Abundant menstruation with clots

Sometimes in a woman's life there is a problem of copious periods with clots, which does not allow for a full-fledged lifestyle. What kind of illness is it and how to fight it, you can understand by looking at the problem from all sides.

Significant blood loss during menstruation can be both a separate disease and a symptom of a violation of the state of female health. Abundant menstruation with clots, or dysfunctional uterine bleeding is a disease that is characterized by the presence of abnormal bleeding from the uterine cavity, which is not due to the presence of pelvic pathology, systemic diseases or the violation of pregnancy.

[1], [2], [3]

Epidemiology

Abundant menstruation with clots can occur in any period of a woman's life, regardless of her age, place of residence and race. In the hot season, the risk of bleeding increases significantly, due to increased stress on the cardiovascular system. Influence of atmospheric pressure changes on the development of menstrual cycle disorders also takes place.

[4]

Causes of the abundant period with clots

The etiological factors of the occurrence of profuse menstruation are:

• Stress, a strong psychoemotional shock;
• Dysfunctions such as obesity, hypo- and beriberi, starvation;
• Chronic diseases of the liver, cardiovascular system, etc .;
• Violation of the hormonal background;
• Postponed gynecological operations;
• Infectious diseases of the pelvic organs;
• Radiation irradiation;
• Congenital malformations of genital organs.

Risk factors

A variety of unfavorable factors affect the female body at different periods of development, formation, formation and decline of the reproductive function. Most often in periods of greatest vulnerability - pubertal period and menopause. The main risk factors for uterine bleeding are:

During puberty:

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

In the reproductive age:

• Presence of abortions in the anamnesis;
• Complicated delivery;
• Inflammatory diseases of the pelvic organs;
• Neuroendocrine diseases;
• Violation of the hormonal background;
• Occupational hazards;
• Mental and emotional stress.

In the climacteric period:

• Acute and chronic infectious diseases;
• Formation of the pelvic organs;
• Stress;
• Presence of pelvic lowering;
• Diseases of the cardiovascular system and endocrine glands.

[5], [6], [7]

Pathogenesis

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

In medicine, the following concepts are used:

• Hyperpolymenorrhea is a violation of menstrual function, which manifests itself in regular, abundant bleeding, exceeding the total blood loss of 80 ml per menstrual period.
• Acute menorrhagia is an unforeseen abundant uterine bleeding that is not associated with a cycle.
• Metrorrhagia is an abundant, prolonged, irregular bleeding between menstruation.

Abundant menstruation may indicate such violations of women's health as: the presence of uterine myoma, neoplasms of the cervix, pathological menopause, complications of pregnancy, etc.

The main pathogenetic aspect of the development of uterine bleeding is a violation of the balance of the main hormones against the background of changes in the function of the major links of the hypothalamic-pituitary and ovarian systems.

The woman's reproductive system is built on a hierarchical type, the main links in which are: the cerebral cortex, the 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 luteinizing hormone (LH). Hypothalamus is one of the main structural formations of the brain that produces releasing hormones releasing hormones of the pituitary gland and statins that suppress their secretion. 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 preovulant period, and the lowest frequency in the second phase of the cycle. Direct participation in the regulation of the menstrual cycle is taken by gonadotropins - pituitary hormones such as: prolactin (PRL) - lactation hormone, follitropin (FSH) - growth hormone and follicle maturation, and lutropin (LH) - a yellow body hormone. Ovaries synthesize estrogens, gestagens and androgens - hormones that have vegetative (development and vital functions of the genital organs) and generative (hormonal background) effect on the female body. Thus, with the loss or breakdown of at least one of the links - the regulators of the cycle, there will be a failure of the hormonal background and a change in the proliferation of the endometrium of the uterus. Excessive stimulation of the uterus by estrogen will lead to an increase in the thickness and hypoxia of the endometrium, which, due to increased contractility of the uterus, will be permanently and non-simultaneously torn away, one after the other, which in turn is accompanied by abundant uterine bleeding with prolonged clots.

[8]

Symptoms of the abundant period with clots

Depending on the cause of bleeding from the genital tract, a woman may be troubled by various symptoms, ranging from painful sensations to dizziness and loss of consciousness. More details on the cause of the onset, a detailed description of the symptoms, the first signs and complaints is given below.

