The causes of heavy periods in girls, women,premenopause period

Update: October 2018

According to statistics, heavy menstruation is diagnosed in a third
representatives of the weaker sex. As a rule, it is observed
copious periods with clots, i.e. excess menstrual flow
blood, not having time to leave the uterus, begins to collapse, in
as a result, clots are formed. Anyway необходимо
determine why your periods have become very abundant and hold
appropriate treatment.

Abundant menstruation: how to determine?

Menstruation is assessed according to the following criteria:

  • duration (not longer than 7 days);
  • the abundance of secretions (in normal menstruation differ by abundance
    only the first 2 – 3 days);
  • the amount of blood loss (the total amount per day does not exceed 120,
    maximum 150 ml);
  • intervals between periods (not less than 21 days);
  • menstruation soreness (normal mild discomfort is normal or
    moderate pain);
  • intermenstrual bleeding (in normal
    menstrual cycle, they are absent).

Based on the listed symptoms, you can independently
determine if there is heavy menstruation. Abundant
menstruation is a syndrome that can occur with many
gynecological and not only diseases. Therefore, this state
does not apply to diseases, but requires identifying the causes of abundant
monthly Abundant periods are characterized (they are also called
menorrhagia or hyperpolymenorrhea) with the following symptoms:

  • menstruation lasts a week and longer;
  • spotting significant, with large clots;
  • the volume of blood lost is large, 150 ml and more, requires replacement
    pads or tampons every hour, including
    at night;
  • shortening of the menstrual cycle (less than 3 weeks);
  • the appearance of bleeding not only on menstruation days;
  • the occurrence of significant pain in menstrual days;
  • the entire period of bleeding is characterized
    profusion;
  • the occurrence of menstruation or other bleeding
    a year later and after menopause.

Causes of heavy periods

Why do abundant periods arise? There are many
factors that are “guilty” in the occurrence of hyperpolymenorrhea. it
there may be problems associated with either the reproductive state
systems, either with general health, as well as with
heredity and psycho-emotional overload:

  • violation of uterine contractile activity (myoma, cancer,
    polyp / polyps, adenomyosis) and endometrial hyperplastic processes
    (polyps, hyperplasia);
  • fluctuations (jumps) in the hormonal state (pubertal
    age, menopause);
  • wearing intrauterine device;
  • inflammation of the uterus and / or appendages;
  • blood diseases (coagulopathies);
  • taking anticoagulants and antiplatelet agents;
  • lack of vitamins and minerals involved in the regulation
    blood coagulation system (C, K, P, calcium and others);
  • genetic predisposition;
  • after childbirth (especially complicated);
  • after termination of pregnancy, including ectopic;
  • stress, overwork, climatic conditions;
  • pathology of the liver, cardiovascular system, thyroid
    gland, urinary system);
  • fermented milk diet (under the action of fermented milk products
    the liver begins to synthesize enzymes that inhibit
    blood coagulation);
  • excessive exercise;
  • misuse of hormonal drugs, abuse
    emergency hormonal contraception (postinor and others).

Abundant менструации в подростковом возрасте

Menorrhagia in adolescents is quite common and reaches
37%. As a rule, heavy menstruation occurs in the first 3 years.
after menarche, but another situation is possible when the first periods
abundant.

Major role in the occurrence of menorrhagia in adolescent girls
play:

  • chronic and acute infectious diseases
  • poor diet leading to development
    hypovitaminosis
  • mental injury
  • intellectual overload.

Infectious diseases (sore throat, flu, rheumatism and others),
stresses and other factors disrupt the work of the hypothalamic-pituitary
system, which in turn affects folliculogenesis and
synthesis of hormones in the ovaries. Due to the above estrogen
are produced monotonously, keeping the same level and
for a long time. Progesterone is produced in insufficient quantities
there is a shortage of it, as a result of which the lining of the uterus is not
passes the stage of secretory transformation (second phase of the cycle), and
hyperplassed.

