Heavy periods with clots

Sometimes in a woman's life there is a problem of heavy periods with clots, which does not allow her to lead a full life. What kind of disease it is and how to fight it, you can understand by considering the problem from all sides.

Significant blood loss during menstruation can be both a separate disease and a symptom of a disorder in women's health. Heavy periods with clots, or dysfunctional uterine bleeding, is a disease characterized by abnormal bleeding from the uterine cavity that is not caused by pathology of the pelvic organs, systemic diseases, or abnormal pregnancy.

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Epidemiology

Heavy periods with clots can occur at any time in a woman's life, regardless of her age, place of residence, and race. In hot weather, the risk of bleeding increases significantly due to increased stress on the cardiovascular system. There is also an effect of changes in atmospheric pressure on the development of menstrual cycle disorders.

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Causes heavy periods with clots

The etiological factors for the occurrence of heavy menstruation are:

• Stress, severe psycho-emotional shock;
• Eating disorders such as obesity, hypo- and avitaminosis, starvation;
• Chronic diseases of the liver, cardiovascular system, etc.;
• Hormonal imbalance;
• Previous gynecological surgeries;
• Infectious diseases of the pelvic organs;
• Radiation exposure;
• Congenital anomalies in the development of the genital organs.

Risk factors

Various unfavorable factors affect the female body at different periods of development, formation, establishment and decline of reproductive function. Most often during periods of greatest vulnerability - puberty and menopause. The main risk factors for the development of uterine bleeding are:

During puberty:

• Excessive physical activity;
• Malnutrition, hypovitaminosis;
• Mental stress and strain;
• Acute and chronic diseases of infectious origin.

In reproductive age:

• History of abortions;
• Complicated labor;
• Inflammatory diseases of the pelvic organs;
• Neuroendocrine diseases;
• Hormonal imbalance;
• Occupational hazards;
• Mental and emotional stress.

During the climacteric period:

• Acute and chronic infectious diseases;
• Pelvic organ formations;
• Stress;
• Presence of prolapse of the pelvic organs;
• Diseases of the cardiovascular system and endocrine glands.

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Pathogenesis

Normally, menstruation is a regular, cyclical, painless uterine bleeding that occurs when the functional layer of the endometrium is rejected due to a decrease in the level of progesterone and estrogens and does not exceed 80 ml of total blood loss during the period of menstruation.

The following concepts are used in medicine:

• Hyperpolymenorrhea is a menstrual dysfunction that manifests itself as regular heavy bleeding, exceeding the total blood loss of 80 ml during one menstruation.
• Acute menorrhagia is an unexpected heavy uterine bleeding that is not related to the cycle.
• Metrorrhagia is heavy, prolonged, irregular bleeding between periods.

Heavy menstruation may indicate such problems with women's health as: the presence of uterine fibroids, neoplasms of the cervix, pathological menopause, pregnancy complications, etc.

The main pathogenetic aspect of the development of uterine bleeding is the imbalance of essential hormones against the background of changes in the function of the most important links of the hypothalamic-pituitary and ovarian systems.

The female reproductive system is built on a hierarchical type, the main links of which are: the cerebral cortex, hypothalamus, pituitary gland, ovaries, uterus and other target organs (mammary glands, thyroid gland). So in the cerebral cortex the main regulators of the menstrual cycle are dopamine and norepinephrine, which control the hypothalamic gonadotropin-releasing hormone (GnRH), and serotonin, which controls the luteinizing hormone (LH). The hypothalamus is one of the main structural formations of the brain, which produces releasing hormones that release pituitary hormones, and statins that suppress their release. GnRH is the main hypothalamic hormone involved in the menstrual cycle. It is released into the bloodstream once every 60 minutes and the maximum frequency of its release is recorded in the preovulatory period, and the lowest - in the second phase of the cycle. Gonadotropins, pituitary hormones such as prolactin (PRL) - the lactation hormone, follitropin (FSH) - the growth hormone and maturation of follicles, and luteinizing hormone (LH) - the hormone of the corpus luteum, take direct part in the regulation of the menstrual cycle. The ovaries synthesize estrogens, gestagens and androgens - hormones that have a vegetative (development and activity of the genitals) and generative (hormonal background) effect on the female body. Thus, if at least one of the links - the regulators of the cycle - falls out or is disrupted, the hormonal background will fail and the proliferation of the uterine endometrium will change. Excessive stimulation of the uterus with estrogens will lead to an increase in the thickness and hypoxia of the endometrium, which, due to the increased contractility of the uterus, will be rejected continuously and non-simultaneously, one area after another, which in turn is accompanied by profuse uterine bleeding with clots of a prolonged nature.

