Heavy Menstrual Bleeding | CDC

Menorrhagia is menstrual bleeding that lasts more than 7 days. It can also be bleeding that is very heavy. How do you know if you have heavy bleeding? If you need to change your tampon or pad after less than 2 hours or you pass clots the size of a quarter or larger, that is heavy bleeding. If you have this type of bleeding, you should see a doctor.

Untreated heavy or prolonged bleeding can stop you from living your life to the fullest. It also can cause anemia. Anemia is a common blood problem that can leave you feeling tired or weak. If you have a bleeding problem, it could lead to other health problems. Sometimes treatments, such as dilation and curettage (D&C) or a hysterectomy, might be done when these procedures could have been avoided.

Causes

Possible causes fall into the following three areas:

1. Uterine-related problems
   1. Growths or tumors of the uterus that are not cancer; these can be called uterine fibroids or polyps.
   2. Cancer of the uterus or cervix.
   3. Certain types of birth control—for example, an intrauterine device (IUD).
   4. Problems related to pregnancy, such as a miscarriage or ectopic pregnancy, can cause abnormal bleeding. A miscarriage is when an unborn baby (also called a fetus) dies in the uterus. An ectopic pregnancy is when a baby starts to grow outside the womb (uterus), which is not safe.
2. Hormone-related problems
3. Other illnesses or disorders
   1. Bleeding-related disorders, such as von Willebrand disease (VWD) or platelet function disorder.
   2. Nonbleeding-related disorders such as liver, kidney, or thyroid disease; pelvic inflammatory disease; and cancer.

In addition, certain drugs, such as aspirin, can cause increased bleeding. Doctors have not been able to find the cause in half of all women who have this problem. If you have bleeding such as this, and your gynecologist has not found any problems during your routine visit, you should be tested for a bleeding disorder.

View and print this chart [PDF – 675 KB]

Signs

You might have menorrhagia if you:

• Have a menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row.
• Need to double up on pads to control your menstrual flow.
• Need to change pads or tampons during the night.
• Have menstrual periods lasting more than 7 days.
• Have a menstrual flow with blood clots the size of a quarter or larger.
• Have a heavy menstrual flow that keeps you from doing the things you would do normally.
• Have constant pain in the lower part of the stomach during your periods.
• Are tired, lack energy, or are short of breath.

Diagnosis

Finding out if a woman has heavy menstrual bleeding often is not easy because each person might think of “heavy bleeding” in a different way. Usually, menstrual bleeding lasts about 4 to 5 days and the amount of blood lost is small (2 to 3 tablespoons). However, women who have menorrhagia usually bleed for more than 7 days and lose twice as much blood. If you have bleeding that lasts longer than 7 days per period, or is so heavy that you have to change your pad or tampon nearly every hour, you need to talk with your doctor.

To find out if you have menorrhagia, your doctor will ask you about your medical history and menstrual cycles.

He or she may ask you questions like the following:

• How old were you when you got your first period?
• How long is your menstrual cycle?
• How many days does your period usually last?
• How many days do you consider your period to be heavy?
• How do your periods affect your quality of life?

Your doctor may also ask if any of your family members have had heavy menstrual bleeding. He or she may also have you complete this questionnaire [PDF – 127 KB] to help determine if you need to be tested for a possible bleeding disorder.

You might want to track your periods by writing down the dates of your periods and how heavy you think your flow is (maybe by counting how many pads or tampons you use). Do this before you visit the doctor so that you can give the doctor as much information as possible. Above is a picture of a chart that is used by some doctors to track your period. You can make your own chart based on the one shown. Your doctor also will do a pelvic exam and might tell you about other tests that can be done to help find out if you have menorrhagia.

