostic tests are used to detect influenza, but compared to RT-PCR methods, they have a low sensitivity, and the reliability of their results largely depends on the conditions in which they are used.

Treatment

Patients not in high-risk groups should receive symptomatic treatment. If they have symptoms, they are encouraged to stay at home to minimize the risk of infection to others in the community.Treatment is aimed at relieving flu symptoms such as high fever. Patients should monitor their condition and seek medical help if it worsens. If patients are known to be at high risk of serious illness or complications (see above), they should receive antiviral drugs as soon as possible in addition to symptomatic treatment.

Patients with severe or progressive clinical illness associated with suspected or confirmed viral infection of influenza (for example, with clinical syndromes of pneumonia, sepsis, or exacerbation of concomitant chronic diseases) should receive antiviral drugs as soon as possible.

• Neuraminidase inhibitors (eg, oseltamivir) should be prescribed as soon as possible (ideally within 48 hours after symptom onset) to maximize therapeutic benefits. For patients at a later stage of the disease, medication should also be considered.
• Treatment is recommended for at least 5 days, but can be extended until satisfactory clinical results are obtained.
• The use of corticosteroids should be considered only for other indications (such as asthma and other specific health problems), as it is associated with a longer elimination of viruses from the body and weakening of the immune system, which leads to bacterial or fungal superinfection.
• All currently circulating influenza viruses are resistant to antiviral drugs of the adamantane class (such as amantadine and rimantadine), therefore these drugs are not recommended for use as monotherapy.

WHO GISRS monitors antiviral resistance among circulating influenza viruses in order to provide timely guidance on the use of antiviral drugs for clinical management and potential chemoprophylaxis.

Prevention

The most effective way to prevent the disease is vaccination . Safe and effective vaccines have been available and used for over 60 years. After some time after vaccination, immunity weakens, therefore, annual vaccination is recommended to protect against influenza. Injectable inactivated influenza vaccines are the most widely used in the world.

In healthy adults, influenza vaccine provides protection even if circulating viruses do not match the vaccine viruses exactly.However, for older people, influenza vaccination may be less effective in preventing illness, but reduces the severity and reduces the likelihood of complications and death. Vaccination is especially important for people at high risk of complications and for people living with or caring for people at high risk.

WHO recommends annual vaccination for the following populations:

90,068 90,069 pregnant women at any stage of pregnancy

90,069 children aged 6 months to 5 years 90,076
90,069 Seniors (over 65) 90,076
90,069 people with chronic health problems

The effectiveness of an influenza vaccine depends on how well the circulating viruses match the viruses in the vaccine. Due to the ever-changing nature of influenza viruses, the WHO Global Influenza Surveillance and Response System (GISRS) – a system of National Influenza Centers and WHO Collaborating Centers around the world – continuously monitors influenza viruses circulating in humans and updates them twice a year. composition of influenza vaccines.

Over the years, WHO has been updating its recommendations for the composition of a vaccine (trivalent) targeting the 3 most prevalent circulating virus types (two influenza A subtypes and one influenza B subtype). Beginning in the 2013-2014 influenza season in the northern hemisphere, a fourth component is recommended to support the development of a quadrivalent vaccine. Quadrivalent vaccines include a second type B influenza virus in addition to the viruses in the trivalent vaccine and are expected to provide broader protection against Type B influenza virus infections.Many inactivated and recombinant influenza vaccines are available in injectable form. The live attenuated influenza vaccine is available as a nasal spray.

Pre-exposure and post-exposure prophylaxis with antiviral drugs is possible, but its effectiveness depends on a number of factors, such as individual characteristics, type of exposure and the risk associated with exposure.

In addition to vaccination and antiviral treatment, public health measures include personal protective measures such as:

• Regular washing and proper drying of hands;
• Appropriate Respiratory Hygiene – Covering your mouth and nose when coughing and sneezing with napkins and then dispose of them appropriately;
• Timely self-isolation of people who feel unhealthy, with high fever and other flu symptoms;
• prevention of close contact with sick people;
• Prevention of touching eyes, nose and mouth.

WHO Activities

WHO, through the WHO GISRS system and in collaboration with other partners, monitors influenza activity on a global scale, provides recommendations on the composition of a seasonal influenza vaccine twice a year for the northern and southern hemispheres, and helps countries with tropical and subtropical climates in the selection of vaccine preparations ( for the northern and southern hemispheres) and decisions on the timing of vaccination campaigns and supports Member States in developing prevention and control strategies.

WHO is working to strengthen national, regional and global capacity to respond to influenza (including diagnosis, antiviral susceptibility monitoring, disease surveillance and outbreak response), expand vaccination coverage in high-risk populations, and prepare to the next flu pandemic.