Heavy periods with clots after a delay

Sometimes, after a delay in menstruation, a woman experiences profuse bleeding with clots from the genital tract, and there may be painful sensations of a noisy character in the lower abdomen with irradiation into the anus. The cause of such a symptom complex may be an abnormal pregnancy, the use of an oral contraceptive. Determine the cause will help determine the level of chorionic gonadotropin in the blood. Even with a complete spontaneous abortion, its figures, for a while, remain at a high level. This is due to the fact that there is a rejection of the non-viable embryo by the prepared endometrium and is accompanied by a large amount of blood loss. In this case, a woman experiences weakness, dizziness, nausea, sometimes vomiting. In the presence of such symptoms, it is necessary to immediately call an ambulance for hospitalization in a specialized medical institution.

[9]

Abundant period 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 drawing pain in the lower parts of the abdomen, which gives into the rectum, in the second half of the pregnancy the pain can be cramping. Bloody discharge, in this case, in a significant amount with clots of varying intensity. Depending on the period of pregnancy, vacuum-aspiration of the uterine content is carried out in the first trimester, after the sixteenth week of pregnancy, the fertilization product is evacuated under adequate anesthesia and hemodynamic control. In the absence of contraindications, it is permissible to appoint uterotonics to accelerate the expulsion of uterine contents.

At later stages of pregnancy, vaginal bleeding may indicate placenta previa. At the same time, bleeding can be of different intensity and absolutely painless. If a woman has a period of more than 20 weeks of pregnancy, this condition should immediately call an ambulance.

Abundant period with clots after delivery

Usually immediately after birth, the woman has a physiological bleeding - lochia. It can be of different intensity and will continue until the entire postpartum uterus is reduced to normal size. After this, if the mother gives birth to a newborn, she has no menstruation. This phenomenon is called lactational amenorrhea and, as a rule, it lasts until introduction into the diet of infants breastfeeding. And so after 6-12 months a woman's menstrual cycle is restored. Due to physiological changes in the body of a woman, such as shortening the cervix, expanding the cervical canal, increasing the size of the uterus, increasing the volume of the endometrium, menstrual flow becomes more intense and abundant.

Immediately after 2-4 weeks after childbirth, excessive bleeding with clots, caused by the presence of placental residues in the uterine cavity, may occur. In this bloody discharge bright-scarlet with an unpleasant odor and accompanied by pain in the lower abdomen with irradiation in the lower back. In this case, it is necessary to seek qualified medical care, since it is possible to infect the placenta remnants and the development of endometritis - inflammation of the uterus.

Abundant monthly with clots after cesarean section

Often, abundant spotting 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 the unchanged cervical canal and cervix, which is an obstacle to loose lochia, as after normal delivery. As a consequence, bleeding becomes more prolonged with more clots. Over time, the menstrual cycle will improve and the amount of menstrual blood will become more normal.

[10]

Abundant monthly with clots after curettage of uterine cavity

Abundant menstruation with clots after curettage of the uterine cavity may be as a result of an instrumental abortion. In this case, the curettage of the uterine cavity is carried out by the curette, layer by layer removing the endometrium with the fetal egg. If during any such procedure any part of the cavity was missed by the surgeon, bleeding with clots of scarlet color, accompanied by aching pain in the lower abdomen, may develop on day 2-4. In this case, you must go to the medical institution where the pregnancy was interrupted.

If bleeding occurs on the 7-10th day after curettage of the uterus, it is also necessary to seek medical help, since this condition may be due to the presence of the placental polyp, which arises in the place of the remnants of the product of fertilization. In this case, a woman may have bloody discharge of different intensity, pain in the lower abdomen, subfebrile body temperature and nausea. To eliminate this symptom complex in a stationary gynecological ward against a background of adequate antibiotic therapy, a second scraping of the uterine cavity is performed, with the further administration of oral contraceptive preparations.

[11], [12], [13], [14]

Abundant period with clots after hysteroscopy

Hysteroscopy is a gynecological procedure using an optical device, through which the doctor has the opportunity not only to visualize the inside of the uterus, but also to take the material without traumatizing the entire cavity of the uterus, as when scraping. Hysteroscopy is carried out both for the purpose of diagnosis and for therapeutic purposes. In this case, in the case of diagnostic hysteroscopy, there is no change in the menstrual cycle. As for surgical hysteroscopy, the cycle here is lengthening, often monthly ones become more abundant than ever. But sometimes spotting changes the smell, clots appear in them and their color changes, which may indicate an infection. If the abundant spotting gets black on the background of severe pain, it can be a symptom of the disease - endometriosis. Endometriosis is a complex hormone-dependent disease in which endometrial tissue is located not only in the uterine cavity, but also beyond its limits. In this case, the woman is worried about the severe pain in the first days of menstruation. The doctor will prescribe the exact diagnosis after additional diagnostic tests.