Click here to view a larger image

Tests

Your doctor might tell you that one or more of the following tests will help find out if you have a bleeding problem:

• Blood test. In this test, your blood will be taken using a needle. It will then be looked at to check for anemia, problems with the thyroid, or problems with the way the blood clots.
• Pap test. For this test, cells from your cervix are removed and then looked at to find out if you have an infection, inflammation, or changes in your cells that might be cancer or might cause cancer.
• Endometrial biopsy. Tissue samples are taken from the inside lining of your uterus or “endometrium” to find out if you have cancer or other abnormal cells. You might feel as if you were having a bad menstrual cramp while this test is being done. But, it does not take long, and the pain usually goes away when the test ends.
• Ultrasound. This is a painless test using sound waves and a computer to show what your blood vessels, tissues, and organs look like. Your doctor then can see how they are working and check your blood flow.

Using the results of these first tests, the doctor might recommend more tests, including,

• Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This lets your doctor look for problems in the lining of your uterus. Mild to moderate cramping or pressure can be felt during this procedure.
• Hysteroscopy. This is a procedure to look at the inside of the uterus using a tiny tool to see if you have fibroids, polyps, or other problems that might be causing bleeding. You might be given drugs to put you to sleep (this is known as “general anesthesia) or drugs simply to numb the area being looked at (this is called “local anesthesia”).
• Dilation and Curettage (D&C). This is a procedure (or test) that can be used to find and treat the cause of bleeding. During a D&C, the inside lining of your uterus is scraped and looked at to see what might be causing the bleeding. A D&C is a simple procedure. Most often it is done in an operating room, but you will not have to stay in the hospital afterwards. You might be given drugs to make you sleep during the procedure, or you might be given something that will numb only the area to be worked on.

Treatment

The type of treatment you get will depend on the cause of your bleeding and how serious it is. Your doctor also will look at things such as your age, general health, and medical history; how well you respond to certain medicines, procedures, or therapies; and your wants and needs. For example, some women do not want to have a period, some want to know when they can usually expect to have their period, and some want just to reduce the amount of bleeding. Some women want to make sure they can still have children in the future. Others want to lessen the pain more than they want to reduce the amount of bleeding. Some treatments are ongoing and others are done one time. You should discuss all of your options with your doctor to decide which is best for you. Following is a list of the more common treatments.

Drug Therapy

• Iron supplements. To get more iron into your blood to help it carry oxygen if you show signs of anemia.
• Ibuprofen (Advil). To help reduce pain, menstrual cramps, and the amount of bleeding. In some women, NSAIDS can increase the risk of bleeding.
• Birth control pills. To help make periods more regular and reduce the amount of bleeding.
• Intrauterine contraception (IUC). To help make periods more regular and reduce the amount of bleeding through drug-releasing devices placed into the uterus.
• Hormone therapy (drugs that contain estrogen and/or progesterone). To reduce the amount of bleeding.
• Desmopressin Nasal Spray (Stimate®). To stop bleeding in people who have certain bleeding disorders, such as von Willebrand disease and mild hemophilia, by releasing a clotting protein or “factor”, stored in the lining of the blood vessels that helps the blood to clot and temporarily increasing the level of these proteins in the blood.
• Antifibrinolytic medicines (tranexamic acid, aminocaproic acid). To reduce the amount of bleeding by stopping a clot from breaking down once it has formed.

Surgical Treatment

• Dilation and Curettage (D&C). A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. This procedure might need to be repeated over time.
• Operative hysteroscopy. A surgical procedure, using a special tool to view the inside of the uterus, that can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage heavy menstrual flow.
• Endometrial ablation or resection. Two types of surgical procedures using different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. While some patients will stop having menstrual periods altogether, others may continue to have periods but the menstrual flow will be lighter than before. Although the procedures do not remove the uterus, they will prevent women from having children in the future.
• Hysterectomy. A major operation requiring hospitalization that involves surgically removing the entire uterus. After having this procedure, a woman can no longer become pregnant and will stop having her period.