Abundant menstruation occurs due to blood stagnation and plethora,
dilation of capillaries, necrotization of individual sections of the endometrium and
its uneven rejection. In addition, prolonged menstruation
also contributes to the reduction of uterine contractility in
case of its underdevelopment (hypoplasia). Abundant месячные в
puberty may vary in intensity and
duration, and the clinical picture depends on the degree
blood loss.

Menorrhagia in adolescents quickly leads to:

  • anemisation – weakness, fatigue, decreased appetite,
    pallor of skin and mucous membranes, increased heart rate
  • blood coagulation disorder – decreased platelet count and
    prothrombin index.

Abundant менструации в пременопаузальном возрасте

Pre-menopausal age is the period lasting from 45 to
55 years old when the female body loses the ability to conceive and
smoothly into the end of menstruation.

If 12 months have passed since the last menstrual period, which
characterized by the absence of bleeding, this
Time lapse is called menopause.

The next step will be postmenopause, when the development of genital
hormones are dramatically reduced and any bleeding from the genital
pathways are treated as pathology.

What happens with menstruation during premenopause?
The hypothalamic-pituitary-ovarian system undergoes processes
involution, or, roughly speaking, aging, which leads to its failure
functioning. Cyclic release of gonadotropins, maturation
follicles and the production of sex hormones in the ovaries is disturbed.

As a result, relative hypeestrogenism develops.
(estrogens are known to be produced in the first phase of the cycle) on
background of absolute hyperprogesteronemia (due to the arising luteal
insufficiency with inferiority of the corpus luteum). All this leads to
disruption of proliferation processes (phase 1) and secretory
transformations (phase 2 of the cycle) of the endometrium and the occurrence of hyperplasia
mucous uterus.

  • Premenopausal women notice that menstruation has become more abundant and
    longer.
  • In addition, in premenopause, in addition to menorrhagia (cyclic
    bleeding) there may be acyclic bleeding or
    metrorrhagia that are associated with contractile contraction
    ability of the uterus.
  • Various tumors and tumor-like formations (fibroids, polyps,
    endometrial foci) alter the structure of the uterine wall, replacing
    the area of ​​the muscle layer of connective tissue or endometrioid.
    As a result, the uterus, both during menstruation and outside, does not
    able to adequately reduce, which causes heavy bleeding
    during menstruation or after the action of various factors (coitus,
    physical stress, stress).

Пример из практики: У меня наблюдалась
a 48-year-old patient who suffered for several years
copious periods, which of course led to the development of anemia.
After an ultrasound of the pelvic organs was diagnosed:
�“Glandular hyperplasia of the endometrium. Suspected polyp
endometrium. The patient was recommended consultation in the regional
the hospital where she was appointed and treated
hysteroscopy followed by curettage of the uterus. But also
after surgical treatment, the situation has not changed.
Hemoglobin remained within 90 – 100 g / l, despite taking
iron-containing drugs, and the monthly differed abundance
secretions. Six months after the second consultation with the regional
gynecologists woman suggested to remove the uterus. After uterine amputation
a histological study of the drug was carried out and rendered
Conclusion: Multiple myomatous nodes of small size (0.5
– 1 cm) against the background of common adenomyosis. Adenomatous polyp
(5 cm) of the uterus. Within 6 months after surgery, hemoglobin reached
normal performance, and menstruation stopped immediately after
removal of the uterus. It becomes clear that the endometrial polyp of such
dimensions could not be removed by hysteroscopy, and even
in case of excision, concomitant endometriosis of the uterus and
myoma nodes would serve as a supporting factor for menorrhagia.

Menorrhagia after childbirth and cesarean section

Physiological causes

After childbirth, the nature of menstruation changes; they become
somewhat more intense and longer. it связано с
anatomical transformations of both the uterus itself and its cervix.
After giving birth, the cervical canal shortens and becomes
шире, что объясняет увеличение менструальных secretions. Besides,
the uterus itself, and therefore its cavity become large
size, rather than before pregnancy, increases the area of ​​the mucous
uterus that automatically leads to an increase in bleeding
during menstruation.