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Symptoms heavy periods with clots

Depending on the cause of vaginal bleeding, a woman may be bothered by various symptoms, ranging from pain to dizziness and loss of consciousness. More details regarding the cause of occurrence, a detailed description of symptoms, first signs and complaints are presented below.

Heavy periods with clots after a delay

Sometimes after a delay in menstruation, a woman experiences heavy bleeding with clots from the genital tract, and there may be aching pain in the lower abdomen radiating to the anus. The cause of such a symptom complex may be a disrupted pregnancy, taking an oral contraceptive. Determining the level of chorionic gonadotropin in the blood will help determine the cause. Even with a complete spontaneous abortion, its numbers remain high for some time. This occurs due to the rejection of a non-viable embryo by the prepared endometrium and is accompanied by a large amount of blood loss. In this case, the woman experiences weakness, dizziness, nausea, and sometimes vomiting. If such symptoms are present, it is necessary to immediately call an ambulance for hospitalization in a specialized medical institution.

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Heavy periods with clots during pregnancy

The appearance of bleeding from the genital tract in a pregnant woman usually indicates a spontaneous abortion. The first symptom is a nagging pain in the lower abdomen, which radiates to the rectum; in the second half of pregnancy, the pain may be cramping. Bloody discharge, in this case, in significant quantities with clots of varying intensity. Depending on the gestational age, vacuum aspiration of the uterine contents is performed in the first trimester; after the sixteenth week of pregnancy, the evacuation of the fertilization product is performed under adequate anesthesia and hemodynamic control. In the absence of contraindications, it is permissible to prescribe uterotonics to accelerate the expulsion of the uterine contents.

In later stages of pregnancy, vaginal bleeding may indicate placenta previa. In this case, bleeding can be of varying intensity and is absolutely painless. If a woman experiences this condition after 20 weeks of pregnancy, it is necessary to immediately call an ambulance.

Heavy periods with clots after childbirth

Usually, immediately after childbirth, a woman experiences physiological bleeding - lochia. It can be of varying intensity and will continue until the postpartum uterus has completely contracted to normal size. After this, if the woman in labor is breastfeeding the newborn, she will not have menstruation. This phenomenon is called lactational amenorrhea and, as a rule, it continues until complementary foods are introduced into the infant's diet. And so, after 6-12 months, the woman's menstrual cycle is restored. Due to physiological changes that have occurred in the woman's body, such as shortening of the cervix, expansion of the cervical canal, an increase in the size of the uterus, an increase in the volume of the endometrium, menstrual flow becomes more intense and abundant.

Immediately 2-4 weeks after birth, there may be heavy bleeding with clots, caused by the presence of placental remnants in the uterine cavity. In this case, the bloody discharge is bright red with an unpleasant odor and is accompanied by pain in the lower abdomen radiating to the lower back. In this case, it is necessary to seek qualified medical help, since infection of the placental remnants and the development of endometritis - inflammation of the uterus - are possible.

Heavy periods with clots after cesarean section

Often, profuse bloody discharge with clots is observed after a cesarean section. This is due to the presence of a scar on the uterus, reduced contractility of the uterus and unchanged cervical canal and cervix, which is an obstacle to the free discharge of lochia, as after a normal birth. As a result, bleeding becomes longer with a large number of clots. Over time, the menstrual cycle will improve and the amount of menstrual blood released will become more normal.

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Heavy periods with clots after uterine curettage

Heavy periods with clots after curettage of the uterine cavity may be the result of an instrumental abortion. In this case, curettage of the uterine cavity is performed with a curette, removing the endometrium with the fertilized egg layer by layer. If the surgeon missed any part of the cavity during such a procedure, bleeding with scarlet clots may develop on the 2nd-4th day, accompanied by aching pain in the lower abdomen. In this case, you should contact the medical institution where the termination of pregnancy was performed.

