Period last for 3 days: Shorter Periods: What does it mean?
Shorter Periods: What does it mean?
Three days of bleeding, which may seem short, is still considered normal as long as you’re menstruating regularly. That means that every few weeks, an ovary releases an egg and estrogen builds a thick lining in the uterus called the endometrium, which the body will shed if fertilization doesn’t occur. As long as a woman’s short menstrual period is part of a steady pattern and fits within this range, this is normal menstruation for her body.
“If your period lasts for three days, month in and month out, that’s your pattern,” says Maria Arias, MD, a gynecologist at Atlanta Women’s Specialists in Georgia.
Reasons for a Short Menstrual Period
Estrogen is the all-important hormone required to create the endometrium each month. If you do not produce a certain amount of estrogen, that lining won’t be very thick and, when it is shed, “bleeding tends to be scant and for fewer days,” Dr. Arias says.
Younger women may have short and irregular periods as they enter puberty, because their hormone levels, including estrogen, haven’t completely balanced out yet.
Older women approaching menopause may also experience irregular or short menstrual periods. As women age, their ovaries stop producing estrogen and progesterone and therefore the endometrium fails to form.
Doctors treating women of childbearing age who are experiencing irregular periods will check for abnormal causes like an ectopic pregnancy, which is when a fertilized egg sits in a fallopian tube instead of the uterus. “If your period isn’t coming on time, the first thing doctors rule out is pregnancy,” says Arias.
A short menstrual cycle could also be due to the birth control method you use. Some of the more contemporary methods, like the hormonal intrauterine device that a doctor implants in the uterus, are designed to suppress the growth of the uterine lining, thus decreasing flow level. This is considered an additional benefit of some types of birth control.
Low weight, excessive exercising, eating disorders, and stress may also impact the duration and frequency of your menstrual periods.
When to Call Your Gynecologist About Short Menstrual Periods
If your irregular or short menstrual cycle is a new development and not your typical pattern, you may want to consult with your doctor. For example, says Arias, going 60 days without a period and spotting for just a few days is not normal.
Hormonal problems stemming from the pituitary gland and hypothalamus (which can affect ovarian functioning), thyroid dysfunction, and polycystic ovary syndrome (PCOS) are just some of the conditions that can alter your menstrual cycle. Usually these conditions are accompanied by other symptoms, so look for other changes to alert your doctor about.
Keep track of your period in a journal or calendar if you’re concerned about a menstrual cycle that’s too short. This way you’ll have the most accurate information to share with your doctor and will be able to easily detect a menstruation pattern that’s not normal for you.
Normal Menstruation (Monthly Period): Menstrual Cycle & Symptoms
Female Reproductive Organs
What is menstruation?
Menstruation is the monthly shedding of the lining of a woman’s uterus (more commonly known as the womb). Menstruation is also known by the terms menses, menstrual period, cycle or period. The menstrual blood—which is partly blood and partly tissue from the inside of the uterus—flows from the uterus through the cervix and out of the body through the vagina.
What is a normal menstrual cycle?
The menstrual cycle is a term used to describe the sequence of events that occur within a woman’s body as it prepares for the possibility of pregnancy each month. A menstrual cycle is considered to begin on the first day of a period. The average cycle is 28 days long; however, a cycle can range in length from 21 days to about 35 days.
The steps in the menstrual cycle are triggered by the rise and fall of chemicals in the body called hormones. The pituitary gland in the brain and the ovaries in the female reproductive tract manufacture and release certain hormones at certain times during the menstrual cycle that cause the organs of the reproductive tract to respond in certain ways. The specific events that occur during the menstrual cycle can be described as follows:
- The menses phase: This phase, which typically lasts from day one to day five, is the time when the lining of the uterus is actually shed out through the vagina if pregnancy has not occurred. Most women bleed for three to five days, but a period lasting only two days to as many as seven days is still considered normal.
- The follicular phase: This phase typically takes place from days six to 14. During this time, the level of the hormone estrogen rises, which causes the lining of the uterus (called the endometrium) to grow and thicken. In addition, another hormone—follicle-stimulating hormone—causes follicles in the ovaries to grow. During days 10 to 14, one of the developing follicles will form a fully mature egg (ovum).
- Ovulation: This phase occurs roughly at about day 14 in a 28-day menstrual cycle. A sudden increase in another hormone—luteinizing hormone—causes the ovary to release its egg. This event is called ovulation.
- The luteal phase: This phase lasts from about day 15 to day 28. After the egg is released from the ovary it begins to travel through the fallopian tubes to the uterus. The level of the hormone progesterone rises to help prepare the uterine lining for pregnancy. If the egg becomes fertilized by a sperm and attaches itself to the uterine wall, the woman becomes pregnant. If pregnancy does not occur, estrogen and progesterone levels drop and the thickened lining of the uterus is shed during the menstrual period.
At what age does menstruation typically begin?
Girls start menstruating at the average age of 12. However, girls can begin menstruating as early as 8 years of age or as late as 16 years of age. Women stop menstruating at menopause, which occurs at about the age of 51. At menopause, a woman stops producing eggs (stops ovulating). Menopause is defined as one year without periods, and after this time a woman can no longer become pregnant.
What are some of the symptoms of a normal menstruation?
- Trouble sleeping
- Food cravings
- Cramps in the lower abdomen and back
- Tenderness in the breasts
What symptoms may indicate a need to contact my doctor about my period?
Contact your doctor or healthcare provider if:
- You have not started menstruating by the age of 16
- Your period stops suddenly
- You are bleeding for more days than usual
- You are bleeding more heavily than usual
- You have severe pain during your period
- You have bleeding between periods
- You suddenly feel sick after using tampons
- You think you might be pregnant—for example, you have had sex and your period is at least five days late
- Your period has not returned within three months after stopping birth control pills and you know you are not pregnant
- You have any questions or concerns about your period or possible pregnancy
Shorter Periods – Causes, Symptoms, And What To Do About It
When you get your period, it can feel never ending. So when it peaces out quicker than normal, it might seem like a reason to celebrate. But if your period suddenly goes from lasting a week to lasting just a few days, there could be something more serious going on than the powers that be simply cutting you a break.
“I recommend seeing your gyno if your flow is persistently or newly varied from usual,” says Alyssa Dweck, MD, an ob-gyn and author of The Complete A to Z for Your V. “Most women’s cycles last 21 to 35 days, counting from day one of one cycle to day one of next cycle, and their periods last five to seven days on average.”
And while Dr. Dweck notes that shorter periods can be normal (if your period lasts two to three days, and it’s always lasted two to three days, no biggie), it’s important to pay attention to your cycle, and note any changes. After all, the length of your period is largely determined by hormonal factors, says Lakeisha Richardson, MD, an ob-gyn based in Greenville, Mississippi. That means that everything from medications to underlying health conditions can throw off your cycle. Some of those causes are totally benign, but others are best ruled-out (or caught) early.
Here, experts share the most common reasons that you period might go from six days to, say, three suddenly. Rule them out the next time your period cuts out early.
You’ve Switched Birth Control
If your period is suddenly breaking pattern, consider if you’ve started or changed birth control methods. “The pill might lessen the length of flow,” says Dr. Dweck. Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, agrees. “Most birth control pills and rings, like the Annovera vaginal ring, lead to lighter flow,” she says. “The combined hormonal contraceptives contain a good amount of progestins—synthetic progesterone—which limit the build-up of a lot of tissue lining the uterus,” she explains. As a result, there’s less of a flow when it’s go time. Progestin-only IUDs “allow a very limited buildup,” Dr. Minkin says, and many women have a lighter flow or even no period when they have one of those implanted.
Also, there could be slight hormonal differences in generic versions that could affect your cycle length, so make sure to check the packaging.
You’re On A Certain Type of Medication
Beyond the birth control pill, certain medicines could also affect your period, thanks to the chemicals in them. “NSAIDs [like Advil, Naprosyn, ibuprofen, etc.], antidepressants, thyroid medications, and steroids might shorten flow,” Dr. Dweck says.
The way each of these medications lighten your flow varies slightly. With NSAIDs, “the idea is that the NSAID reduces the number of inflammation compounds called prostaglandins, which in turn can lessen the amount of bleeding because prostaglandins affect the blood vessels in the inner lining of the uterus,” explains women’s health expert Jennifer Wider, MD.
Not sure if the meds you’ve taken are messing with your flow? “Ruling out other causes of change in flow and taking a good medical history might lead to diagnosing medication as the cause of menstrual change,” Dr. Dweck says.
You Have Polycystic Ovarian Syndrome (PCOS)
PCOS is a condition where women overproduce amounts of male hormones, which can suppress ovulation. “Women with PCOS will have a long history of irregular cycles,” explains Dr. Richardson. “They may also have months when they don’t have a menstrual cycle at all because of their imbalanced hormone levels.”
If you’re suffering from PCOS, you’ll likely also experience cysts on your ovaries, hirsutism (or excessive hairiness), acne, obesity, and infertility, she says. “PCOS is not a medical emergency, but seeing your ob-gyn as soon as possible to prescribe medication can help minimize the symptoms.”
You’re Suffering From Premature Ovarian Failure
“Premature ovarian failure or primary ovarian insufficiency occurs when women have loss of normal ovarian function prior to 40 years old,” explains Dr. Richardson. If your ovaries aren’t working correctly, they won’t produce the right amounts of estrogen or release eggs when they’re supposed to, which could lead to shortened and irregular cycles, she says.