Menorrhagia is common among women. But, many women do not know that they can get help for it. Others do not get help because they are too embarrassed to talk with a doctor about their problem. Talking openly with your doctor is very important in making sure you are diagnosed properly and get the right treatment.

Who is Affected

Heavy bleeding (menorrhagia) is one of the most common problems women report to their doctors. It affects more than 10 million American women each year. This means that about one out of every five women has it.

References

1. Fast Facts for Your Health: Menorrhagia. National Women’s Health Resource Center (NWHRC), Washington, D.C. http://www.healthywomen.org.
2. Menstruation: Heavy Bleeding (Menorrhagia). PreventDisease.com. http://preventdisease.com/diseases/menstruation_heavy_bleeding.html.
3. Women with Inherited Bleeding Disorders: Surgical Options for Menorrhagia. Canadian Hemophilia Society. http://www.hemophilia.ca.
4. Menorrhagia (heavy menstrual bleeding). CNN.com. http://www.cnn.com/HEALTH/library/DS/00394.html.
5. Phillip CS, Faiz A, Dowling NF, Beckman M, Owens S, Ayers C, Bachmann G. Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. American Journal of Obstetrics & Gynecology 2008;198:163.e1–163.e8.
6. Apgar BS, Kaufman AH, George-Nwogu U, Kittendorf A. Treatment of menorrhagia. American Family Physician 2007;75:1813–1819,1820. http://www.aafp.org/afp/20070615/1813.html.
7. Heavy Bleeding and Endometrial Ablation. FertilityAnswers.com. http://www.fertilityanswers.com/endometrial_ablation.htm.
8. Menorrhagia (heavy menstrual bleeding). MayoClinic.com Health Library. http://www.riverside-online.com/health_reference/Womens-Health/DS00394.cfm.
   National Collaborating Centre for Women’s and Children’s Health. National Institute for Health and Clinical Excellence (NICE). Heavy menstrual bleeding. London: Royal College of Obstetricians and Gynaecologists Press; 2007.
9. Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. British Journal of Obstetrics and Gynaecology. 1990;97:734–739.

Causes, When to Seek Help, Treatment, and More

If you experience periods that last longer than seven days, see your doctor. It may be a sign of a serious underlying health condition that needs to be addressed.

Generally, a period lasts between three to seven days. A menstrual period that lasts longer than seven days is considered a long period.

Your doctor may refer to a period that lasts longer than a week as menorrhagia. You may also be diagnosed with menorrhagia if you experience unusually heavy bleeding that lasts less than a week. Five percent of women have menorrhagia.

A long period may be a sign of a serious underlying health condition, such as:

• hormone irregularities
• uterine abnormalities
• cancer

It’s important to see your doctor if you experience a long or heavy period so they can identify the underlying cause or rule out more serious possible causes.

Menorrhagia can cause discomfort during your period as well as disrupt your regular routine. You may find that the bleeding affects your activities or your sleep. You may also experience iron deficiency anemia if you regularly experience long menstrual periods, especially if they’re heavy.

Read on to learn more about long periods, including possible causes and what you can do to manage this symptom.

Long periods can be caused by a wide range of underlying conditions.

Hormone and ovulation changes

Changes to your hormones or ovulation may cause a long period. You may notice hormonal changes when you first get your period during puberty or in perimenopause. You may also experience a hormonal imbalance from different health conditions, such as thyroid disorders or polycystic ovary syndrome.

If your hormones aren’t at a normal level or if your body doesn’t ovulate during your menstrual cycle, the uterine lining can become very thick. When your body finally sheds the lining, you may experience a period that’s longer than normal.

Medications

You may experience long periods because of medications you take. These can include:

• contraceptives, such as intrauterine devices and extended birth control pills
• aspirin and other blood thinners
• anti-inflammatories

Pregnancy

While not actually a period, extended vaginal bleeding may be a sign of an unsafe or nonviable pregnancy, such as an ectopic pregnancy or a miscarriage.

