Long periods – menstruation lasting more than 7 days. They are most often detected in diseases of the uterus, ovarian dysfunction and hyperestrogenism. In some women, puberty and preclimacteria are observed, sometimes they result from the use of certain contraceptives or pathologies accompanied by a violation of blood clotting. The cause of the symptom is determined according to the survey, gynecological examination, ultrasound, hysteroscopy, laboratory techniques. Treatment – hormone therapy, physiotherapy, surgical interventions.
Causes of long periods
Physiological causes
Episodic prolonged menstruation is noted during periods of hormonal adjustment – at puberty and on the eve of menopause. They are combined with fluctuations in the duration of the cycle, can alternate with short meager monthly periods. In the reproductive age, the cause sometimes becomes an intrauterine device.
A short-term increase in the duration of the cycle is possible when adapting to changed living conditions, for example, switching to a new job, moving to another climatic zone. More prolonged violations are noted with prolonged stress, improper nutrition, 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 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 education supplemented by periodic or permanent soreness in the lower abdomen. The features of the clinical picture differ somewhat depending on the type of fibroids:
- Submucous. The symptom is most pronounced in this variant of the disease. Constant blood loss eventually leads to anemia. In 20-50%, cramping menstrual pains occur. 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 caused by compression of the bladder are detected.
- Subserous. Long periods are possible, but less typical than with other variants of pathology. With the growth of the tumor, pain comes to the fore. Depending on the localization of fibroids, there are signs of compression of the bladder, rectum, less often – the main veins.
The symptoms of multiple fibroids are determined by their type. Manifestations are often more pronounced than with single nodes. There are severe pains, compression of nearby organs.
Fibroids and polyps
With fibroma, a clinical picture is observed, including metrorrhagia, menorrhagia, algomenorrhea, cramping or pulling abdominal pain. As in the case of fibroids, the 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 in interstitial tumors, are less pronounced or later appear in interstitial fibroma. Infertility is possible.
Along with long periods, with polyps, acyclic bleeding, premenstrual bleeding, the appearance of bloody discharge after sexual contacts are noted. With large polyps, the clinic is supplemented by cramping pains in the lower abdomen, unpleasant sensations during intercourse, mucous whites. Infertility often develops, pregnant women have a high risk of miscarriage.
Endometrial hyperplasia
Pathology is observed in two variants. It is often combined with inflammatory lesions of the internal genitals, mastopathy, adenomyosis, obesity. In both cases, long periods and metrorrhagia develop. Details vary depending on the type of disease:
- Glandular hyperplasia. It can occur in patients of any age, more often manifests in puberty and preclimacteria. Menorrhagia occurs after a short delay. In adolescents, profuse sudden bleeding with the release of clots is possible.
- Atypical hyperplasia. It is typical for patients aged 45-55 years. The delay before a long menstruation can be from 1 to 3 months, less often there are regular long periods. A third of women show signs of virilization, the frequency of manifestation increases significantly with obesity.
Other diseases of the uterus
Long, extremely abundant, sharply painful menstruation is the most characteristic symptom of adenomyosis (uterine endometriosis). There may be clots, the appearance of a smearing 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, and metrorrhagia are detected. Episodic pulling pains, non-abundant serous discharge are detected.
- Endometritis. As in the previous case, menstruation can be both scarce and abundant, prolonged. The discharge is bloody or serous-purulent. Pain in the lower abdomen of a nagging nature, soreness 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, nabotovian cysts, intrauterine synechiae, CPPS are often observed.
Another possible cause of long periods are anomalies in the position of the uterus. The symptom is most often found with retroflexia, may be accompanied by heaviness in the abdomen, pathological whites, dyspareunia, impaired bowel and bladder functions.
Hyperestrogenism
Menstruation is abundant, painful, can be both long and short. Pain syndrome is eliminated only for a short time by analgesics. The discharge is bright scarlet, with clots. A set of body weight with fat deposition is determined mainly in the hip area, premenstrual syndrome with a bright emotional component and the development of edema. The condition is observed in the following pathologies:
- Tumors. The level of estrogens 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 detected both with hypothyroidism and hyperthyroidism.