Premature ovary failure typically shows up around age 27, but occurs in one in 1,000 women between the ages of 15 and 29 and one in 100 women between the ages of 30 and 39, according to RESOLVE: The National Infertility Association. “The most common symptom of premature ovarian failure is infertility and amenorrhea [loss of periods],” says Dr. Richardson, “and it’s diagnosed by ultrasound and blood test—the hormone levels would be consistent with menopause.”
Translation: If you think you may have premature ovarian failure and want to get pregnant in the future, talk to your doc about getting tested as well as your fertility options.
You Have Uterine Scarring
Scarring in the uterus can lead to shorter periods. This is known as Asherman Syndrome, a rare condition that most often occurs in women who have had multiple dilation and curettage (D&C;) procedures, says Dr. Richardson. D&C;’s are often used to empty the uterus following miscarriage, as an abortion method, and to treat certain gynecological conditions.
“Women who have Asherman Syndrome have shorter cycles or amenorrhea because only the areas of the uterus that are not scarred are capable of bleeding. The more scarring that is involved, the less bleeding will occur.”
This condition would be diagnosed by hysteroscopy, says Dr. Richardson, and the adhesions (or scars) would have to be removed surgically in order for your flow to return to normal and to improve your ability to conceive, if desired.
“Most women who are breastfeeding exclusively will not have a cycle while they are breastfeeding,” says Dr. Richardson. “Breastfeeding could delay ovulation for as long as 18 months, because the body is suppressing ovulation hormones by producing prolactin, alpha-lactalbumin, and lactose synthesis.” A normal cycle will return only when you stop or decrease the amount of breastfeeding, but even then, it could be shorter than normal due to the fluctuating hormones.
You Have A Thyroid Disorder
It sounds strange, but your thyroid can actually affect your period. “The thyroid gland is regulated in the pituitary-hypothalamus axis of the brain, as are the hormones that regulate ovulation and menstruation,” says Dr. Dweck. “When one aspect of the axis is disturbed, so might be other aspects.”
Other indications of an over- or underactive thyroid issue can include appetite and weight changes, difficulty with temperature regulation, hair changes, feelings of anxiety, and heart palpitations, according to Dr. Dweck. If you think you might have a thyroid disorder, talk to your doc about getting tested. Thyroid issues are common and treating them is important to maintaining both fertility (if that’s your thing) and overall health.
Watch a doctor explain what you can do to help a thyroid disorder:
You Have Implantation Bleeding
Implantation is an early part of the pregnancy process when an embryo (i.e. fertilized egg) burrows into your uterine lining. It’s possible to bleed a little when that happens. And, if the timing lines up with your period, it’s understandable that you might think you’re having a period when you’re actually not.
“Implantation can be associated with some light bleeding—and to some women they might think it’s a very light period,” Dr. Minkin says.
“It can be difficult to tell the difference between implantation bleeding and a short period for some women because implantation can occur roughly six to 12 days after conception, which is often when a woman would expect her period,” Dr. Wider says. “The symptoms can look the same.” If there’s a chance you might be pregnant and you’re not sure what’s going on down there, a pregnancy test can help rule pregnancy in or out, she says.
You’re Really Stressed Out
Oscar WongGetty Images
Stress can screw with just about everything in your life, so it’s hardly shocking that it can mess with your cycle, too. “High levels of stress can cause an increase in the production of [stress hormone] cortisol which in turn can cause a disruption in the way our bodies function normally,” Dr. Wider says.
Under normal (read: non-frazzled) times, your brain’s hypothalamus produces chemicals that trigger your pituitary gland to signal your ovaries to release estrogen and progesterone, she explains. “With an increase in cortisol from stress, that axis can get messed up and the menstrual cycle can become irregular,” Dr. Wider says.
“The less estrogen, the less stimulation of the lining of the uterus, so less bleeding,” Dr. Minkin adds.
You’re In Perimenopause
“As women age, their cycle may become shorter—especially as they get closer to menopause,” says Dr. Richardson. Perimenopause, the time before menopause, when your body starts transitioning hormonally, typically starts in a woman’s 40s, but can start as early as the thirties. And “it can last anywhere from four to six years,” says Richardson. “During that time, women may have shorter cycles or may not have a cycle at all.” This is all perfectly normal, and there’s no need to seek medical attention during this time, she says. But if you’re concerned, especially about your fertility, a visit to your doc certainly can’t hurt.
Ashley Mateo is a writer, editor, and UESCA- and RRCA-certified running coach who has contributed to Runner’s World, Bicycling, Women’s Health, Health, Shape, Self, and more.
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What is the average period length?
Top things to know:
- A normal period length for someone who’s not using hormonal birth control or an IUD is 8 days or less
- Hormonal birth control methods like the pill, patch, ring, or IUD often make period lengths shorter
- Copper IUDs may make period lengths longer
The length of your menstrual period is the number of continuous days of bleeding within each of your menstrual cycles.
Your menstrual period is the shedding of your endometrium (the lining of the uterus). During your period, blood and endometrial tissue flow down through your cervix and vagina. The first day of your period is considered the first day of your menstrual cycle.
Periods are a healthy and normal part of the menstrual cycle. But prolonged or heavy periods are associated with iron deficiency, which can lead to anemia and/or feeling unwell (1-3). Long or heavy periods may also be one sign of a health condition that should be addressed with a healthcare provider. It is possible to have [heavy menstrual bleeding](https://helloclue.com/articles/cycle-a-z/heavy-periods-how-to-tell-if-your-heavy-periods-are-normal “Heavy Periods: How to tell if your heavy periods are “normal””) even when your period length is within range.
Short periods are generally less of a concern, but may be an indication of a health condition in some cases. A sudden, short period may also sometimes be spotting from a pregnancy (4).
Spotting or bleeding on days that are not continuous with the menstrual period should not be considered part of the period, and should be noted in your period tracking app as spotting.
If your period is irregular or prolonged, speak to your healthcare provider. It could be due to many underlying health conditions, such as polycystic ovarian syndrome, fibroids, uterine polyps, or bleeding disorders (3,5).
What is the normal period length for people
not on hormonal birth control?
Adult period length
For an adult who is not using any form of hormonal birth control or IUD, a normal period length is up to 8 days (6).
The first two days of the period are usually the heaviest flow, with the latter days having progressively less blood (7). Variations between differing period length and cycle lengths are normal, as your period changes over your reproductive life (7,8). If your period length is regularly longer than eight days, consult your healthcare provider (6,7).
Adolescent period length
The period length of adolescents around the time of menarche, the first menstrual period, can vary greatly. It’s common for cycles to be somewhat irregular for a few years after your first period. This means your periods may not always come at the same time every cycle, and they may be somewhat different cycle-to-cycle. As you progress through adolescence, period lengths and cycles become more regular, but may still be somewhat variable (9,10).
A normal period length for an adolescent usually ranges between 2 to 7 days, but may sometimes be longer or shorter (9).
What is the normal “period” length for people on hormonal birth control (e.g. the pill, the ring, the patch)?
Hormonal birth control (HBC) options like the pill, vaginal ring, or patch control the release and regulation of hormones like estrogen and progesterone within your body. When used correctly, the hormones in your HBC prevent your ovaries from preparing and releasing eggs (ovulation).
Your number of bleeding days and cycle length will depend on the type of HBC you use. Bleeding typically happens during your “no hormone” days (when you take placebo pills, or the times in between new rings or patches). The bleeding you experience while using hormonal birth control is called withdrawal bleeding, and is not considered a menstrual period. Withdrawal bleeding is caused by the decline in reproductive hormones in your body during days when you get low or no hormones from your pill, patch, or ring (6,11).
Many people experience lighter bleeding and some don’t bleed at all while using hormonal birth control (12). When affected by hormonal birth control, the lining of your uterus doesn’t thicken as much as it does without hormonal birth control. This typically results in lighter, shorter, or occasionally absent “periods,” especially for people who have been using hormonal birth control for many months or years.
Some people also decide to skip any bleeding while using HBC, by skipping over the “no-hormone” days. Some hormonal birth control options have a cycle that mimics a normal cycle length (usually 28 days), while other types of hormonal birth control are continuous, which limits bleeding to once every three months, or even once a year (11).
What is the normal “period” length for people on progestin-only birth control (e.g. the mini pill, the shot, the implant)?
There are many different types of hormonal birth control, all containing differing types and levels of hormones. Some types of birth control do not contain any estrogens and only contain progestins—a synthetic form of progesterone (13). These methods include progestin-only pills (the mini pill), progestin injections (the shot), or progestin implants (13).
Bleeding can vary a lot on progestin-only contraceptives. Changes in period length and heaviness happen in response to the changes in hormones. These hormones affect the growing and shedding of your uterine lining.
Methods like the contraceptive injection and the implant usually suppress ovulation (14,15). Some progestin-only pills also suppress ovulation, but it depends on the type (13). Most people who don’t ovulate due to progestin-only contraceptives experience shorter, lighter, or occasionally absent bleedings days, though this doesn’t always happen (13).
Unpredictable bleeding, spotting, and prolonged bleeding are common when using these methods, especially during the first few months (16). These symptoms usually improve with time, but they can continue for some people.
What’s the normal period length for people with intrauterine devices (IUDs)?
Your period on the hormonal IUD
While using the hormonal IUD, it’s common to experience irregular bleeding or lighter bleeding, and some people don’t bleed at all (8,13,18). This happens because the endometrium doesn’t thicken as much as it does when you’re not using hormonal birth control. This typically results in lighter or occasionally absent bleeding, especially for people who have been using the hormonal IUD for many months or years (13).