You may also have extended bleeding in pregnancy if you have a condition like placenta previa.

If you’ve had a pregnancy test come back positive and you’re experiencing vaginal bleeding, see your healthcare provider.

Uterine fibroids or polyps

Uterine fibroids and polyps can lead to extended, and sometimes heavy, bleeding.

Fibroids occur when muscle tissue begins to grown in the wall of the uterus.

Polyps are also the result of irregular tissue growth in the uterus and cause small tumors to grow.

Generally, neither fibroids or polyps are cancerous.

Adenomyosis

Adenomyosis is another type of tissue buildup. The condition occurs when your endometrium, or uterine lining, embeds itself into the muscles of your uterus. This can lead to a long or heavy period.

Thyroid condition

You may have a long period if your thyroid is underperforming. This condition is known as hypothyroidism.

Bleeding condition

You may have a condition that affects your body’s ability to clot blood, causing your long periods. Two of these conditions are hemophilia and von Willebrand’s disease.

A long period may be the only sign of one of these conditions, or you may have other symptoms.

Obesity

Excess weight may cause long periods. That’s because fatty tissue can cause your body to produce more estrogen. This excess estrogen can lead to a change in your period.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) occurs when bacteria infect your reproductive organs. In addition to changes to your menstrual cycle, PID can also lead to abnormal vaginal discharge among other symptoms.

Cancer

A prolonged period may the sign of cancer in your uterus or cervix. For some women, this may be one of the earliest symptoms of either of these cancers.

Don’t ignore a long period. It’s important to see your doctor to discuss why you might be experiencing this symptom. Delaying your diagnosis and treatment could lead to a worsening of the underlying condition responsible for the extended bleeding.

You may want to seek immediate care with a long period if you spike a fever or are losing an abnormally heavy amount of blood or large blood clots. A sign that you’re losing a lot of blood is if you need to change a pad or tampon one to two times per hour for several hours. You may also begin to feel lightheaded if you’re losing a lot of blood.

There are many causes for a long period, so your doctor will likely begin your appointment by asking you some questions. These may include:

• when your period started
• how many pads and tampons you’ve used in the last day
• your sexual activity
• other symptoms you’re experiencing
• your medical and relevant family histories

They may also do a physical exam that includes a pelvic exam and measuring your vital signs.

Your doctor may also recommend any of the following tests to help them make a diagnosis:

• blood tests to check hormone levels and also to look for signs of an iron deficiency
• pap smear
• biopsy
• abdominal or transvaginal ultrasound
• hysteroscopy
• dilation and curettage

Treatment methods for a long period can vary. Your doctor will treat the underlying cause. They may also recommend a treatment to reduce your current bleeding, regulate your period, or relieve any discomfort.

Hormonal birth control may regulate your period and shorten it in the future. This medication can be administered as:

• a pill
• an intrauterine device
• a shot
• a vaginal ring

Your doctor also may advise you to take medication that reduces pain or discomfort you experience from the prolonged period. These medications may include over-the-counter nonsteroidal anti-inflammatories, such as Advil or Motrin.

In some cases, your doctor may recommend a surgical procedure to alleviate long periods.

Dilation and curettage can thin the layer of your uterus and reduce how much you bleed during your period.

If you’re no longer considering having children, you may undergo endometrial ablation, resection, or a hysterectomy. These procedures can relieve the long periods, but they may also eliminate the possibility of getting pregnant.

Delaying a diagnosis could result in a more invasive procedure or intensive treatment for the underlying cause.

Additionally, if your long period causes heavier blood loss, you could be at risk of developing anemia. This may contribute to feelings of tiredness and weakness.

Your doctor can use results from a blood test to diagnose anemia. If your iron levels are low, your doctor may recommend boosting your diet with iron-rich foods and a possible iron supplement to get your levels back to normal.

Long periods may also be painful and interfere with your well-being and quality of life. You may miss days of school or work, or withdraw from activities you enjoy because of your long period.