(1) Estimates of US influenza-associated deaths made using four different methods.
Thompson WW, Weintraub E, Dhankhar P, Cheng OY, Brammer L, Meltzer MI, et al. Influenza Other Respi Viruses. 2009; 3: 37-49

(2) Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis.
Nair H, Abdullah Brooks W, Katz M et al. Lancet 2011; 378: 1917-3

(3) WHO recommended surveillance standards, Second edition.

The Chief Otorhinolaryngologist of the Ministry of Health denied misconceptions about the loss of smell in COVID-19

Anosmia (loss of smell) has long been considered a hallmark of coronavirus infection.But now it turned out that this is not an obligatory clinical manifestation of the disease, the chief freelance specialist – otorhinolaryngologist of the Ministry of Health, director of the NMITs otorhinolaryngology (NMITSO) FMBA Nikolay Daykhes said in an interview with “MV”.

“More information is needed to assess the impact of coronavirus infection on the pathology of ENT organs, and even more so to develop treatment algorithms. The information and views with which we entered the pandemic, both in terms of the development of the disease, and in terms of symptoms and the impact of COVID-19 on the organs and systems of the body, have undergone great changes, ”he stressed.

According to Dyhes, a number of scientific publications in Russia and abroad have also reported hearing loss in patients with COVID-19. “Meanwhile, the auditory nerve suffers against the background of any intoxication of the body. The same can be said about other symptoms of the disease – pathological processes in the nasal cavity, pharynx … ”, the specialist noted.

To eliminate these contradictions, serious analytical work is required, he is sure. The pandemic is still ongoing, and with such a scale of morbidity, with such a complexity of treating this infection, conclusions can only be drawn after an objective analysis of a large clinical material.“This is what we are doing now,” added the director of the NMITSO.

He clarified that, according to observations, the sense of smell in those who have undergone COVID-19 is usually restored after a month and a half, maximum two. Hearing impairments require a longer period of recovery and observation of the patient, because the auditory nerve is one of the “delicate” structures of the body. Complications such as the development of chronic sensorineural hearing loss are possible.

“Proven treatment regimens are used to restore these important functions, I mean hearing and smell, but improvement may not come immediately, and full recovery may take months or even years,” concluded Dyhes.

Gastritis

Diagnostics

In our clinic you can undergo a comprehensive examination, according to the results of which the doctors will develop an individual treatment regimen.

Diagnosis of gastritis includes:

• collection of anamnesis of the disease;
• palpation of the abdomen;
• clinical and biochemical blood test;
• studies of the secretory function of the stomach;
• if necessary – appointment of gastroscopy with biopsy sampling;
• X-ray examination;
• if necessary – consultation of related specialists.

Treatment in our clinic is based on the use of medicines. In addition, our experts give recommendations on what diet should be followed in your case. Dieting is an important adjunct to drug therapy, without which complete recovery is impossible.

Chronic gastritis

Chronic gastritis – chronic inflammation of the gastric mucosa. A number of factors contribute to the development of the disease:

• Eating spicy, fatty, hot and too cold foods;
• violation of the diet;
• food allergies;
• alcohol abuse;

90,069 smoking;

• long-term use of a number of drugs;
• metabolic disorders;
• diseases of the organs of internal secretion;
• transferred infectious diseases;
• occupational hazards.

Helicobacter pylori infection is of global importance in the development of chronic gastritis (gastroduodenitis). It is a coiled gram-negative bacillus that colonizes the stomach lining and is the causative agent of the most common form of gastritis. It is widely distributed all over the world. In Russia, according to epidemiological data, about 80% of the adult population is infected.

Gastritis caused by this infection is the most common type of gastritis.The presence of H. pylori and the disease caused by it does not manifest itself in a specific clinical picture. As a rule, the complaints of patients are symptoms of dyspepsia, which become the reason for seeking medical attention. These are, as a rule: belching, aching or burning pain in the stomach, lack of appetite, nausea, weight loss.

If the patient has complaints of pain and discomfort in the epigastrium, and ulceration is not detected during endoscopy, then the specialist usually diagnoses FD (functional dyspepsia).

Most patients have chronic gastritis without symptoms, some patients develop peptic ulcer disease. In others, the progression of gastritis becomes the cause of the development of precancerous disease and the further development of stomach cancer. The disease is morphologically characterized by inflammation, atrophy and impaired regeneration of the gastric mucosa.

In our clinic, we offer you to undergo a comprehensive examination, according to the results of which the doctors will develop an individual treatment regimen.

Diagnosis of chronic gastritis includes:

• collection of anamnesis;
• palpation of the abdomen;
• clinical and biochemical blood test;
• urease test;
• immunological blood test for the determination of antibodies to H. Pylori
• study of the secretory function of the stomach;
• gastroscopy with biopsy for H. pylori;
• X-ray examination;
• if necessary – consultation of related specialists.