[15]

Abundant period with clots with myoma

Myoma of the uterus is a benign formation that consists of connective tissue or muscle elements. If the muscle structure prevails in the structure of the formation, it is a myoma, if the connective tissue prevails - about fibroids. One of the first symptoms of uterine fibroids is profuse menstruation. The nature of the discharge depends on the location of the myomatous node in the uterus. So, with its location in the submucosal layer from the very beginning of its formation, a woman is concerned about copious, prolonged menstruation with clots, which is also associated with a violation of the tone of the uterus.

 Sometimes growth in the uterine cavity of the submucosal myomatous node is directed toward the cervical canal, which eventually leads to its exit from the uterine cavity. This process is accompanied by abundant uterine bleeding, cramping pain in the lower abdomen, general weakness, a drop in blood pressure and loss of consciousness. In such a situation, the provision of care is possible only in a medical institution. The main goal of treatment in this case is to stop uterine bleeding, anesthesia and surgical removal of the birth of the myomatous node with subsequent scraping of the uterine cavity.

[16]

Abundant period with clots after 45-50 years

In premenopausal women often have profuse uterine bleeding. This is due to the aging of the hypothalamus, in which the hormonal background is broken in the direction of hyperestrogenism against the background of a decreased level of progesterone, which leads to excessive growth of the endometrium and a violation of its transformation and manifests itself as prolonged, plentiful monthly with clots. In this case, the cyclicity is violated, and the time interval between the monthly lengthens. The treatment of this category of patients is mainly surgical and is presented in the form of scraping the uterine cavity and the cervical canal. In the future, hormonal therapy is prescribed to suppress menstrual function.

[17], [18], [19]

Abundant menstruation with clots at menopause

The appearance of bleeding in postmenopause may be a symptom of malignant formation of the pelvic organs. Therefore, if there is such a symptom, you should immediately contact a gynecologist for the necessary examinations. Such bleeding occurs without a cause and can be of varying intensity and duration.

Another cause of bleeding in menopause can 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 increased its vulnerability. Such bleeding occurs after physical exertion, weight lifting, or sexual intercourse. In any case, when bloody discharge from the genital tract occurs, you should seek medical help from a gynecologist.

Abundant prolonged period with clots

Menorrhagia or prolonged profuse menstruation may occur in the presence of pathology of the development of the uterus, endometriosis, endometrial hyperplasia, endocrine diseases and disorders of blood coagulation. Also, the cause of such a symptom may be an intrauterine device or an incorrectly selected oral contraceptive. The disease can occur at any age and not be cyclical. This condition is dangerous because, against prolonged heavy bleeding, anemia usually develops, which is hard to correct due to the presence of a genital cause of bleeding. If there are recurring episodes of long periods, you need to contact a gynecologist who will prescribe the necessary diagnostic procedures and treatment.

[20], [21]

Abundant painful periods with clots

Algodismenorea is a disease that is haunted by a large number of women and manifested by painful copious menses. There are many reasons for this disease. Painful menstruation can disturb women with uterine fibroids, endometriosis, intrauterine contraceptive, malformation of genital organs, as well as inflammatory diseases of the pelvic organs and diseases of the endocrine and nervous systems. Pain, as a rule, occurs a couple of years after the onset of menarche and begin on the first day of the menstrual cycle or a day before it. Pain cramp spastic character with irradiation in the rectum, loins, ovaries. Sometimes, with severe pain and bleeding, a woman has nausea, vomiting, dizziness. Such a symptom complex leads to temporary loss of ability to work and requires medical treatment.

[22]

Complications and consequences

The main complication, which occurs due to abundant periods with clots, is anemia. Because of the significant volume of blood loss, the reserves of the 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 haemostatic therapy. With profuse bleeding often develops hemorrhagic shock, which requires the immediate introduction of blood products.

In the absence of anti-relapse treatment, it is possible to resume abundant periods with clots, except for conditions after hysterectomy.