There are many reasons you may have a period that’s longer than normal. Long periods can get in the way of your normal life, and they may also be a sign of an underlying condition that requires treatment.

See your doctor to find out the cause of your long period so you can begin to treat it. Delaying treatment may cause complications and lead to more invasive treatments in the future.

Long periods | diagnosis and treatment of cycle disorders

Prolonged periods | diagnosis and treatment of cycle disorders

HOW DOES MENORRHAGIA MANIFEST?

When menstruation lasts longer and more than 90-100 ml of blood is secreted (even if they do not cause discomfort or pain), it is necessary to seek advice from a gynecologist.

How often you change your tampon or pad during your period can be an indicator of how much blood is lost. If you need to replace your hygiene product every 2 hours or more often, this is a reason for an unscheduled gynecological examination.

Long periods are usually a symptom of existing gynecological problems. It can be endometriosis, submucosal uterine leiomyoma, polyps, endometrial hyperplasia. They can also be associated with a disorder of the blood coagulation process (for example, with thrombocytopenia) or endocrine disorders – dysfunction of the thyroid gland, adrenal glands.

Our advantages

Our medical center has modern diagnostic and treatment equipment. Laboratory studies are carried out on the basis of our own diagnostic laboratory.

Treatment is carried out only in accordance with international recommendations and WHO standards, diagnostic and treatment standards of the Ministry of Health of Ukraine, taking into account the world experience of leading experts.

From the first day of work, we adhere to an individual approach to the problem of each client, as we are convinced that this is the key to effective treatment and minimal risk of complications.

Reception and treatment is carried out by highly qualified specialists. We pay special attention to the selection of personnel, as well as create all the conditions for their professional growth and improvement.

They recommend us to their relatives, which means they trust us. More than 50% of patients come to us on the recommendation of their relatives, relatives or friends.

Terms and results may vary, depending on the patient’s body

STAGES OF TREATMENT OF LONG MENSTRUCTION

Consultation and examination by a gynecologist. Collection of anamnesis.

Tests:

• clinical blood test;
• thyroid function tests (if necessary)

Ultrasound diagnostics of the pelvic organs (performed at different periods of the menstrual cycle on days 7 and 21).

Follow-up consultation based on test results and prescription of treatment.

The essence of the treatment will depend on the results of the examinations carried out and is more directed to the treatment of the disease that caused heavy menstruation.

The price of treatment for menorrhagia (heavy menstruation) in Kyiv at the Health of the Family clinic depends on the number and types of examinations performed. The cost of a consultation with a gynecologist starts from 750 UAH. In addition, the services of our medical center can be found in the price list.

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Consulting services UAH 750 Obstetrician-gynecologist consultation (history taking, examination, treatment appointment, provisional diagnosis) Consulting services 875 UAH. Consultation of a leading specialist, obstetrician-gynecologist (history taking, examination, treatment appointment, preliminary diagnosis) Ablyalimova Albina Shevketovna Obstetrician-gynecologist, ultrasound doctor Work experience 13 years https://familyhealth.ua/wp-content/uploads/2021 /09/al3.png https://familyhealth.ua/wp-content/uploads/2021/09/al3-300×272.png https://familyhealth. ua/doctors/ablyalimova-albina-shevketovna/ Shkuta Anatoly Nikolaevich Gynecologist Categories Work experience 27 years 300×272.png https://familyhealth.ua/doctors/shkuta-anatolij-nikolaevich/ Semyonova Alina Olegovna Obstetrician-gynecologist, ultrasound doctor EXPERIENCE 4 years https://familyhealth.ua/wp-content/uploads/2022/08 /ao_dlya-sajta.png https://familyhealth.ua/wp-content/uploads/2022/08/ao_dlya-sajta-300×272.png https://familyhealth.ua/doctors/semyonova-alina-olegovna/ Servetnik Larisa Sergeevna Doctor – obstetrician – gynecologist of the highest category, gynecologist-endocrinologist, ultrasound doctor WORK EXPERIENCE 27 YEARS https://familyhealth.ua/wp-content/uploads/2020/11/doc01.png https://familyhealth.ua/wp-content /uploads/2020/11/doc01-300×272.png https://familyhealth.ua/doctors/servetnik-larisa-sergeevna/ Kovalenko Elena Gennadievna Obstetrician-gynecologist, ultrasound doctor EXPERIENCE 15 years https://familyhealth.ua/ wp-content/uploads/2022/08/eg_dlya-sajta.png https://familyhealth. ua/wp-content/uploads/2022/08/eg_dlya-sajta-300×272.png https://familyhealth.ua/doctors/ kovalenko-elena-gennadievna/