Pathological causes

But in some cases, menstruation after childbirth becomes
too abundant and long. it связано с возникновением
complications during childbirth, resulting in disturbed
contractile activity of the uterus due to its overstretching (large
fetus, polyhydramnios, or multiple pregnancy — twin pregnancy) or abnormality
generic forces (discoordination, weakness of contractions, clinically narrow
pelvis).

These factors affect the uterine involution in the postpartum
period and provoke abundant menstruation. Also on the occurrence
menorrhagia after childbirth affects how pregnancy proceeds.

  • Malnutrition, low hemoglobin, stress and various
    complications of pregnancy can not affect how to become
    менструального цикла, так и на характере monthly
  • After cesarean section, a suture remains on the uterus, which also
    plays a role in its contractile ability. Therefore, monthly after
    abdominal delivery become abundant since the scar
    on the uterus is mostly represented connective tissue not
    able to shrink.

Menorrhagia after abortion and intrauterine
interventions

As you know, pregnancy causes the strongest hormonal
restructuring, and its interruption, as in the form of medical abortion
(consequences) and miscarriage is a stress for
body that can not affect the hormonal balance.

It should immediately make a reservation that any intrauterine device
interventionsо (гистероскопия или выскабливание с целью диагностики
either removal of the ovum / residue) is accompanied by the appearance
bleeding in the postoperative period, which women
often taken for periods.

  • Norm – menstruation is normal after intrauterine manipulation
    begins on average a month later, and bleeding after
    curettage of the uterus lasts 3 to 7 days, maximum 10. Discharges such as
    usually moderate and even scanty, painless or deliver
    slight discomfort.
  • Abundant monthly – in case of abundant monthly
    immediately after abortion / curettage or hysteroscopy
    consult a doctor. Most likely the cause of the development of menorrhagia
    is inflammation of the uterus.

In this case, the monthly will be:

  • abundant, dark red or “dirty”, like meat slop
    and accompanied by an unpleasant smell.
  • a woman will be bothered by pain in the lower abdomen cramping
    of character
  • fever and symptoms of intoxication (weakness,
    lack of appetite, dyspeptic symptoms).

If the diagnosis of endometritis is not confirmed, it indicates
disruptions in the hypothalamic-pituitary-ovarian system that disappear
after the appointment of oral combination contraceptives for a period of
3, maximum 6 months.

Abundant menstruation with medication

A common cause of heavy periods is to take some
drugs, which are forgotten or even unaware of most women.

Anticoagulants and antiplatelet agents

First of all, such drugs include
blood thinners – anticoagulants and antiplatelet agents.

  • Anticoagulants (heparin, fenilin, syncumar) or prevent
    thrombosis (direct acting anticoagulants) or suppress
    coagulation factor secretion (indirect action).
  • Antiplatelet agents (aspirin, trental, chimes) inhibit aggregation and
    adhesion (sticking) of platelets, making the blood more fluid.
    It is enough to cancel or at least reduce the dosage listed
    medications like menstruation become moderate and
    short.

Hormonal drugs

  • Combined oral contraceptives

Secondarily, the occurrence of menorrhagia causes
hormonal drugs. Often, copious menstruation occurs on
background use of combined oral contraceptives that
associated with either an incorrectly chosen drug (more often it is
high-dosage COC: rigevidon, regulon), or in violation of
regimens (delayed menstruation or not accepted in time
tablet).

  • Hormonal drugs после полового акта

Very often the cause of menorrhagia is abuse
means of fire contraception (postinor, escagel). Since in
such hormone pills contain huge doses of progestogen
– levonorgestrel, taking them causes menstrual disorders
cycle that leads not only to the emergence of massive menstrual
bleeding, but often requires a long treatment for
cycle recovery and ovulation.