Your period on the copper IUD
Many people experience heavier and longer bleeding while using the copper IUD, especially in the first 6–12 months (13,19). This may happen due to vascular changes and changes to blood flow in the uterus (18,20-22). Bleeding may be accompanied by an increase in large clots and cramping. Using nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce bleeding and pain (13).
Copper IUDs are non-hormonal, so you will experience the same fluctuations of estrogen and progesterone across your cycle as you did when you weren’t using a copper IUD.
Prolonged or irregular bleeding on birth control
Starting a new method of birth control can cause changes the amount of days you bleed. Irregular bleeding is common when starting a new birth control method and usually goes away within three months.
Be mindful of how your bleeding days change and how you feel on an new form of birth control. Different brands and types of hormonal birth control contain different levels of reproductive hormones, so some brands or types may be better suited for you than others. Talk to your healthcare provider about trying another brand if you have continued spotting three months after starting a new method, or if your bleeding has gotten heavier (3).
Prolonged bleeding on hormonal birth control can also be caused by underlying health conditions such as uterine fibroids or an untreated infection (3,23).
If you suspect that your period is prolonged or irregular, speak to your healthcare professional. When talking to your healthcare provider, show them your tracking history. Also tell them if you’ve recently noticed unexpected changes in your body, such as unexplained abdominal pain, difficulty controlling your weight, or unusual hair growth on your face or body. This can help them identify what might be causing your long periods (13).
Why periods vary
The length of your typical period is determined by your age, genes, health, body mass index (BMI), behaviors, and birth control methods (23).
If you’ve had your period for a few years, it should generally be about the same length and volume each cycle. You may still notice changes from time to time— the heaviness and length of your period depends on your hormones, which can fluctuate due to factors like diet, stress, or taking an emergency contraception pill (the morning-after pill) (1,25-27).
Periods can fluctuate in cycles where ovulation doesn’t occur. This is why periods can fluctuate during adolescence, after giving birth, during breastfeeding, and during perimenopause (the menopausal transition) (28,10). People are less likely to ovulate consistently during these times.
Exercise, smoking cigarettes, and drinking alcohol may also affect period length and heaviness (29-34).
__Download Clue to track your menstrual period. __
Periods – NHS
A period is the part of the menstrual cycle when a woman bleeds from her vagina for a few days.
For most women this happens every 28 days or so, but it’s common for periods to be more or less frequent than this, ranging from day 21 to day 40 of their menstrual cycle.
Your period can last between 3 and 8 days, but it will usually last for about 5 days. The bleeding tends to be heaviest in the first 2 days.
When your period is at its heaviest, the blood will be red. On lighter days, it may be pink, brown or black.
You’ll lose about 30 to 72ml (5 to 12 teaspoons) of blood during your period, although some women bleed more heavily than this.
Read more about heavy periods, period pain, irregular periods and stopped or missed periods.
When do periods start?
Periods usually begin at around the age of 12, although some girls will start them earlier or later.
A delay in starting periods isn’t usually a cause for concern. Most girls will be having regular periods by age 16 to 18.
Read more about girls and puberty.
Sanitary products soak up or collect the blood released during your period. The main types of sanitary products are:
- sanitary pads
- menstrual cups
Sanitary pads are strips of padding that have a sticky side you attach to your underwear to hold them in place. One side of the pad is made of an absorbent material that soaks up the blood.
Pads come in many sizes, so you can choose one to suit how heavy or light your period is.
Pantyliners are a smaller and thinner type of sanitary pad that can be used on days when your period is very light.
Tampons are small tubes of cotton wool that you insert into your vagina to soak up the blood before it comes out of your body.
There are 2 types of tampon – ones that come with an applicator and others without an applicator that you insert with your fingers. In both cases, there’s a string at one end of the tampon, which you pull to remove it.
Tampons come with instructions that explain how to use them. If the tampon is inserted correctly, you should not be able to feel it inside you. If you can feel it or it hurts, it might not be in properly.
It is not possible for a tampon to get stuck or lost inside you. Your vagina holds it firmly in place and it expands inside you as it soaks up the blood.
For more information, read:
Menstrual cups are an alternative to sanitary pads and tampons. The cup is made from silicone and you put it inside your vagina.
Menstrual cups collect the blood rather than absorb it. Unlike sanitary pads and tampons, which are thrown away after they’ve been used, you can wash menstrual cups and and use them again.
PMS (premenstrual syndrome)
Changes in your body’s hormone levels before your period can cause physical and emotional changes.
This is known as PMS (premenstrual syndrome) or PMT (premenstrual tension).
There are many possible symptoms of PMS, but typical symptoms include:
These symptoms usually improve when your period starts and disappear a few days afterwards. Not all women who have periods get PMS.
Working out when you can get pregnant – your fertile time – can be difficult. It’s around the time you ovulate, which is about 12 to 14 days before the start of your next period.
But sperm can survive inside a woman’s body for up to 7 days before ovulation occurs. This means your fertile time extends back earlier in your cycle.
You can calculate when your period will start and your peak ovulation times using an online period calendar.
You cannot get pregnant if you do not ovulate. Some hormonal methods of contraception, such as the contraceptive pill, contraceptive patch and contraceptive injection, work by preventing ovulation.
Read more about the menstrual cycle, fertility, contraception and getting pregnant.
Changes in your periods
Your periods can change – for example, they may last longer or get lighter. This does not necessarily mean there’s a problem, but it does need to be investigated.
You can see your GP, or visit your nearest women’s clinic or contraceptive clinic.
Bleeding between periods, bleeding after having sex, or bleeding after the menopause needs to be checked by a doctor.
It might be caused by an infection, abnormalities in the neck of the womb (the cervix) or, in rare cases, it could be cancer.
You could be pregnant if you miss a period and you’ve had sex. See your GP if you’ve taken a pregnancy test and the result is negative (you’re not pregnant) and you’ve missed 3 consecutive periods.
They will investigate the cause and recommend any necessary treatment.
Read more about stopped or missed periods.
When do periods stop?
Your periods will continue until you reach the menopause, which usually happens when you are in your late 40s to mid-50s. In the UK the average age of menopause is 51.
Your periods may start to become less frequent over a few months or years before stopping altogether. In some cases they can stop suddenly.
Video: menstrual cycle
This animation explains in detail how the menstrual cycle works.
Media last reviewed: 21 October 2020
Media review due: 21 October 2023
Page last reviewed: 05 August 2019
Next review due: 05 August 2022
What’s Normal and When It Can Vary
We’ve all got that one friend who only bleeds lightly for 2 days and then she’s done for the month. Frustrating isn’t it?
But what about the rest of us? How long should our period last? What’s a normal menstrual cycle and when should we be taking a trip to the doctor to talk about our periods?
How long do periods usually last?
Menstrual cycles happen once a month to prepare for a possible pregnancy. If a pregnancy doesn’t occur then the lining of the uterus sheds and the period will start. A typical menstrual cycle is 28 days long and will occur around every 24-38 days. However, each woman is different, and cycles can vary each month . Periods usually last somewhere between 4-8 days.
Menstruation – is also known as a period and is when blood and tissue leave the vagina. It usually happens once a month.
Menstrual cycle – is the hormonal process a woman’s body goes through each month to prepare for a possible pregnancy.
Ovaries – are the reproductive gland in a female which sit in the pelvis on each side of the uterus. The ovaries produce eggs (ova) and female hormones.
Ovulation – is the release of an egg from one of a woman’s ovaries. Ovulation typically lasts one day and occurs in the middle of a woman’s menstrual cycle, about two weeks before she expects to get her period.
Signs your period is too heavy, long, or irregular
It’s important to remember that what’s ‘normal’ for your friend, will be different for you. However, there are some things that tell us whether our periods aren’t quite right and we need to speak to our doctor.
Each period most women will lose 60 millilitres (around 2.02 ounces) of blood, which is around 4 tablespoons. On average that means it would take 4 hours for a pad or tampon to become full. If a woman is bleeding around 80 millilitres each period (around 2.70 ounces) she is considered to have heavy bleeding .
Physical signs of heavy periods include:
Regularly needing to change pads, tampons, or reusable menstrual products after only one or two hours.
Using two or more menstrual products at the same time to prevent leaking.
Large clumps of blood in your pad or when you remove your tampon.
Feeling tired and sluggish.
Heavy periods can have a huge impact on our emotional state too such as,:
A negative impact upon work productivity.
Our family life and social relationships and events.
Our sexual relationships.
It’s important to recognize that heavy menstrual bleeding has a major impact on a woman’s quality of life, and any interventions should aim to improve this rather than just focusing on blood loss.
If your periods are longer than 7 days on a regular basis then it’s considered a long period and you should speak to a doctor , . Longer lasting periods are often referred to as menorrhagia, meaning someone is experiencing heavy periods. Around 1 in every 20 women has menorrhagia .
If you experience different amounts of time in between your periods then they are irregular. Again, this may be normal for you, especially if you don’t have any other period-related symptoms such as painful cramps, blood clots, or heavy bleeding, and doesn’t necessarily mean there is a problem. It’s especially common for younger girls to have irregular periods during the first 2-3 years after starting their period. It’s also common for women entering perimenopause to experience irregular periods. Note that you can still get pregnant despite having irregular periods.
Practice guidelines published in Best Practice & Research Clinical Obstetrics & Gynecology found that between 14% and 25% of women have abnormal uterine bleeding, including heavy menstrual bleeding .
Is it normal for periods to be short?