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Long periods – causes, diagnosis and treatment

Long periods – menstruation lasting more than 7 days. Most often detected in diseases of the uterus, ovarian dysfunction and hyperestrogenism. In some women, they are observed in puberty and premenopause, sometimes they are the result of the use of certain contraceptives or pathologies accompanied by a violation of blood clotting. Establishing the cause of the symptom is made according to the survey, gynecological examination, ultrasound, hysteroscopy, laboratory techniques. Treatment – hormone therapy, physiotherapy, surgical interventions.

Why long periods occur

Physiological causes

Episodic long periods are observed during periods of hormonal changes – in puberty and on the eve of menopause. They are combined with fluctuations in the duration of the cycle, can alternate with short, meager periods. In reproductive age, the intrauterine device sometimes becomes the cause.

A short-term increase in the duration of the cycle is possible when adapting to changed living conditions, for example, moving to a new job, moving to another climatic zone. Longer violations are observed with prolonged stress, malnutrition, a sharp increase in body weight. In some women, the symptom is hereditary, persists throughout life.

Fibroids

One of the most common pathological causes of disorders are fibroids. Long periods with the release of blood clots are considered the most frequent manifestation of the disease, combined with acyclic uterine bleeding, with the growth of the formation, they are supplemented by periodic or constant pain in the lower abdomen. Features of the clinical picture differ somewhat depending on the type of fibroids:

• Submucosal. The symptom is most pronounced in this variant of the disease. Constant blood loss eventually leads to anemia. In 20-50% there are cramping menstrual pains. Signs of compression of neighboring organs are uncharacteristic.
• Interstitial. There are algomenorrhea, intermenstrual pain and menorrhagia, sometimes – acyclic bleeding, iron deficiency anemia. With large nodes, compression of the inferior vena cava, dysuric phenomena due to compression of the bladder are found.
• Subserous. Long periods are possible, but less typical than in other pathologies. With the growth of the tumor, pain comes to the fore. Depending on the localization of the fibroid, there are signs of compression of the bladder, rectum, and less often the main veins.

Symptoms of multiple fibroids are determined by their type. Manifestations are often more pronounced than with single nodes. Severe pain, compression of nearby organs are noted.

Fibromas and polyps

Fibroma has a clinical picture, including metrorrhagia, menorrhagia, algomenorrhea, cramping or pulling pains in the abdomen. As with fibroids, manifestations vary depending on the location of the mass. Long menstruation comes to the fore with submucosal localization of the node. They are combined with signs of compression of the rectum and urinary tract with an interstitial tumor, less pronounced or appear later with interligamentous fibroma. Possible infertility.

Along with prolonged menstruation, polyps are marked by acyclic bleeding, premenstrual sanious discharge, the appearance of bloody discharge after sexual contact. With large polyps, the clinic is supplemented by cramping pains in the lower abdomen, discomfort during intercourse, and mucous whites. Infertility often develops, and pregnant women have a high risk of miscarriage.