  • Duphaston

In some cases, women note that menstruation has become
more abundant and longer amid the reception of duphaston, and also appeared
postmenstrual daub. A similar effect from taking duphaston
possible due to the re-installation of hormonal and
�“Addiction” of the body to the entry of progestogen from the outside. Not worth it
frightened, after 2, maximum 3 months monthly return to
source parameters.

Treatment

If the monthly very abundant – what to do? Anyway
should consult a gynecologist. Only a doctor after careful
collection of anamnesis, clarification of complaints, gynecological examination and
conducting additional survey methods can figure out
cause of menorrhagia, pick up adequate treatment and
monitor its effectiveness.

Therapy for heavy menstruation depends on factors that
led to the development of menorrhagia, concomitant diseases, admission
certain drugs using contraceptive methods as well
on the severity of clinical signs and patient age.

  • In the event of a pathology of blood, liver or thyroid
    the gland is prescribed a corrective therapy of the main
    diseases.
  • If the cause of hypermenorrhea is the intrauterine device, its
    remove.
  • When taking certain drugs, a different one is selected.
    treatment regimen with these drugs or canceled treatment by them.

There are 2 directions in the treatment of heavy menstruation:
conservative and surgical.

Conservative treatment

It is held for girls and young women who have not given birth, and
provides for the symptomatic and hormonal
hemostasis.

As symptomatic hemostasis is used when
Abundant monthly hemostatic medication.

  • Dicine is may be dicynone injections and tablets,
    tranexamic and aminocaproic acids.
  • Vitamins – Vicasol (vitamin K, which promotes the formation of
    prothrombin liver), vitamins that reduce insight
    vascular wall (C and P or a complex preparation –
    askorutin).
  • Infusions of medicinal herbs, reducing menstrual flow
    (nettle, corn silk, yarrow, shepherd’s bag, geranium
    meadow and others). Infusions should be taken on ½ – 1 cup three times.
    a day for 2 – 3 before the onset of menstruation and the entire period of discharge.
  • НПВС  -хорошо зарекомендовали себя в лечении обильных
    menstruation nonsteroidal anti-inflammatory drugs (ibuprofen,
    indomethacin, naproxen). Taking these drugs reduces
    blood loss of up to 40% and reduces the duration of menstruation.
  • Treatment анемии – параллельно проводится антианемическая
    therapy, iron preparations are prescribed for this purpose (see
    iron preparations for anemia).

Hormonal drugs

Hormonal drugs при обильной менструации назначаются
after the end of the discharge for a period of 3 – 6 months. Are selected
combined oral contraceptives with low doses of hormones
(marvelon, mercilon or logest), which are accepted by
contraceptive scheme. Also women of reproductive age and
girls are given vitamin therapy in the phases of the menstrual cycle.
In the first phase, vitamins of group B are taken, in the second, vitamins A,
E, C.

Intrauterine device

Intrauterine devices have a good effect in the treatment of menorrhagia.
levonorgestrel helix (Mirena). Progestin released from
Navy inhibits the proliferation of the endometrium, reduces its blood supply
and thickness. However, this method is not suitable for patients, menorrhagia
which arose on the background of wearing intrauterine
contraceptive.

Surgery

In case of significant bleeding, there is no effect from
therapeutic measures, severe anemia or physiological
disorders of the genital organs are surgical treatment.
Hysteroscopy and curettage of the uterus is performed to patients
with:

  • endometrial hyperplastic processes
  • adenomyosis and polyps of the uterine lining
  • women with recurrent menorrhagia.

As a result, these gynecological procedures are removed.
pathological endometrium and tumor formation, and the resulting
the material is sent for histological examination. Then in
Depending on the results of histology, hormone replacement is prescribed.
therapy.

Hysterectomy (removal of the uterus) is resorted to only in extremely
neglected cases of menorrhagia in young women or in heavy
menstruation and associated tumor formations of the uterus in
premenopausal women.

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