- Obesity. With a large amount of adipose tissue in the body, the level of androgens increases, which turn into estrogens.
- Liver diseases. When hepatocytes are destroyed against the background of cirrhosis or hepatitis, the splitting of hormones is not carried out in the required volume.
Ovarian dysfunction
Long, meager 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 fibromyoma, ovarian neoplasms, uterine cancer.
- Endocrine disorders: diabetes mellitus, obesity, hyper- or hypothyroidism, adrenal gland damage.
- Physical and mental fatigue: prolonged stress, excessive physical exertion, constant lack of sleep, lack of rest, irrational nutrition.
- Termination of pregnancy: miscarriages, mini-abortions, medical abortions.
- Other reasons: incorrect position of the intrauterine device, taking certain medications, radiation exposure.
Clotting disorders
The following disorders from the blood coagulation system are accompanied by the symptom:
- Thrombocytopenia. Initially, patients have subcutaneous hemorrhages, 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. Pronounced gingival and nasal bleeding, menorrhagia, bleeding into the abdominal cavity during ovulation are determined.
- Hypovitaminosis K. Hemorrhagic syndrome includes bleeding, hematomas, ecchymoses, petechiae. Hemarthrosis is often observed. A typical sign is delayed bleeding after operations and manipulations. Menstruation is abundant, prolonged.
Diagnostics
The etiology of long periods is established by a gynecologist. If blood diseases, somatic and endocrine pathology are suspected, patients are referred for consultations to appropriate specialists. When collecting anamnesis, they find out in detail how puberty took place, when the duration of the cycle changed, how the symptom transformed over time. Establish other complaints. The following diagnostic procedures are prescribed:
- Gynecological examination. In the course of a bimanual study in women with fibroids, fibroids, 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 white spots. With hyperestrogenism, the increased friability and juiciness of the mucous membranes attract attention.
- Ultrasonography. Allows you to specify the nature, size and localization of volumetric formations. With cystic adenomyosis, it is carried out in different phases of the cycle, since the formations appear only before menstruation. Detects an increase in the thickness of the endometrium, which indicates inflammatory processes or hyperplasia. Ultrasound hysterosalpingoscopy, breast ultrasound, thyroid sonography may be required to clarify the causes of hypoestrogenism and ovarian dysfunction, to assess the condition of target organs.
- 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, aspiration biopsy and diagnostic curettage are performed. In some cases, laparoscopy is required.
- Laboratory tests. To detect hyperplasia and other endometrial changes, to exclude malignant tumors, histological or cytological examination of aspirates and biopsies is performed. In patients, the level of sex hormones is determined, STIs are excluded. According to the indications, thyroid and adrenal hormones are examined. If there are suspicions of clotting disorders, BT is prescribed, a detailed coagulogram, an analysis for vitamin K.
Treatment
Conservative therapy
Therapeutic tactics are determined taking into account the cause of long periods:
- Fibroids, fibroids. With small single nodes, hormonal therapy is carried out using gonadoliberin agonists, progestogens, antigonadotropic and estrogen-progestogenic agents. 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. The COC, gestagens, and the Mirena intrauterine system are shown. GnRH agonists are used in older patients. Non-drug treatment includes physiotherapy and acupuncture.
Women with hyperestrogenism and patients with ovarian dysfunction are also given hormone therapy. If possible, the provoking factors are eliminated, the underlying disease is treated.
Surgical treatment
Patients with long periods undergo the following operations:
- Volumetric formations: hysteroscopic or laparoscopic myomectomy, myometroectomy, in some cases – supravaginal amputation or hysterectomy, with malignant fibroids or ovarian neoplasms – pangisterectomy.
- Adenomyosis, endometrial hyperplasia: endocoagulation of foci of endometriosis, resection or ablation of the endometrium, with progression in old age, ineffectiveness of other methods of treatment – various options for removal of the uterus.
- Hyperestrogenism: transnasal removal of pituitary adenoma, radical surgical treatment of chorioncarcinoma, ovarian resection, oophorectomy or adnexectomy for tumors of the appropriate localization, thyroid surgery.