Women’s cycles can vary in length. For some, this is normal, for others, a trip to the doctor might be needed.
Birth control pills may cause bleeding in the first few weeks and it may take around 3 months for your periods to settle down. You may notice your periods are lighter when taking contraceptive pills as the lining of your uterus isn’t as thick., .
There are a range of reasons why girls and women experience lighter and shorter periods, these include :
4 factors that affect how long your period lasts
There are a number of factors that can affect how long your period may last for. These include:
1. Menstruation can change with age
Girls begin their period around the age of 8-12 years. When their periods first start they are likely to last around 5 days. During the first 2-3 years, it’s common for the period to be irregular. After this, they will begin to arrive every 4-5 weeks and still only last for around 5 days . During the teenage years, it’s common for periods to be heavier and can become lighter in your 20’s and 30’s, and the menstrual cycle will typically last between 24-38 days.
Entering perimenopause also has an effect on how regular the menstrual cycle is. Women usually enter this stage in their lives around the age of 40.
2. Birth control’s influence on the length of periods
All types of hormonal birth control can have an effect on the menstrual cycle, especially in the first 3-6 months of using it.
When using the combined pill, the contraceptive patch, the contraceptive injection, and the vaginal ring, it stops an egg being released from the ovary. If you still have a monthly bleed, this may be lighter and is called a withdrawal bleed.
The birth control pill and period length
Whether taking a combined pill which contains estrogen and progestin, or a progestin-only pill, it’s likely that you will experience breakthrough bleeding or spotting in the first few months.
If you’re taking the progestin-only pill you may also spot if you forget to take the pill, even if it’s a couple of hours difference. The pill works by stopping ovulation and preventing the male’s sperm from reaching the egg .
It can take around three months for your periods to return to a regular pattern once you stop using the pill.
The birth control injection or implant and period length
The hormonal implant is a tiny tube that is placed underneath the skin in the arm. The tube releases progesterone which inhibits the pituitary gland, to stop the ovaries from releasing an egg. The most common side effect of the implant is light and irregular bleeding .
The injection contains progesterone and is given every 3 months. The injection stops the ovaries from releasing an egg and thickens the fluid at the top of the womb. The injection can cause irregular bleeding and may happen during the first few months of having the injection, but this may settle down as you have more injections .
The IUD and period length
The copper IUD may cause you to have irregular bleeding for 3-6 months and may cause heavier or longer periods .
The progestin IUD can also cause irregular bleeding for 3-6 months. This should improve over time, become lighter and may disappear . In fact, a significant number of women no longer get their period while using an IUD.
The vaginal ring and period length
The vaginal ring is a flexible ring that is placed inside the vagina, it contains both estrogen and progesterone. You wear the ring for 3 weeks and then remove it to have a period during the 4th week. However, using the ring may cause irregular bleeding or spotting  within the first few months.
The emergency contraceptive pill and period length
Emergency contraception can change the timing of your next period. It may also cause spotting or irregular bleeding during the week or month after you’ve taken the pill .
3. Underlying health conditions and irregular periods
There are different health conditions that can cause irregular, heavy, or prolonged bleeding such as ,
If you think you may be experiencing any of the above, it’s important to go and see your doctor.
4. Sexually transmitted infections (STI’s) and irregular periods
Sexually transmitted infections such as chlamydia and gonorrhea can cause irregular bleeding and spotting between periods . Pelvic inflammatory disease is caused when a bacterial infection spreads from the vagina or the cervix to the reproductive organs. This infection can cause bleeding between periods, during and after sex, and heavy periods .
When to see a doctor about abnormal periods
Abnormal periods vary person to person. Below are some signs that your period is abnormal .
Your periods last longer than 7 days.
You experience a cycle less than 24 days or more than 35 days.
You have irregular periods.
You are experiencing heavy bleeding and you’re having to change your pad or tampon every 1-2 hours.
You are seeing blood clots of around 1 inch in size
You’ve started bleeding after you’ve gone through menopause.
Solutions for long and heavy periods
Before trying to treat long or heavy periods, it’s vital that you speak with your doctor or nurse first to rule out any health conditions and receive any necessary treatment.
If there are no obvious reasons for your long or heavy periods then the doctor may suggest you begin a form of contraception. At first, this may cause irregular bleeding or spotting. However, over time, this should settle and help your periods to fall into a regular pattern.
Not all women wish to use contraception and may choose to look at other ways to manage their long or heavy periods such as,
Maintaining a healthy weight
Weight can influence menstrual cycles. Losing too much weight or losing weight quickly can cause irregular cycles or your period may stop. Also, women who are obese may have irregular periods .
Delaying or skipping periods
Heavy or prolonged bleeding can be emotionally and physically draining. With the advice and support of your doctor, it is possible to delay or sometimes stop your periods for a longer amount of time.
If your doctor is in agreement, they may prescribe you the combined contraceptive pill. If you take your packets back-to-back, you will probably skip a period. However, one side effect of taking pill packets together can be unexpected bleeding.
The IUD and vaginal ring can also be used to delay or prevent a period.
The length of a woman’s period is unique to her, however, there are factors that can influence menstruation, including health issues and birth control. If you notice any changes to your menstrual cycle or period then it’s important to speak to your doctor.
Womenshealth.gov.Menstrual Cycle. Updated March 16, 2018.
Whitaker L. Critchley H. Abnormal uterine bleeding. Published November 25, 2015
National Health Service UK. Irregular Periods. Reviewed April 9, 2018
Cleveland Clinic. Menorrhagia (Heavy Menstrual Bleeding). Reviewed August 3, 2018
Kids Health. All About Periods. Reviewed October 2018
NCBI. Heavy Periods. Reviewed May 4, 2017
Abraham G. Nutritional factors in etiology of the premenstrual tension syndromes. July 1983
Young Women’s Health. Birth Control Pills. Updated June 8, 2020
National Health Service . Sexually transmitted infections. April 9, 2018
NCBI. The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Mar- Apr 2019
Centres for Disease, Control, and Prevention. Heavy Menstrual Bleeding. December 2017
Young Women’s Health. Medical Uses of the Birth Control Pill. June 2020
Healthline. What Causes Your Period To Be Shorter or Lighter Than Normal. December 2018
Mayo Clinic. Perimenopause. May 2019
Medical News Today. What are the side effects of an IUD?. August 2018
Centre for Women’s Health. Hormonal Implants. April 2019
Contraception Choices. Injection.
Mayo Clinic. Vaginal Ring. February 2020
ACOG. Emergency Contraception. June 2020
Wouk, N. & Helton, M. American Family Physician. Abnormal Uterine Bleeding in Premenopausal Women. April 2019
Mayo Clinic. Pelvic Inflammatory Disease. April 2020
American Family Physician. Abnormal Bleeding During Your Period. January 2012
The Office on Women’s Health. Weight Loss and Women. March 2019
PubMed. Herbal Medicines in Idiopathic Heavy Menstrual Bleeding: A Systematic Review. October 2016
Female Bleeding: When Should You See a Doctor?
Thankfully, most of the time your period will come and go without causing much fuss. But what about those times when your cycle gets thrown out of whack and you have abnormal bleeding? Should you be concerned?
Every woman is different when it comes to her cycle. However, when period changes happen – such as a heavier or lighter flow than usual or timing abnormalities – it can be hard to decide if you need to call your doctor or if what you’re experiencing is in the range of normal.
It’s a good idea to always track your menstrual cycles, including how heavy your flows are, how long they last and how many tampons or pads you use during a single cycle. This information can be useful for your doctor.
We spoke to INTEGRIS Health OB-GYN Dr. Elise Schrop to get her insights on a scary topic. What causes abnormal bleeding, just what is “abnormal” anyway, and when should you consult your doctor?
“Abnormal bleeding is a very common problem for women,” Dr. Schrop says. “In fact, about a third of office visits to the gynecologist are for abnormal bleeding. It can happen to women of all ages but most commonly occurs in the first several years after a young woman starts having a period and as women start to make the transition to menopause.”
What is considered normal menstrual bleeding?
Most woman have a definition of what “normal” looks like for them. Many women already know that on average, menstrual periods last four to seven days, with a normal cycle occurring every 21 to 35 days. But did you know this interesting fact? Blood loss during a period averages about 40 ccs, or the equivalent of only three tablespoons.
What is abnormal?
A menstrual cycle may be labeled abnormal if any of the following problems occur.
- Your periods occur less than 21 days apart (polymenorrhagia)
- Your periods occur more than 35 days apart (oligomenorrhea)
- You miss three or more periods in a row
- Your blood flow is much heavier or lighter than usual
- Your periods last longer than seven days
- You experience excessive pain, cramping, nausea or vomiting during your periods (dysmenorrhea)
When should you see a doctor about abnormal bleeding?
“You need to see a doctor if you don’t have a monthly period or have more than one period per month. Feeling lightheaded or dizzy when you stand is also concerning,” says Dr. Schrop. She also urges women to see a doctor if they experience bleeding after going through menopause, or if they experience bleeding while pregnant.
Finally, Dr. Schrop says to see a gynecologist if you are experiencing any of the following:
- Bleeding that requires more than one tampon or sanitary pad in an hour, for several hours in a row
- Bleeding or spotting between periods
- Bleeding after having sex
- Severe pain
- Abnormal discharge or color
- Unexplained weight gain or loss
- Unusual hair growth
- New onset of acne
- Nipple discharge
What is menorrhagia?