If bleeding occurs 7-10 days after curettage of the uterus, it is also necessary to seek medical help, since this condition may be caused by the presence of a placental polyp, which occurs at the site of the remains of the fertilization product. In this case, a woman may have bloody discharge of varying intensity, pain in the lower abdomen, subfebrile body temperature and nausea. To eliminate this symptom complex, in the inpatient gynecological department, against the background of adequate antibiotic therapy, a repeated curettage of the uterine cavity is performed, with subsequent prescription of oral contraceptives.

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Heavy periods with clots after hysteroscopy

Hysteroscopy is a gynecological procedure using an optical device, with which the doctor can not only visualize the inside of the uterus, but also take material without traumatizing the entire uterine cavity, as with curettage. Hysteroscopy is performed both for diagnostic and therapeutic purposes. In this case, in the case of diagnostic hysteroscopy, there are no changes in the menstrual cycle. As for surgical hysteroscopy, here the cycle is lengthened, often the period becomes heavier than usual. But sometimes the bloody discharge changes its smell, clots appear in it and its color changes, which may indicate the addition of an infection. If profuse bloody discharge turns black against the background of severe pain, this may be a symptom of the disease - endometriosis. Endometriosis is a complex hormone-dependent disease in which the endometrial tissue is located not only in the uterine cavity, but also outside it. In this case, the woman is bothered by severe pain in the first days of menstruation. The doctor will make an accurate diagnosis after additional diagnostic examinations.

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Heavy periods with clots due to fibroids

Uterine myoma is a benign formation that consists of connective tissue or muscle elements. If muscle fibers predominate in the structure of the formation, we are talking about myoma, if connective tissue predominates, we are talking about fibromyoma. One of the first symptoms of uterine myoma is heavy menstruation. The nature of the discharge depends on the location of the myomatous node in the uterus. So, if it is located in the submucosal layer from the very beginning of its formation, the woman is bothered by heavy, prolonged menstruation with clots, which is also associated with a violation of the tone of the uterus.

Sometimes the growth of a submucous myomatous node in the uterine cavity is directed towards the cervical canal, which eventually leads to its exit from the uterine cavity. This process is accompanied by profuse uterine bleeding, cramping pain in the lower abdomen, general weakness, a drop in blood pressure and loss of consciousness. In this condition, assistance can only be provided in a medical facility. The main goal of treatment in this case is to stop uterine bleeding, provide pain relief and surgically remove the emerging myomatous node with subsequent curettage of the uterine cavity.

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Heavy periods with clots after 45-50 years

During the premenopause period, women often experience heavy uterine bleeding. This is due to the aging of the hypothalamus, in which the hormonal background is disturbed towards hyperestrogenism against the background of reduced progesterone levels, which leads to excessive growth of the endometrium and disruption of its transformation and is manifested by long, heavy periods with clots. In this case, the cyclicity is disrupted, and the time interval between periods is extended. Treatment of this category of patients is mainly surgical and is presented in the form of curettage of the uterine cavity and cervical canal. Subsequently, hormonal therapy is prescribed to suppress the menstrual function.

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Heavy periods with clots during menopause

The appearance of bleeding in postmenopause may be a symptom of a malignant tumor of the pelvic organs. Therefore, if such a symptom is present, it is necessary to immediately contact a gynecologist for the necessary examinations. Such bleeding occurs without a reason and can be of varying intensity and duration.

Another cause of bleeding during menopause may be senile colpitis, which occurs due to a decrease in the level of estrogens in the blood, which leads to thinning of the vaginal mucosa and its increased vulnerability. Such bleeding occurs after physical exertion, lifting weights or sexual intercourse. In any case, if bloody discharge from the genital tract appears, you must seek medical help from a gynecologist.