Long periods

Endometrial hyperplasia

Pathology is observed in two variants. Often combined with inflammatory lesions of the internal genitalia, mastopathy, adenomyosis, obesity. In both cases, long periods, metrorrhagia develop. Details vary according to the type of illness:

• Glandular hyperplasia. May occur in patients of any age, more often manifests in puberty and premenopausal. Menorrhagia occurs after a slight delay. Adolescents may experience profuse, sudden bleeding with clots.
• Atypical hyperplasia. Typical for patients 45-55 years old. The delay before a long menstruation can be from 1 to 3 months, regular long periods are less common. In a third of women, signs of virilization are detected, the frequency of manifestation increases significantly with obesity.

Other diseases of the uterus

Long, extremely heavy, sharply painful menstruation is the most characteristic symptom of adenomyosis (endometriosis of the uterus). It is possible to release clots, the appearance of a spotting discharge in the middle of the cycle, before and after menstruation. Often there is a pronounced premenstrual syndrome. The disorder also accompanies chronic inflammatory diseases of the uterus:

• Metritis. Long periods, hypomenorrhea, metrorrhagia are detected. Episodic pulling pains, mild serous discharge are found.
• Endometritis. As in the previous case, menstruation can be either scanty or profuse, prolonged. Detachable bloody or serous-purulent. Pain in the lower abdomen of a aching nature, pain during sexual intercourse are determined.
• Metroendometritis. Menstrual dysfunction usually comes to the fore. The pains are periodic, pulling, localized above the pubis, in the sacrum and lower back. Concomitant adnexitis, nabothian cysts, intrauterine synechia, CPPS are often observed.

Another possible cause of long periods is an abnormal position of the uterus. The symptom is most often found with retroflection, may be accompanied by heaviness in the abdomen, pathological leucorrhoea, dyspareunia, dysfunction of the intestines and bladder.

Hyperestrogenia

Menstruation is profuse, painful, both long and short. The pain syndrome is only temporarily eliminated by analgesics. The discharge is bright scarlet, with clots. A body weight gain with fat deposition mainly in the thigh area, premenstrual syndrome with a bright emotional component and the development of edema are determined. The condition is observed in the following pathologies:

• Tumors. The level of estrogen increases with hormonally active neoplasms of the ovaries and adrenal glands, neoplasia of the hypothalamus and pituitary gland. Another possible cause is chorionepithelioma.
• Diseases of the thyroid gland. Hyperestrogenism occurs due to failures in the production of regulatory hormones secreted by the pituitary gland. It can be found in both hypothyroidism and hyperthyroidism.
• Obesity. With a large amount of adipose tissue in the body, the level of androgens increases, which turn into estrogens.
• Diseases of the liver. With the destruction of hepatocytes on the background of cirrhosis or hepatitis, the splitting of hormones is not produced in the required volume.

Ovarian dysfunction

Long, scanty or irregular menstruation in combination with severe premenstrual syndrome, acyclic bleeding, infertility and periodic amenorrhea are characteristic of ovarian dysfunction, which occurs against the background of the following pathological processes:

• Inflammatory diseases: oophoritis, adnexitis, salpingitis, endometritis.
• Non-inflammatory female diseases: endometriosis, adenomyosis, uterine fibroids, ovarian neoplasms, uterine cancer.
• Endocrine disorders: diabetes mellitus, obesity, hyper- or hypothyroidism, adrenal disease.
• Physical and mental fatigue: prolonged stress, excessive physical activity, constant lack of sleep, lack of rest, poor diet.
• Termination of pregnancy: miscarriages, mini-abortions, medical abortions.
• Other causes: incorrect position of the intrauterine device, taking certain medications, radiation.