A blood flow of 80 ccs (five tablespoons) or more that lasts longer than seven days may signal that you have menorrhagia — excessively heavy and prolonged menstrual periods. With menorrhagia, women may find they need to use several tampons and/or sanitary pads per hour throughout the day or wake up in the middle of the night simply to change the pad.
If heavy and prolonged periods interfere with living your daily life consult your doctor. Excessive blood loss can also lead to anemia, an iron deficiency, and may signal other medical conditions. Anemia can cause fatigue, pale skin, shortness of breath or dizziness.
What is metrorrhagia?
Bleeding that occurs between periods or is not directly associated with your normal menstruation is referred to as metrorrhagia. This can consist of light or heavy bleeding or spotting that may be accompanied by abdominal pain or cramps. Metrorrhagia is more common for teenagers and women nearing menopause.
Why are there bleeding irregularities?
“The most common causes depend on your age,” Dr. Schrop says. “Commonly, bleeding irregularities can come from not ovulating regularly (irregular ovulation can be caused by several things, including abnormalities of the uterus and pregnancy). Less commonly, bleeding irregularities can indicate pre-cancer or cancer. “
Other causes of bleeding irregularities
Stress and lifestyle changes – Stress and lifestyle changes, such as gaining or losing weight, dieting, changing exercise routines, traveling, illness and other disruptions to your normal daily routine can impact your menstrual cycle and cause irregularities.
Birth control – Going on or off birth control pills can affect your menstruation. Some women may experience irregular periods or miss periods for up to six months after stopping birth control pills. Other forms of birth control, such as IUDs, can cause period irregularities (lighter or heavier flows) or cause your period to stop. Birth control pills that only contain progestin (no estrogen) may cause bleeding between periods.
Medications – Some anti-inflammatory drugs, anticoagulants (blood thinners), hormone medications or steroids can affect menstrual bleeding.
Hormone imbalances – An excess of estrogen and progesterone can cause heavy bleeding. This is most common for girls in the first year or so of having her first period and for women nearing menopause.
Uterine polyps or fibroids – Uterine polyps are small growths in the lining of the uterus, while fibroids are tumors that attach to the wall of the uterus. Both are usually benign (noncancerous) but can cause heavy bleeding and pain during periods.
Pregnancy complications – Pregnancy should interrupt normal menstruation although some spotting during the first trimester is often no cause for concern. Bleeding heavily during pregnancy may be a sign that you are experiencing a miscarriage or an ectopic pregnancy (when a fertilized egg implants itself in the fallopian tube rather than the uterus). Consult your doctor right away if you experience bleeding during pregnancy.
Endometriosis – Endometriosis occurs when the endometrial tissue that lines your uterus begins to grow outside the uterus, sometimes growing on the ovaries, fallopian tubes, intestines or other digestive organs. This condition can cause painful bleeding, cramps and painful intercourse.
Pelvic inflammatory disease – Pelvic inflammatory disease (PID) is a bacterial infection that can cause heavy vaginal discharge with unpleasant odor, irregular periods, pelvic or lower abdominal pain, fever, nausea, vomiting or diarrhea.
Polycystic ovary syndrome – Polycystic ovary syndrome occurs when the ovaries release abnormal amounts of androgens (male hormones), causing cysts to form. These ovarian cysts can cause hormonal changes that can prevent ovulation and menstruation from occurring. Women with PCOS may experience irregular periods or stop menstruating completely.
Premature ovarian insufficiency – Premature ovarian insufficiency occurs in women under 40 whose ovaries do not function properly, causing their menstrual cycle to stop prematurely (similar to menopause). This can occur in women being treated for cancer with chemotherapy and radiation or those who have a family history of the condition.
Treating abnormal periods
Treatment for abnormal or irregular period bleeding will depend on your overall health and the cause of the abnormality.
Dr. Schrop says, “At home, taking NSAIDs such as ibuprofen during periods of heavy bleeding can lessen bleeding and control pain, but will not resolve any underlying problem. Taking a warm bath or using a heating pad might provide some temporary relief, but there is nothing women can do at home to resolve abnormal bleeding without seeing a gynecologist.” Also, it’s important to note that aspirin is not recommended to treat menstrual pain as it can cause heavier bleeding.
Dr. Schrop reminds women they do not have to live with abnormal bleeding. “There are many different conditions that can cause abnormal bleeding,” she says. “You will only be able to determine the cause after a visit with your gynecologist and appropriate tests are done. It can take several visits to complete the evaluations and explain treatment options. “
Medical treatment for abnormal bleeding may include hormones such as estrogen or progestin to control heavy bleeding, low-dose birth control to control bleeding, iron supplements to treat anemia caused by heavy bleeding or an intrauterine device (IUD) to lessen heavy bleeding.
For more severe issues, surgery or even a hysterectomy (the removal of the uterus) may be necessary to correct bleeding irregularities.
If you’re concerned about abnormal period bleeding, find an INTEGRIS Health OB-GYN near you. Dr. Schrop practices at INTEGRIS Canadian Valley Women’s Care. For more information on female health, check out the INTEGRIS On Your Health blog.
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90,000 Runny nose: symptoms, stages and course of the disease | What to do if a runny nose is diagnosed
Author, editor and medical expert – Klimovich Elina Valerievna.
Date of last update: 26.08.2021
Number of views: 162 634.
Average reading time: 8 minutes.
Causes of a cold
Mechanism of development of acute rhinitis
Symptoms of infectious rhinitis
Treatment of infectious rhinitis
Other types of rhinitis
Again a runny nose? Do you think an infection? You should not rush to conclusions and buy drops from the common cold.It can be caused not only by a cold, but also by other reasons. This means that the treatment in each case will be different.
Causes of runny nose
Runny nose, or rhinitis, is an inflammatory disease of the nasal mucosa 1 . And its main culprit is indeed infection 1 , or rather, pathogens that enter the body with inhaled air.
Most often, a runny nose appears as one of the manifestations of acute respiratory diseases 1 .Among the most common pathogens:
- viruses: rhinoviruses that cause up to half of all acute respiratory viral diseases (ARVI) in adults 1 , influenza and parainfluenza viruses, adenoviruses, enteroviruses, respiratory syncytial viruses and others;
- bacteria: streptococci, haemophilus influenzae, etc.;
- mushrooms that more often cause symptoms of rhinitis in patients with severely reduced immunity 1 .
The nasal cavity is the initial section of the respiratory tract that performs extremely important functions.Here, the air is warmed and humidified, and it is partially disinfected. Protection from viruses, bacteria and other microorganisms is provided by the mucociliary barrier, which consists of ciliated epithelial cells and nasal mucus, which contains various immune factors. Damage to the mucociliary barrier facilitates the penetration of infection into the nasal mucosa and contributes to the development of rhinitis 1 .
The following can act as a damaging factor:
- hypothermia, primarily of the feet and back: scientists have proven that the effect of cold on these parts of the body leads to reflex vasoconstriction of the vessels of the nasal mucosa and a decrease in local defense mechanisms 1 ;
- dry air: when inhaled, the mucous membrane gradually dries up, the amount of nasal mucus decreases, it partially loses its protective properties;
- Inhalation of contaminated air containing dust particles, allergens, chemical impurities;
- Injuries: for example, from impacts, nose-picking, as a result of operations 1.2 .
Why not self-medicate in the hope of quickly getting rid of a cold? The fact is that the disease can be associated with non-infectious causes.
Rhinitis can be:
- allergic: seasonal, associated with a reaction to plant pollen, or year-round, for example, if you are allergic to household dust or pets 1.2 ;
- professional related to working conditions and production factors 1.3 ;
- medication caused by the use of drugs 1.3 ;
- hormonal, due to fluctuations in the amount of hormones in the body, for example, a change in the level of sex hormones during puberty, before menstruation, during pregnancy, during menopause 2.3 ;
- food related to the reflex reaction of the vessels of the mucous membrane of the nasal cavity to food, for example, to hot and spicy foods, to dyes and preservatives contained in food, as well as to alcohol 3 ;
- psychogenic, arising as a reaction to stress and emotions 3 ;
- age (senile), due to the aging process of the body 3 , etc.e.
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Mechanism of development of acute rhinitis
Despite the variety of reasons, in almost all cases the development of rhinitis follows the same path. As a result of the influence of any factor in the mucous membrane of the nasal cavity, an inflammatory reaction occurs: small blood vessels expand, edema appears, due to which the movement of air along the nasal passages is partially or completely blocked. Running a little ahead, let’s say that local vasoconstrictor drugs, widely used in the treatment of rhinitis in adults and children, facilitate nasal breathing precisely by narrowing the blood vessels and reducing tissue edema 1 .
Inflammation of the mucous membrane is accompanied by increased secretion of nasal mucus. Discharge from the nasal passages becomes profuse and fluid. In the future, they can acquire a different character depending on the type of rhinitis 1 .
Since the nasal cavity is closely connected with the paranasal sinuses, the same processes often occur in them. This is manifested by heaviness in the central part of the face, headache 1 .
Violation of nasal breathing forces to breathe through the mouth.The mucous membrane of the pharynx dries up, there is a sore throat, inflammation can develop – pharyngitis.
Violation of nasal breathing leads to a deterioration in the supply of oxygen to the brain, leading to problems with sleep and chronic fatigue. As a result, daytime sleepiness, decreased concentration, performance and mental stress 1 .
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Symptoms of infectious rhinitis
Let us examine how the clinical picture of the most common type of rhinitis – infectious concomitant ARVI – develops.