Heavy, prolonged periods with clots

Menorrhagia or prolonged heavy menstruation may occur in the presence of pathology of the uterus, endometriosis, endometrial hyperplasia, endocrine diseases and blood clotting disorders. Also, the cause of such a symptom may be an intrauterine contraceptive or an incorrectly selected oral contraceptive. The disease can occur at any age and not have a cyclical pattern. This condition is dangerous because against the background of prolonged heavy bleeding, as a rule, anemia develops, which is difficult to correct due to the presence of a genital cause of bleeding. If repeated episodes of prolonged menstruation occur, you must consult a gynecologist who will prescribe the necessary diagnostic procedures and treatment.

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Heavy, painful periods with clots

Algomenorrhea is a disease that affects a large number of women and manifests itself in painful, heavy cyclic menstruation. There are many causes of this disease. Painful periods can bother women with uterine fibroids, endometriosis, intrauterine contraceptives, abnormalities in the development of the genitals, as well as inflammatory diseases of the pelvic organs and diseases of the endocrine and nervous systems. Pain usually occurs a couple of years after the onset of menarche and begins on the first day of the menstrual cycle or a day before it. The pain is cramping, spastic in nature, radiating to the rectum, lower back, and ovarian area. Sometimes, with severe pain and bleeding, a woman experiences nausea, vomiting, and dizziness. Such a symptom complex leads to temporary disability and requires drug treatment.

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Complications and consequences

The main complication that occurs as a result of heavy periods with clots is anemia. Due to the significant volume of blood loss, the reserves of hematopoietic cells are depleted, erythropoiesis is disrupted, which leads to persistent anemia with all the resulting symptoms: weakness, dizziness, nausea, loss of appetite. In addition, this condition reduces the effectiveness of hemostatic therapy. With profuse bleeding, hemorrhagic shock often develops, which requires immediate administration of blood products.

In the absence of anti-relapse treatment, heavy periods with clots may recur, with the exception of conditions after hysterectomy.

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Diagnostics heavy periods with clots

Heavy periods with clots is a disease that requires immediate medical and sometimes surgical treatment. But in order to begin its treatment, it is necessary to conduct diagnostics and establish an accurate clinical diagnosis.

The diagnosis of this disease is made by an obstetrician-gynecologist, at the initial visit to him with complaints of heavy periods with clots. First of all, the doctor collects a detailed somatic anamnesis (history): the presence of liver diseases, cardiovascular and endocrine systems, injuries and operations on female genital organs. Then the menstrual and gynecological anamnesis: the age at which menarche began, the quality of the cycle, the beginning of sexual life, sexual activity, gynecological diseases and methods of contraception. Of no small importance is the intake of medications such as estrogens, antidepressants, anticoagulants, corticosteroids, digoxin and propranolol, which could cause heavy bleeding from the genital tract.

After a detailed survey, the doctor conducts functional diagnostic tests, such as: basal temperature monitoring, hormonal colpocytology, estrogen saturation tests, which make it possible to determine the hormonal background.

Laboratory examination

A pregnancy test or determination of human chorionic gonadotropin is performed to rule out pregnancy pathology, or trophoblastic disease, or ectopic pregnancy.

A complete blood count, biochemical blood test, and coagulogram are performed to determine the degree of anemia in the body for further correction of anemia.

Hormonal examination in dynamics is recommended for all women suffering from heavy periods to determine the hormonal status. For this purpose, the level of FSH, prolactin, LH, testosterone, progesterone and estradiol in the blood serum is determined in dynamics. Examination of thyroid and adrenal hormones is also important.

It is recommended to determine the tumor markers CA 19-9, CA 125.

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Instrumental diagnostics

Ultrasound examination of the pelvic organs and hysteroscopy are reliable and accessible methods for diagnosing pathologies of the female reproductive organs. Sometimes hysterosonography is performed (filling the uterine cavity with a saline solution under the control of an ultrasound machine), which allows identifying submucous myomatous nodes of the uterus, endometrial polyps, etc.

Diagnostic curettage of the cervical canal and uterine cavity is performed on all women in menopause if there are complaints of bleeding from the genital tract. In other cases, it is performed if there are ultrasound signs of endometrial pathology.

It is also possible to perform MRI, computed tomography, laparoscopy, hysterosalpingography and other diagnostic methods if there are indications for them.

Differential diagnosis

Differential diagnostics of heavy periods with clots is carried out in accordance with the age indicators of the woman, since each period of a woman’s life is characterized by the occurrence of certain diseases.

