Long periods are periods that last 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 do long periods occur?
Physiological causes
Episodic prolonged menstruation occurs 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.
Myomas
One of the most common pathological causes of the disorder 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 vary 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 variants of pathology. 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.
Fibroids and polyps
With fibroma, a clinical picture is observed, including metrorrhagia, menorrhagia, algomenorrhea, cramping or pulling pains in the abdomen. As with fibroids, manifestations vary depending on the location of the formation. 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 long periods, with polyps, acyclic bleeding, premenstrual sanious discharge, and the appearance of bloody discharge after sexual contact are noted. 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. The details vary according to the type of disease:
- Glandular hyperplasia. It can 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 is both scanty and plentiful, long. 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 are abnormalities in the 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 against 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 that 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 damage.
- Physical and mental overwork: prolonged stress, excessive physical exertion, constant lack of sleep, lack of rest, poor nutrition.
- Termination of pregnancy: miscarriages, mini-abortions, medical abortions.
- Other reasons: incorrect position of the intrauterine device, taking certain medications, radiation.
Clotting disorders
The symptom is accompanied by the following disorders of the blood coagulation system:
- thrombocytopenia. Initially, subcutaneous hemorrhages appear in patients, bruises are easily formed, 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 are formed on the skin and mucous membranes. Expressed 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.
Diagnostics
The etiology of long periods is established 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 duration of the cycle changed, how the symptom transformed over time. Fix other complaints. The following diagnostic procedures are prescribed:
- Gynecological examination. In the course of a bimanual study in women with myomas, fibromas, polyps and adenomyosis, an increase in the size of the uterus, tuberosity, or the presence of a single node is determined. 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 volumetric 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. With various volumetric formations, hysteroscopy is informative. 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:
- Myomas, fibromas. With small single 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 introduced into the uterine mucosa. Physiotherapy is actively used: mud therapy, paraffin therapy, laser therapy, UHF, therapeutic baths, electrophoresis.
- hyperplasia of the endometrium. COCs, gestagens, intrauterine system "Mirena" 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 undergo hormone therapy. If possible, provoking factors are eliminated, the underlying disease is treated.
Surgery
For patients with long periods, the following operations are performed:
- Volumetric formations: hysteroscopic or laparoscopic myomectomy, myometrectomy, in some cases - supravaginal amputation or hysterectomy, with malignant fibroids or ovarian neoplasms - panhysterectomy.
- Adenomyosis, endometrial hyperplasia: endocoagulation of endometriosis foci, resection or ablation of the endometrium, with progression at an older age, ineffectiveness of other methods of treatment - various options for removing the uterus.
- Hyperestrogenism: transnasal removal of a pituitary adenoma, radical surgical treatment of choriocarcinoma, ovarian resection, oophorectomy or adnexectomy for tumors of the corresponding localization, thyroid surgery.