Stage 1 Stage – “dry”, lasts from several hours to 1-2 days and is characterized by the appearance of dryness, burning and tickling in the nose, which cause sneezing attacks. At the same time, there are general symptoms of the disease: malaise, weakness, “weakness”, headache, possibly an increase in body temperature. The severity of these manifestations depends on the type of infectious agent 1 .
2nd stage – “serous discharge” (lasts 1-3 days).During this period, as the inflammatory changes increase, abundant mucous discharge from the nasal passages appears. Nasal congestion occurs. Decreases sensitivity to odors. Conjunctivitis may develop, manifested by reddening of the white membrane of the eyes and lacrimation 1 .
Since nasal mucus contains ammonia and sodium chloride, it irritates the skin in the upper lip area, and often reddens appear on it 1 .
If the inflammation invades the nasopharynx and the Eustachian tube region, a feeling of ear congestion may occur 1 .
3rd stage – “mucopurulent discharge” , develops when a bacterial infection is attached. Discharge from the nasal passages becomes yellow or yellow-green.
Gradually they become denser, their number decreases and disappears. Recovery is coming 1 .
Acute rhinitis usually resolves in 8-12 days. With a normal state of immunity and a mild course of nasal discharge, even without treatment, it can disappear in just 2-3 days.If you cannot get rid of a runny nose and nasal congestion for more than 2-3 weeks, it means that the disease has acquired a protracted course of 1 , and you cannot do without a doctor. Perhaps the immune system is weakened by some disease and cannot resist the disease, there are congenital or acquired anomalies of the intranasal structures or foci of chronic infection in the body 1 . Only a specialist can deal with this. He will conduct the necessary research and prescribe treatment for the common cold, taking into account the identified pathology.
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Treatment of infectious rhinitis
In order to reduce the number of pathogens on the surface of the nasal mucosa, with rhinitis, doctors recommend rinsing the nose with saline solutions 1 .
What else can be used to treat a cold in adults and children? At the heart of drug therapy are local vasoconstrictor drugs (decongestants), which reduce swelling of the nasal tissues, restore nasal breathing and thereby significantly improve well-being 1 .
For a cold, you can use the TIZIN ® Classic xylometazoline nasal spray 6 . The drug is available in the form of a 0.05% xylometazoline solution intended for children from 2 to 6 years old, and a 0.1% solution for adults 6 . The action begins to develop in 2 minutes and can persist up to 12 hours 6 .
The use of decongestants sometimes leads to “drying” of the nasal mucosa 1 . Therefore, when choosing a drug, priority is often given to a drug that, along with a vasoconstrictor, contains moisturizing components 1 , for example, the nasal spray TIZIN ® Expert.This drug, like TIZIN ® Classic, is available in two dosages: for children from 2 to 6 years old and for children over 6 years old and adults 7 . In addition to xylometazoline, it contains hyaluronic acid, which helps moisturize and restore the nasal mucosa 7 .
The preparation does not contain preservatives, it is equipped with a special SILVER TURBO spiral, which prevents the penetration of microorganisms into the bottle. Thanks to this, the medicinal solution remains sterile throughout the entire period of use.
Important! The use of decongestants for more than 10 days can lead to the development of “rebound syndrome” and medication-induced rhinitis, therefore it is not recommended to use vasoconstrictors for infectious rhinitis for a long time 1 . With vasomotor and allergic rhinitis, side effects appear even earlier, by about 5-7 days, so decongestants are canceled after 4 days 1 .
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Other Types of Rhinitis
Consider the symptoms and treatment of some other types of rhinitis in adults.
Allergic rhinitis is a non-infectious form of rhinitis that develops as a result of a pathological immune response to certain types of allergens 3.4 .
The development of the disease begins with the appearance on the mucous membrane of the nasal cavity of a local area of ”hypersensitivity” to the allergen, that is, capable of triggering the production of antibodies (IgE) on contact with it 3.4 . At this stage, it is extremely difficult to detect the disease, since the allergic texts used to diagnose allergies have not yet been triggered.They become positive when almost the entire nasal mucosa becomes “susceptible” to the allergen 3 .
A feature of allergic rhinitis is the frequent combination of symptoms of the common cold with manifestations of conjunctivitis: a mesh of dilated blood vessels of the tunica albuginea, lacrimation, itching and burning in the eyes. Symptoms can occur suddenly, upon contact with an allergen, and progress as the disease worsens 3 .
How to treat allergic rhinitis?
As with any form of allergy, it is important to eliminate or at least reduce contact with the allergen.If it is possible to eliminate the allergen, for example, to exclude contact with a pet, you get rid of a cold quickly. However, this is not always possible, especially since most often the allergy is combined, that is, it occurs on several allergens at once. In such cases, the doctor prescribes drug therapy: antiallergic drugs, glucocorticoid hormones, decongestants and nasal antihistamines such as Tizin ® Allergy.
Spray Tizin ® Allergy contains levocabastine – a second generation antihistamine that acts on histamine H1 receptors and thereby helps to reduce the manifestations of allergy 8 .The drug can be used not only for adults, but also for children over 6 years old 8 . It relieves the symptoms of the disease within 5 minutes and is able to maintain its effect for 12 hours 8 .
In the absence of contraindications for allergic rhinitis, allergen-specific immunotherapy is carried out – “inoculation” of the allergen 3 .
Vasomotor rhinitis is diagnosed in 50% of patients presenting with complaints of rhinitis symptoms 3 .More often it is found in women suffering from dysfunction of the autonomic nervous system.
As “provocateurs” of a cold are:
- sharp odors and chemical impurities in the air;
- changes in temperature and humidity of the inhaled air;
- atmospheric pressure fluctuations; 90 044
- stress and emotions;
- physical activity;
- sexual activity;
- alcohol, spicy food;
- hormonal changes 2.3 .
How vasomotor rhinitis develops is still unknown. It is believed that it is caused by a violation of the autonomic nervous system (activation of its parasympathetic part), leading to the expansion of blood vessels and increased secretion of nasal mucus 2.3 .
It will not be possible to quickly cure a vasomotor rhinitis, the disease proceeds in a chronic form. It can be reduced by playing sports 2 . Exercise is thought to help constrict the blood vessels in the nasal mucosa.As medical therapy, doctors usually prescribe antihistamines, intranasal glucocorticoids, decongestants, and other medications 2.3 .
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Rhinitis of pregnant women
A runny nose in pregnant women occurs due to changes in hormonal levels. Its first manifestations usually appear in the second trimester of pregnancy (14-27 weeks) and disappear a couple of weeks after childbirth. The cause of a runny nose is an increase in estrogen levels, which causes shifts in the functioning of the autonomic nervous system and an expansion of the blood vessels of the nasal cavity 3 .
How is rhinitis of pregnancy treated? Since the use of local vasoconstrictor drugs (topical decongestants) during pregnancy is prohibited, therapy is limited to rinsing the nasal cavity with saline solutions, eliminating irritants and dosed physical activity 3 .
Atrophic rhinitis can develop as an independent disease or as a result of other types of rhinitis. One of the leading reasons is long-term exposure to various damaging environmental factors such as dust, high and low temperatures, chemicals, including prolonged use of excessive doses of topical decongestants.
Atrophic rhinitis is characterized by progressive thinning of the nasal mucosa, as a result of which it becomes dry and vulnerable. The main symptoms are: a feeling of dryness in the nose, crusting, impaired sense of smell, repeated nosebleeds, and sometimes a fetid odor.
There can be no question of quickly curing such a runny nose in an adult or child. Treatment of the disease is long-term, including regular rinsing of the nose with saline solutions, the use of drugs that moisturize and protect the mucous membrane and help restore it.
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The information in this article is for reference only and does not replace professional medical advice. Consult a qualified professional for diagnosis and treatment.
- Gurov A. V., Izotova G. N., Kryukov A. I., Kunelskaya N. L. Approaches to the treatment of acute rhinitis // Medical Council. – No. 9. – 2016. – S. 45-47.
- Vasomotor rhinitis: an unsolved problem.Review of D.P. Polyakova. Pediatrics. Consilium Medicum. 2019; 1: 29-32. DOI: 10.26442 / 26586630.2019.1.1
- Pavlyushina E.M., Smolkin Yu.S., Suprun E.N. – No. 4 (31). – 2012 .– S. 16-23.
- Luss L. V., Tsarev S. V. Allergic rhinitis // Asthma and Allergy. – No. 1. – 2017 – S. 23-25.
- Karpishchenko S. A., Kulikova O. A., Lavrenova G. V. Modern therapy of atrophic rhinitis // General Medicine.- No. 1. – 2018 – S. 36-40.
- Instructions for the medical use of the drug TIZIN ® Classic.
- Instructions for medical use of the drug TIZIN ® Express.
- Instructions for medical use of the drug TIZIN ® Alerji.
Treatment of a cold
A cold in a child
Tetanus is an acute infectious disease caused by spores of the bacterium Clostridium tetani .These spores are found everywhere in the environment, especially in soil, ash, intestines / faeces of animals and humans, and on the surface of skin and rusty tools such as nails, needles, barbed wire and others. Due to the high resistance of spores to high temperatures and most antiseptics, they can live for years.
Anyone can get tetanus, but it is most common and most severe in newborn babies and pregnant women who have not been adequately immunized with tetanus toxoid vaccines.Tetanus during pregnancy or in the first 6 weeks after pregnancy is called maternal tetanus, and tetanus in the first 28 days of life is called neonatal tetanus.