Thus, in the pubertal period, differential diagnosis is carried out with diseases of the hematopoietic system, accompanied by blood clotting disorders and bleeding; liver and gastrointestinal tract dysfunction, developmental abnormalities of the genitals, diseases of the endocrine system (adrenal glands, thyroid gland), foreign bodies of the genital tract and vaginal neoplasms.

Differential diagnostics in reproductive age are carried out with ectopic pregnancy, uterine myoma, adenocarcinoma, endometrial hyperplasia, and endometrial trauma from an intrauterine contraceptive.

In the menopausal period, differential diagnosis is carried out with endometrial adenocarcinoma, adenomyosis and hormone-producing ovarian tumors.

Treatment heavy periods with clots

The method of treating heavy periods with clots is prescribed by the doctor in accordance with the patient's age, the cause of occurrence, the amount of blood lost and the duration of bleeding. But, in any case, the first stage is hemostasis - stopping the bleeding, which can be done surgically or with medication.

How to stop heavy periods?

The first thing you should do is calm down, because when you are worried, the blood vessels expand and the bleeding may increase. If bleeding occurs in a pregnant woman, you need to take a horizontal position with the foot end of the bed raised, relax, call an ambulance. It is allowed to take the tablet form of etamzilat "Dicynone" 1-2 tablets with water.

For other reasons of heavy periods with clots, pre-medical measures should be as follows:

• Call an ambulance.
• Take a horizontal position with the foot end of the bed raised.
• Place a heating pad, bottle or any other container with cold water on the lower abdomen, which will help constrict blood vessels and reduce bleeding.
• Drink plenty of fluids to replace the amount of blood lost.
• Taking medications that stop bleeding, such as: Dicynone 1-2 tablets, maximum 4 tablets per day at 0.25 mg, Water pepper tincture 25 drops 3 times a day, Shepherd's purse extract 25 drops 3 times a day, Calcium gluconate 1-2 tablets 3 times a day.

Further treatment will be prescribed by a gynecologist according to the indications.

1. Hemostatic therapy is aimed at stopping bleeding, for which fibrinolysis inhibitors are used - Aminocaproic acid and Tranexam.

Aminocaproic acid is an effective antihemorrhagic agent, the action of which is aimed at inhibiting fibrinolysis, which provides a hemostatic effect. The effect of the drug occurs 15 minutes after intravenous administration. The drug is prescribed intravenously by drip 100 ml of a 5% solution no more than 8 g per day or orally 30 ml 4 times a day. Contraindications for use are coagulopathy, a tendency to thrombus formation, cerebrovascular accidents in the anamnesis, ischemic heart disease. The drug is prescribed with caution with estrogen-containing contraceptives, which increases the risk of thromboembolism.

Tranexam is an antifibrinolytic drug with local and systemic hemostatic action. The effect of the drug occurs 3 hours after oral administration and lasts up to 17 hours. Take 1 tablet 4 times a day for 4 days. Tranexam is administered intravenously by drip at 15 mg / kg every 6 hours not faster than 1 ml / min. Contraindications for use are subarachnoid hemorrhage, renal failure. It is prescribed with caution in case of deep vein thrombophlebitis, thromboembolic syndrome. Side effects occur with an increase in recommended doses or with individual hypersensitivity to the active substance of the drug, and may manifest as nausea, vomiting, dizziness, development of thrombosis, tachycardia, skin rash, itching, urticaria.

2. Hormonal therapy is indicated based on age and examination results.

During puberty, hormones are prescribed if there is no effect from the hemostatic therapy. Preference is given to combined oral contraceptives: Microgynon, Lindinet 20, Yarina 2-3 tablets per day with a gradual reduction in the dose to 1 tablet over 21 days.

It is possible to prescribe gestagens: Duphaston, Norcolut, Utrozhestan, 2 tablets per day with subsequent reduction of the dose.

In reproductive age, it is performed only on women who have not given birth if the ultrasound M-echo of the endometrium does not exceed 8 mm. The drugs of choice are: 17OPK 12.5% 2 ml intramuscularly once a day for 7 days, Duphaston 1 tablet 3-5 times a day, Norcolut 1 tablet 3-5 times a day with subsequent gradual reduction to 1 tablet per day.