As with the acute form of gastritis, the treatment of chronic gastritis in our clinic is based on the use of medications.

In addition to him, experts give recommendations on what diet should be followed in your case. Dieting is an important adjunct to drug therapy, without which complete recovery is impossible.

Care and Treatment – Disease Detection and Treatment – HIV / AIDS: UN Children’s Fund

Disease detection and treatment

Care and Treatment

“When I found out that I had HIV, for ten minutes I had the feeling that my life was over… However, after receiving later consultations, I realized that life goes on regardless of my HIV status. I needed support, love, care. ” – Nelao, 21, Namibia.

It is very difficult to know that you are infected with HIV. However, you can learn to cope with illness. Most people develop the infection slowly, and if you take good care of yourself, eat well, and receive the necessary treatment, you can live a fulfilling life for 10–20 years.

A counselor calms a five-year-old boy and his mother outside their home on the outskirts of the Zimbabwean capital. Photo by UNICEF. Antiretroviral drugs (ARVs) are drugs that are used to fight HIV infection and help maintain health over a longer period. A combination of three or more ARPs, commonly referred to as a “drug cocktail,” is particularly effective. Unfortunately, these medications are expensive and not yet available in many countries around the world.

It should be remembered that HIV infection through unprotected sex, non-sterile needles or breastfeeding is possible even with the use of these drugs and the presence of good health and appearance. Therefore, it is important to follow the basic rules of protection against HIV infection.

Your healthcare professional should also tell you how to take care of your health, for example by following a balanced diet, getting enough rest, and avoiding stressful situations and STDs as much as possible.

HIV / AIDS patient care

If you know someone with HIV, remember that they need not only medical care, but also love, respect and understanding. It is important for such people that their families, parents and communities accept them and help them live fulfilling lives at home, where they feel most comfortable and where they can receive the most attention. An HIV-infected person needs hospitalization only in the event of a serious condition or if a doctor has issued an appropriate referral.

Caring for someone with HIV is not associated with the risk of contracting the virus. In fact, many people living with HIV are living reasonably healthy and fulfilling lives, happy and active in their communities.

However, caring for someone with AIDS or any other chronic illness can take a lot of time and effort. In places where HIV infection is spread, families may already be responsible for orphaned relatives or are simply struggling to survive.In addition, fear and misunderstanding about the spread of HIV leads to communities discriminating against people caring for their HIV-positive relatives or friends, as well as against people living with HIV.

The rules of care for HIV / AIDS are the same as for other diseases. Therefore, families, friends and caregivers should try to provide the HIV / AIDS patient with good food and rest. Attention should be paid to hygiene, both your own and those of the sick.Hands should be washed before preparing food, before eating, before dispensing medication, and after using the toilet. (Everything is done to protect you and the HIV-infected person from other bacteria, since HIV is not transmitted by touch). If you are helping to take medications, read the labels so that the patient is getting the right medication, at the right dosage, as prescribed by the doctor.

Marine fatty acid therapy for stroke

Review question
To evaluate the effect of marine omega-3 fatty acids in stroke after short (up to three months) and longer (more than three months) follow-up periods.

Relevance
The concept of stroke refers to a group of diseases of the blood vessels of the brain. A stroke can be caused by bleeding or blockage of these vessels, resulting in loss of brain cell function. A transient ischemic attack (TIA), also called a mini-stroke, is a temporary disruption of the blood supply to the brain. Stroke is a disabling disease that usually requires long-term specialized care, and there are currently several treatment options for stroke patients.The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in oily fish, have important functions in the brain. In animal studies, they appear to protect brain cells after stroke, especially if they are injected very early. However, the effectiveness of EPA and DHA as a treatment for stroke in humans is unclear.

Study characteristics
We identified 29 studies that included participants with stroke or TIA, and we found relevant information in nine of them (a total of 3339 participants).Three of them had a short follow-up period (up to three months), and six had a longer follow-up. Three studies compared marine-derived omega-3 fatty acids with conventional care, while the rest used a placebo (dummy). Not all studies assessed all outcomes.

Main Findings
The effect of marine omega-3 fatty acids on stroke recovery is unclear. Only two very small studies reported this and found no significant difference.One study showed less improvement in mood with marine omega-3 fatty acids, but the evidence was low-quality. The effect of marine omega-3 fatty acids on vascular death, stroke recurrence, adverse events and quality of life following stroke or TIA is unclear due to the small number of studies that have evaluated them.

Quality of evidence
In short follow-up studies, we rated the quality of evidence as very low for recovery, relapse, incidence of other types of stroke (hemorrhagic and ischemic), and adverse events, and low for vascular-related death.