Disease remains a serious public health problem in many parts of the world, especially in low-income countries and areas where immunization coverage remains low and childbirth is unsanitary. Neonatal tetanus develops when the umbilical cord is cut with non-sterile instruments or the remainder of the umbilical cord is covered with contaminated materials.Other risk factors include childbirth by people with dirty hands or on contaminated surfaces.
In 2015, about 34,000 newborn babies died from neonatal tetanus, a 96% decrease compared to 1988, when an estimated 787,000 newborn babies died from tetanus in the first month of life. However, there is an increased risk of tetanus in male adolescents and adult men who are circumcised due to declining immunity and limited availability of booster doses in many countries.
Symptoms and Diagnosis
The incubation period for tetanus lasts from 3 to 21 days after infection. In most cases, the disease develops within 14 days.
Symptoms may include:
- jaw spasm or inability to open mouth
- sudden painful muscle spasms, often triggered by occasional murmurs
- Difficulty swallowing
- high fever and sweating
- changes in blood pressure and heart palpitations.
Symptoms of neonatal tetanus include muscle spasms, often preceded by the newborn’s inability to suck or breastfeed, and excessive crying.
Tetanus is diagnosed on the basis of clinical signs and does not require laboratory confirmation. According to the WHO definition, a confirmed case of neonatal tetanus is a case of an illness in a child who had the normal ability to suck and cry in the first 2 days of life, who lost this ability between 3 and 28 days of life and who developed rigidity or had spasms.
According to the WHO definition, the diagnosis of tetanus (not neonatal tetanus) requires at least one of the following: persistent spasm of the facial muscles, in which the lips appear to be stretched into a smile, or painful muscle contractions. By this definition, it is necessary that it be preceded by an injury or injury. However, tetanus is also diagnosed in those patients who cannot remember having any wounds or injuries.
When tetanus develops, emergency medical attention is required, in particular:
- hospital care
- Immediate tetanus treatment
- human immunoglobulin
- intensive wound care
- drugs against muscle spasms
- tetanus vaccination.
People who recover from tetanus do not have natural immunity and may become infected again. Therefore, they need immunization.
Tetanus can be prevented by immunization with tetanus toxoid vaccines. These vaccines are included in routine immunization programs globally and given to women during antenatal care.
To ensure lifelong protection, WHO recommends that each person receive 6 doses (3 primary and 3 booster doses) of tetanus toxoid vaccine.The first 3 dose series should be started at 6 weeks of age with a minimum interval of 4 weeks. It is advisable to administer 3 booster doses during the second year of life (12-23 months), at 4-7 years and at 9-15 years. Ideally, there should be at least a four-year break between booster doses.
There are many types of tetanus vaccines, all of which can be combined with vaccines against other diseases:
- Diphtheria and tetanus (DT) vaccines
- Vaccines against diphtheria, tetanus and pertussis (DTaP)
- Tetanus and diphtheria vaccines (Td)
- Vaccines against tetanus, diphtheria and pertussis (Tdap)
Neonatal tetanus can be prevented by immunizing women of reproductive age with tetanus toxoid vaccine during or outside pregnancy.In addition, good medical practice can also help prevent tetanus, including providing adequate sanitation for childbirth and cutting the umbilical cord, and proper wound care during surgical and dental procedures.
Countries where national programs have maintained high immunization coverage for several decades have very low rates of tetanus.
At the 1989 World Health Assemblythe goal of global elimination of neonatal tetanus as a public health problem (defined as less than one case of neonatal tetanus per 1000 live births in each district) was set in all countries.
In 1999, UNICEF, WHO and the United Nations Population Fund (UNFPA) launched the Maternal and Neonatal Tetanus Elimination (MNE) Initiative to re-energize ESM efforts as a public health issue.
As of April 201814 countries missed the ESMP target.
Once the ESM target has been achieved, continuous strengthening of routine immunization activities for pregnant women and children, maintenance and expansion of access to childbirth with adequate sanitation, adequate surveillance of neonatal tetanus, and the introduction and / or strengthening of immunization in schools there is necessary to maintain the required levels. where possible.
To maintain ESMN levels and protect all people from tetanus, WHO recommends that all children and adolescents receive 6 doses of tetanus toxoid vaccine.
Code of Criminal Procedure Article 162. Term of preliminary investigation / ConsultantPlus
1. The preliminary investigation in a criminal case must be completed within a period not exceeding 2 months from the date of initiation of a criminal case.
2. The period of the preliminary investigation includes the time from the date of the initiation of the criminal case and until the day of its sending to the prosecutor with the indictment or the decision to transfer the criminal case to the court to consider the issue of applying compulsory medical measures or until the day of the decision to terminate the proceedings on criminal case.
3. The period of the preliminary investigation does not include the time for the investigator to appeal against the prosecutor’s decision in the case provided for in paragraph 2 of part one of Article 221 of this Code, as well as the time during which the preliminary investigation was suspended on the grounds provided for by this Code. Federal Law of 28.12.2010 N 404-FZ)
(see the text in the previous
4. The period of preliminary investigation established by part one of this article may be extended up to 3 months by the head of the relevant investigative body.(as amended by Federal laws of 05.06.2007 N 87-FZ, of 03.12.2007 N 323-FZ)
(see the text in the previous version
5. In a criminal case, the investigation of which is of particular complexity, the term of the preliminary investigation may be extended by the head of the investigative body for the constituent entity of the Russian Federation and other equivalent head of the investigative body, as well as by their deputies, up to 12 months. A further extension of the preliminary investigation period may be made only in exceptional cases by the Chairman of the Investigative Committee of the Russian Federation, the head of the investigative body of the corresponding federal executive body (under the federal executive body) and their deputies.
(see the text in the previous version
6. Upon the resumption of proceedings on a suspended or terminated criminal case, as well as upon the return of a criminal case for additional investigation, the head of the investigating body in whose proceedings the criminal case is located shall have the right to set a time period preliminary investigation within one month from the date of receipt of the criminal case by the investigator, regardless of how many times it was previously renewed, terminated or returned for additional investigation, and regardless of the total duration of the preliminary investigation.Further extension of the preliminary investigation period is carried out on a general basis in the manner prescribed by parts four, five and seven of this article. (Part 6 as amended by Federal Law No. 76-FZ of 20.04.2014)
(see the text in the previous version
, as amended )
6.1. In the event that the prosecutor returns the criminal case to the investigator in connection with the discovery by the court of the circumstances specified in parts one and two of Article 237 of this Code, the term for conducting investigative and other procedural actions may not exceed one month from the date of receipt of the criminal case by the investigator.Further extension of the preliminary investigation period is carried out on a general basis in the manner prescribed by parts four, five and seven of this article. (Part 6.1 was introduced by Federal Law No. 64-FZ of 26.04.2013) 6.2. If the court returns the criminal case to the head of the investigative body in connection with the cancellation of the decision to terminate the criminal case or criminal prosecution in accordance with the procedure established by Article 446.5 of this Code, the period for the production of investigative and other procedural actions may not exceed one month from the date of the receipt of the criminal case by the investigator.Further extension of the period of preliminary investigation is carried out on a general basis in the manner prescribed by parts four, five and seven of this Article. (Part 6.2 was introduced by Federal Law No. 323-FZ of 03.07.2016)
the corresponding resolution and submit it to the head of the investigative body no later than 5 days before the date of the expiration of the preliminary investigation.
(as amended by Federal Law 05.06.2007 N 87-FZ)
(see the text in the previous version
8. The investigator shall notify the accused and his defense lawyer, as well as the victim and his representative, in writing about the extension of the preliminary investigation period.
(as amended by the Federal Law of 04.07.2003 N 92-FZ)
(see the text in the previous
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Coronavirus: why do some people have symptoms for weeks?
- Dominic Hughes
- Health Correspondent
David spent several weeks talking to his little daughter through the living room window
David Harris’s world shrank to the size of a living room.
Seven weeks ago he developed symptoms of Covid-19. He says it looked like a bad flu.
Then the 42-year-old British freelance architect isolated himself for the first time in his home in Bristol with his wife and little daughter.
After two weeks he got better, but after another two weeks, to Harris’s surprise, the symptoms returned.
“It was some kind of mini-saga with symptoms returning, I didn’t expect that at all,” he says.
“The second wave was much stronger – the same flu symptoms, but with shortness of breath, because of which I was sure that I had coronavirus.Then for two weeks I, as it seemed to me, was on the mend, “he says.
” And then, in the seventh week, the symptoms returned again. I started the third wave. Fortunately, they were not so strong, but still significant, “says David Harris.
Deciding that it was better not to take risks, David continued to self-isolate. He did not leave the living room of his house, he only changed clothes when he went out to shower, ate and slept
David’s wife carried her 10-month-old daughter Millie to the living room window and showed her to her husband so they could “chat” through the glass.
David was worn out by illness. He did not understand what would happen to him next.
“The hardest part is deciding when to get help. I didn’t want to waste NHS time because obviously there are people who are harder than me,” he says.
“But I didn’t want to find myself in a situation where at the most dangerous moment you do not dare to ask for help, and then something bad happens because you didn’t do it on time,” he says.
“When the symptoms first came back, when I got worse for the first time, it was pretty scary. I didn’t know if that meant it was over. Quite scary when you get worse and you thought you were getting better “.
“Screamed in agony”
49-year-old Londoner Felicity first experienced the symptoms of Covid-19 six weeks ago. But, like David, her illness was difficult.
“The hardest thing was to get over the first ten days of a serious illness, to think that you are recovering, and then face even more severe symptoms,” she says.