Coagulation disorders

The symptom is accompanied by the following disorders of the blood coagulation system:

• Thrombocytopenia. Initially, patients develop subcutaneous hemorrhages, bruises easily, gums bleed. Subsequently, the clinical picture is supplemented by menorrhagia, prolonged bleeding during cuts and medical manipulations.
• Thrombocytopenic purpura. Multiple spontaneous painless hemorrhages of various sizes form on the skin and mucous membranes. Pronounced gingival and nasal bleeding, menorrhagia, bleeding into the abdominal cavity during ovulation are determined.
• Hypovitaminosis K. Hemorrhagic syndrome includes bleeding, hematomas, ecchymosis, petechiae. Hemarthrosis is often observed. A typical symptom is delayed bleeding after operations and manipulations. Menstruation is profuse and prolonged.

Diagnosis

The etiology of long periods is determined by a gynecologist. If blood diseases, somatic and endocrine pathology are suspected, the patients are referred for consultations to the relevant specialists. When collecting an anamnesis, they find out in detail how puberty went, when the cycle duration changed, how the symptom transformed over time. Fix other complaints. The following diagnostic procedures are prescribed:

• Gynecological examination. Bimanual examination of women with fibroids, fibroids, polyps, and adenomyosis reveals uterine enlargement, tuberosity, or a single nodule. Chronic inflammation is indicated by a high density of the uterus, pathological leucorrhoea. With hyperestrogenism, increased friability and juiciness of the mucous membranes attract attention.
• Ultrasonography. Allows you to clarify the nature, size and localization of space-occupying formations. With cystic adenomyosis, it occurs in different phases of the cycle, since formations appear only before menstruation. Detects an increase in the thickness of the endometrium, which indicates inflammatory processes or hyperplasia. To clarify the causes of hypoestrogenism and ovarian dysfunction, to assess the state of target organs, ultrasound hysterosalpingoscopy, ultrasound of the mammary glands, sonography of the thyroid gland may be required.
• Other instrumental methods. Hysteroscopy is informative for various volumetric formations. Sometimes probing of the uterine cavity is indicated. With adenomyosis, an MRI may be prescribed at the final stage. With hyperestrogenism, endometrial hyperplasia, an aspiration biopsy and diagnostic curettage are performed. In some cases, laparoscopy is required.
• Laboratory tests. To detect hyperplasia and other changes in the endometrium, to exclude malignant tumors, a histological or cytological examination of aspirates and biopsies is performed. In patients, the level of sex hormones is determined, and STIs are excluded. According to indications, thyroid and adrenal hormones are examined. If coagulation disorders are suspected, a UAC, a detailed coagulogram, and an analysis for vitamin K are prescribed.

Gynecological examination

Treatment

Conservative therapy

Treatment tactics are determined taking into account the cause of long periods:

• Fibroids, fibromas. For small solitary nodes, hormonal therapy is carried out using GnRH agonists, gestagens, antigonadotropic and estrogen-progestin drugs. Immunomodulators are used, hemostatic therapy is carried out.
• Adenomyosis. The treatment regimen includes anti-inflammatory and hormonal drugs, vitamin complexes, immunomodulators. Medical correction of anemia may be required. In the presence of neurotic symptoms, antidepressants and tranquilizers are recommended.
• Inflammatory processes. Women with chronic metritis, endometritis and metroendometritis are prescribed systemic antibiotics, antibacterial agents are injected into the uterine mucosa. Physiotherapy is actively used: mud therapy, paraffin therapy, laser therapy, UHF, therapeutic baths, electrophoresis.
• Endometrial hyperplasia. COCs, gestagens, Mirena intrauterine system are shown. In older patients, GnRH agonists are used. Non-drug treatment includes physiotherapy and acupuncture.

Women with hyperestrogenism and patients with ovarian dysfunction also receive hormonal therapy. If possible, the provoking factors are eliminated, the underlying disease is treated.

Surgical treatment

For patients with long periods, the following operations are performed:

• Massive formations: hysteroscopic or laparoscopic myomectomy, myometrectomy, in some cases – supravaginal amputation or hysterectomy, with malignant fibroids or ovarian neoplasms – panhysterectomy tomy.