17 OPC (oxyprogesterone capronate) is a synthetic progesterone of gestagenic origin that in high doses inhibits the secretion of gonadotropins, which helps reduce bleeding and has a prolonged gestagenic effect. The drug is administered intramuscularly 2.0 ml of a 12.5% solution every day until bleeding stops and 0.5-1.0 ml on the 21st day to prevent rebleeding. After intramuscular administration, the effect of the drug begins after 5 hours and lasts up to 14 days. Contraindications to the administration of 17OPC are liver dysfunction, a tendency to thrombosis, malignant tumors of the pelvic organs and mammary glands.

In the climacteric period, women over 45 years of age are not recommended to undergo hormonal hemostasis. It is permissible to prescribe gestagens, such as: 17OPK 250 mg on days 14 and 21 of the menstrual cycle, Depo-Provera 200 mg on days 14 and 21.

In case of bleeding associated with ovarian dysfunction, intramuscular administration of progesterone is prescribed at 5-15 mg/day for 7 days, followed by a reduction in the dose if there is positive dynamics.

Gonadotropin-releasing hormone agonists, such as Goserelin and Diphereline, are not used so often to stop heavy periods with clots, but have proven themselves well in further treatment regimens for uterine bleeding. The fact is that with constant administration of drugs, the synthesis of LH decreases and the concentration of estradiol in the blood decreases. This helps to reduce the growth and proliferation of the endometrium, which leads to minimizing the risk of bleeding until the development of menopause. Goserelin is administered subcutaneously in the anterior abdominal wall once every 28 days, which ensures the maintenance of an effective concentration of the drug in the body. The drug is contraindicated in pregnant women, lactating women and children. The drug is well tolerated. In rare cases, headaches, mood swings, dryness of the vaginal mucosa, cessation of menstruation, demineralization of bone tissue may occur.

3. Vitamin therapy. Prolonged, heavy uterine bleeding, as a rule, leads to depletion of vitamins and microelements in the body. First of all, iron deficiency occurs and, as a result, iron deficiency anemia develops. To eliminate it and replenish iron, the following is prescribed:

• Vitamin B12 200 mcg/day.
• Folic acid 0.001 g 2-3 times a day.
• Totema 1-5 ampoules per day orally.
• Globiron 1 tablet 1 time per day.
• Sorbifer Durules 1 tablet 1 time per day.
• Maltofer 1 tablet 1 time per day.
• Venofer intravenously by drip.

The duration of taking iron preparations depends on the degree of anemia and is carried out under the control of blood counts.

Of the vitamin preparations, it is justified to prescribe vitamin B6 and B1 with alternation for intramuscular administration. It is also recommended to prescribe vitamin E at 200 mg per day and rutin at 200 mg 3 times a day.

4. Medicinal herbs and traditional medicine have found wide application in the treatment of heavy periods with clots.

• Pour half a liter of water over dry nettle leaves and boil for 10 minutes, leave for 30 minutes. Take 1 tablespoon 5 times a day.
• Shepherd's purse herb 50g, knotweed herb 50g, mistletoe herb 50g. Pour 200 ml of water over the herbal mixture, boil for 5 minutes, cool. Drink 1 glass 2 times a day from the 3rd day of menstruation.
• Oak bark 30g, wild strawberry leaves 20g, raspberry leaves 20g, yarrow herb 30g. Brew in 200 ml of water and drink 200 ml in the morning and evening from the 1st day of menstruation.
• Buckthorn bark 30g and raspberry bark 30g. Pour boiling water over the mixture, let it brew and drink 1 glass in the morning and evening.

In folk medicine, to treat heavy periods with clots, not only herbal mixtures are used, but also other components for preparing medicinal potions.

• A decoction of orange peels has a good hemostatic property. Boil the peel of 5 oranges in 1 liter of water for 1 hour on low heat. Add a little sugar and drink 1 tablespoon three times a day.
• Mix fresh rowan berries and mint leaves 1:1 and brew as tea. Drink this tea 3 times a day until the end of your period.
• Brew 30g of dried and finely chopped parsley herbs and roots with boiling water in 400 ml of water and boil for 15 minutes, then strain. Take half a glass three times a day 15 minutes before meals.