Felicity had symptoms for six weeks
“In the fifth week of illness, my partner had to call an ambulance – my stomach hurt so much that I just screamed in agony,” she says.
“It was very difficult to understand – are these the consequences of the virus? Is this an immune system response? Inflammation? Before the infection, I had no stomach problems, but the fifth week was just awful,” she says.
Felicity could not get rid of her symptoms for a long time, and weeks of illness tired her.
“I spent an enormous amount of time in bed recuperating. The whole experience – sickness and trying to get well – was psychologically overwhelming,” she says.
Neither Felicity nor David were tested for Covid-19, but doctors told them it was most likely a coronavirus. The couple was also assured that now they can no longer infect anyone.
Most recover quickly
The problem is that we don’t know a lot about the coronavirus.Scientists do not understand, for example, why some sick people have symptoms lasting only a few days, while others, physically strong people, do not stop for weeks.
Philip Gotthard, consultant at the London Clinic for Tropical Diseases, emphasizes that the vast majority of those infected recover relatively quickly and completely.
“Some people have a cough that lasts a long time. Some patients experience severe fatigue, exhaustion. This loss of energy can last from three to six weeks,” he says.
“This is a lot of stress, especially for young and healthy people who are not used to it. For them, the slow and uneven recovery from the disease is a shock,” the doctor notes.
“But the same effect happens with other diseases, when patients recover from an acute form of infection. Their condition worsens and improves, they have good and bad days,” he says.
Tim Spector, an epidemiologist professor at King’s College London, says data collected using the Covid Symptom Study app show that those infected with the coronavirus begin to recover after an average of 12 days.
“But we also see a large number of people who have symptoms for much longer, in some cases for more than 30 days,” he says.
“We are exploring new data with artificial intelligence. Soon we will be able to determine which combination of symptoms and risk factors leads to such duration of symptoms,” he says.
Both David and Felicity are on the mend today. Finally, they hope.
But Covid-19 is a virus that emerged just a few months ago.He continues to give us extremely unpleasant surprises.
The most important safety measure – complete isolation from healthy people – applies to those who are sick with Covid-19.
Strict isolation at home or in the hospital is complete isolation from healthy people. This is an essential security measure to limit the spread of Covid-19.
People with mild symptoms do not need hospital treatment. Doctors can prescribe treatment in isolation at home to prevent the virus from spreading further.Isolation or isolation of a house means being at home or in another specially chosen place, in a separate, well-ventilated room, if possible with a separate toilet. Such safety measures are recommended to be applied while the symptoms of the disease are observed or during another specified period.
Strict rules must be followed when isolated at home.
WHO IS OBLIGED TO OBSERVE?
90,040 90,041 A person who tested positive for Covid-19.
HOW TO OBSERVE?
- Do not meet other people.
- Do not leave rooms where strict isolation is observed (including not going for walks, shopping, etc.).
- Every day you need to talk to your family doctor (if the situation becomes critical, call 113).
- Do not accept guests.
- Wear a face mask if the person with Covid-19 lives with someone in the same household.
- Stay in a well-ventilated area with an openable window.
- Use a separate towel, cutlery, drinking utensils, bed linen and other utensils frequently used on the household.
HOW LONG DOES IT NEED TO BE OBSERVED?
The attending physician decides on the end of the isolation regime and closure of the certificate of incapacity for work of a patient with COVID-19, guided by the following basic principles:
- If a person with a confirmed diagnosis of COVID-19 does not show symptoms of the disease (asymptomatic infection), the isolation mode can be stopped on the 10th day after laboratory confirmation of infection;
- if the COVID-19 disease is symptomatic, but the course of the disease is mild or moderate, the isolation regimen can be stopped on the 10th day after the onset of the disease, provided that the symptoms (fever, etc.signs of acute infection) are not observed for at least 3 days;
- if the course of the COVID-19 disease is severe, the isolation regimen can be stopped on the 20th day from the onset of the disease, provided that the symptoms (fever and other signs of an acute infection) are not observed for at least 3 days.
IS A HOSPITAL LIST ISSUED?
- A person who is sick with Covid-19 is issued a certificate of incapacity for work until he recovers.
90,051 90,000 How will the elections to the State Duma be held in 2021
Who can be elected to the State Duma
In accordance with the Constitution of the Russian Federation, a citizen of the Russian Federation who has reached the age of 21 and has the right to participate in elections can be elected a deputy of the State Duma.
450 deputies are elected to the State Duma: 225 deputies – in single-mandate electoral districts (one district – one deputy) and 225 deputies – from political parties, in the federal electoral district in proportion to the number of votes cast for federal lists of candidates. Parties officially registered by the CEC have the right to participate in the elections.
Who can vote
Citizens of the Russian Federation who have reached the age of 18 have the right to vote in elections to the State Duma on the basis of universal, equal and direct suffrage by secret ballot.Participation in elections is free and voluntary, and no one has the right to interfere with the expression of the will of citizens.
When the elections take place
Elections of deputies are officially appointed by the President of the Russian Federation. The decision to call elections must be made no earlier than 110 days and no later than 90 days before voting day.
Election day is the third Sunday of the month in which the term of office of the previous Duma expires, so the elections in 2021 should be held on September 19.
A single voting day will be appointed on the same date.
Can a vote take several days?
Yes, the law allows the CEC to make such a decision after the official appointment of a voting date. Elections can be held for several days in a row, but no more than three days.
How long will the election campaign last
The campaigning period for a political party begins from the day it makes a decision to nominate a federal list of candidates and candidates in single-mandate constituencies.The campaign period for a candidate nominated on the federal list of candidates begins on the day the federal list of candidates is submitted to the CEC. The campaigning period for a candidate nominated in a single-mandate constituency begins from the day the candidate submits an application for consent to run to the constituency commission.
In this case, all pre-election campaigning stops on the “day of silence” – at zero o’clock local time on the day preceding the day of voting.
Campaigning on television and in the media lasts for 28 days until the “day of silence”.
90,000 Enterovirus infection in children
Enterovirus infections include a group of diseases. Their specificity is such that after the transferred infection, lifelong immunity is formed. However, immunity will only be to the type of virus, the type of which the child has had. Therefore, a child can get sick with an enterovirus infection several times in his life.For the same reason, there is no vaccine for this disease.
Most often children aged from 3 to 10 years get sick. In breastfed children, the body has the immunity received from the mother through breast milk, however, this immunity is not persistent and after the termination of breastfeeding, it quickly disappears.
The virus is transmitted from a sick child or from a child who is a virus carrier. Viruses survive well in water and soil, can survive for several years when frozen, are resistant to disinfectants, but are susceptible to high temperatures (when heated to 45 ° C, they die in 45-60 seconds).
Routes of transmission of the virus:
– airborne (when sneezing and coughing with droplets of saliva from a sick child to a healthy one)
– fecal-oral if personal hygiene is not followed
– through water, when using raw (not boiled) water
– it is possible to infect children through toys if children take them into their mouths
Symptoms of enterovirus infection
Enterovirus infections have both similar and different manifestations, depending on the type.Once in the child’s body, the viruses migrate to the lymph nodes, where they settle and begin to multiply. The incubation period for all enterovirus infections is the same – from 1 to 10 days (usually 2-5 days).
The disease begins acutely – with an increase in body temperature to 38-39º C. The temperature usually lasts 3-5 days, after which it decreases to normal values. Very often the temperature has a wave-like course: the temperature lasts for 2-3 days, after which it decreases and for 2-3 days is at normal numbers, then rises again for 1-2 days and returns to normal again completely.When the temperature rises, the child feels weakness, drowsiness, headache, nausea, vomiting may occur. With a decrease in body temperature, all these symptoms disappear, but with a repeated increase, they can return. Also, the cervical and submandibular lymph nodes increase, as viruses multiply in them.
Depending on which organs are most affected, several forms of enterovirus infection are isolated. Enteroviruses can infect: the central and peripheral nervous systems, mucous membranes of the oropharynx, mucous membranes of the eyes, skin, muscles, heart, intestinal mucosa, liver; in boys, testicular damage is possible.
The most severe consequence of enterovirus is the development of serous enteroviral meningitis. It can develop in a child of any age and is recognized by the following signs:
– a headache of a diffuse nature, the intensity of which increases with every hour;
– vomiting without nausea, after which the child does not feel relief;
– increased pain and a repeated episode of vomiting can be triggered by bright light or loud sound;
– the child may be inhibited or, conversely, extremely excited;
– in severe cases, convulsions of all muscle groups develop;
The final diagnosis of meningitis can only be made by a doctor after performing a lumbar puncture and studying the laboratory parameters of the obtained cerebrospinal fluid.
Treatment of enterovirus infection
There is no specific treatment for enterovirus infection. Treatment is carried out at home, hospitalization is indicated in the presence of damage to the nervous system, heart, high temperature, which cannot be reduced for a long time with the use of antipyretic drugs. The child is shown bed rest for the entire period of increase in body temperature.
Food should be light, rich in proteins. A sufficient amount of liquid is required: boiled water, mineral water without gases, compotes, juices, fruit drinks.
Treatment is carried out symptomatically, depending on the manifestations of the infection. In some cases (angina, diarrhea, conjunctivitis), bacterial complications are prevented.
Children are isolated for the entire period of the disease. The children’s team can be after the disappearance of all symptoms of the disease.
Prevention of enterovirus infection
For prevention, it is necessary to observe the rules of personal hygiene: wash your hands after using the toilet, walking on the street, drink only boiled water or water from a factory bottle, it is unacceptable to use water from an open source (river, lake) for a child to drink.