5. Physiotherapy.

The following types of physiotherapy treatment are widely used in treatment regimens for heavy uterine bleeding with clots:

• Electrophoresis with copper sulfate provides a vasoconstrictive effect
• Cervicofacial galvanization increases the contractile function of the uterine myometrium
• Endonasal electrophoresis with vitamin B1 increases the tone of the uterine muscles
• Vibration massage of the paravertebral zones has a complex effect on the uterine vessels and muscle tone, which helps reduce blood loss.

6. Homeopathy.

If the cause of heavy periods with clots is functional disorders, the following medications are used for treatment:

• Ovarium compositum. It is a complex homeopathic remedy, regulates hormonal levels. It has metabolic, sedative and anti-inflammatory functions. It is prescribed 2.2 ml intramuscularly 2 times a week, from the third week 1 time in 5 days. The course of treatment is 10 injections. Contraindications - hypersensitivity to the components of the drug, children under 12 years of age. It is prescribed with caution to pregnant and lactating women. Among the side effects, increased salivation was noted, in which case it is recommended to reduce the dose of the drug or cancel it.
• Mulimen is a complex homeopathic preparation, the action of which is aimed at regulating the balance of gonadotropic and steroid hormones, normalizing the autonomic nervous system and stabilizing the mental state of a woman. It has hormone-regulating, antispasmodic, sedative and draining pharmacological properties. It is indicated for use in menstrual cycle disorders, mastopathy, treatment of side effects of hormonal contraception, premenstrual and climacteric syndrome. Prescribed 10-12 drops 2 times a day in the intermenstrual period and during menstruation 10-15 drops 3-5 times a day depending on the degree of bleeding. Take 15-20 minutes before meals, holding it in the mouth for a short time. Contraindicated in children under 12 years of age and in case of hypersensitivity to the components of the drug. Prescribed with caution to pregnant and lactating women. The drug is usually well tolerated, although allergic reactions may occasionally occur.

In the case of heavy periods with clots against the background of an inflammatory process in the pelvic organs, the following are additionally prescribed:

• Ginekoheel is a basic anti-inflammatory agent with vasotonic, anti-edematous and analgesic pharmacological properties. It helps to end the inflammatory process, restore microcirculation and form new tissue in the inflammation site. Reduces the risk of complications. It has a regulating effect on the menstrual cycle. Prescribed 10 drops 3 times a day, every day, except for menstrual days. The course of treatment is 3 cycles. The drug is contraindicated for people with allergies to bee, wasp and bumblebee venom. No side effects have been identified.
• Traumeel S is the drug of first choice for any damage to body tissues. It has anti-inflammatory, antiexudative, regenerating and analgesic pharmacological properties. The drug is contraindicated for use in people with hypersensitivity to the components of the drug, suffering from tuberculosis, leukemia, AIDS. Prescribed 1 tablet 3 times a day. Side effects in the form of redness and rash on the skin are possible.

7. Surgical treatment.

Surgical intervention for heavy periods with clots, regardless of the cause, is performed for hemostatic purposes to stop bleeding.

Therapeutic and diagnostic curettage of the uterine cavity walls is performed under general anesthesia with subsequent sending of the obtained scraping for pathohistological examination, which allows in 80% of cases to establish the cause of bleeding. After the operation, the patient is prescribed hemostatic and antibacterial therapy.

Endometrial ablation is a surgical method of treating uterine bleeding, which is performed using a laser or electrode under the control of a hysteroscope and involves removing the entire layer of the endometrium.

Hysterectomy is a radical surgical intervention and involves the removal of the uterus. It is the final stage of treatment for uterine bleeding when the condition cannot be treated by other methods.

Prevention

Prevention of recurrence of heavy periods with clots usually lasts for 3-6 cycles. For this purpose, a work and rest regime is organized, nutrition is balanced, and sedatives, vitamins, and hormonal drugs are prescribed.

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Forecast

With timely treatment, the prognosis is usually favorable. Hormonal therapy helps to normalize hormonal levels and stabilize the woman's overall health.