[23]

Diagnostics of the abundant period with clots

Abundant menstruation with clots is a disease that requires immediate medical and sometimes surgical treatment. But in order to start its treatment, it is necessary to carry out a diagnosis and establish an accurate clinical diagnosis.

Diagnosis of this disease is performed by an obstetrician-gynecologist, with a primary appeal to him with complaints about copious periods with clots. First of all, the doctor collects a detailed somatic anamnesis (history): the presence of liver diseases, cardiovascular and endocrine systems, trauma and operation on female genital organs. Then the menstrual and gynecological history: the age at which the menarche began, the quality of the cycle, the onset of sexual life, sexual activity, gynecological diseases and methods of contraception. It is very important to take medications such as estrogens, antidepressants, anticoagulants, corticosteroids, digoxin and propranolol, which could cause profuse bleeding from the genital tract.

After a detailed survey, the doctor conducts functional diagnostics tests, such as: basal temperature monitoring, hormonal colpocytology, estrogen saturation tests, which enable you to determine the hormonal background.

Laboratory examination

A pregnancy test or the determination of a chorionic gonadotropin is performed to exclude pregnancy pathology, or trophoblastic disease, or an ectopic pregnancy.

A general blood test, a biochemical blood test, a coagulogram are conducted to determine the degree of anemia of the body for further correction of anemia.

Hormonal examination in dynamics is recommended for all women suffering from profuse menstruation for determining hormonal status. For this purpose, the level of serum FSH, prolactin, LH, testosterone, progesterone and estradiol is determined in dynamics. Important is the examination of hormones of the thyroid gland and adrenal glands.

It is recommended to carry out the determination of oncomarkers CA 19-9, CA 125.

[24], [25], [26], [27], [28],

Instrumental diagnostics

Ultrasonic examination of pelvic organs and hysteroscopy are reliable and accessible methods of diagnosing pathologies of the reproductive organs of women. Sometimes hysterosonography is performed (filling the uterine cavity with a physiological solution under the control of the ultrasound apparatus), which allows to detect submucous myomatous nodes of the uterus, polyps of the endometrium,

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

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

Differential diagnosis

Differential diagnosis of copious periods with clots is carried out in accordance with the age index of a woman, as for every period of a woman's life, the occurrence of certain diseases is characteristic.

So in the pubertal period, a differential diagnosis is performed with diseases of the hematopoietic system, accompanied by blood clotting disorders and bleeding; violations of the liver and gastrointestinal tract, abnormalities of genital organs, diseases of the endocrine system (adrenal glands, thyroid gland), foreign bodies of the genital tract and neoplasms of the vagina.

Differential diagnosis in the reproductive age is carried out with ectopic pregnancy, uterine myoma, adenocarcinoma, endometrial hyperplasia, endometrial trauma with intrauterine contraceptive.

In the menopausal period, diffodiagnosis is performed with endometrial adenocarcinoma, adenomyosis and hormone-producing ovarian tumors.

Treatment of the abundant period with clots

The method of treatment of ample menstruation with clots is prescribed by the doctor in accordance with the age of the patient, the causes of the occurrence, the amount of blood lost and the duration of bleeding. But, in any case, the first stage is hemostasis - stopping bleeding, which can be done surgically or medically.

How to stop profuse menstruation?

The first thing to do is to calm down, as blood vessels dilate in the excitement and bleeding may intensify. If the bleeding has occurred in a pregnant woman, it is necessary to take a horizontal position with the raised leg of the bed, relax, call an ambulance. It is allowed to take the tablet form of ethamylate "Dicinon" 1- 2 tablets with water.

For other reasons for the occurrence of copious monthly bunches, the pre-medical measures should be as follows:

• Call an ambulance.
• Take the horizontal position with the raised leg of the bed raised.
• Put a heating pad, a bottle or any other vessel with cold water on the bottom of the stomach, which helps to narrow the blood vessels and reduce bleeding.
• Use a large amount of fluid to fill the volume of blood loss.
• The use of drugs that stop bleeding, such as: Dicycin 1-2 tablets, maximum 4 tablets per day for 0.25 mg., Tincture of water pepper 25 drops 3 times a day, extract of a shepherd's bag of 25 drops 3 times a day., Calcium gluconate 1-2 tablets 3 times a day.

Further treatment will be prescribed by a gynecologist in accordance with the indications.

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

Aminocaproic acid is an effective antihemorrhagic drug whose action is directed to inhibition of fibrinolysis, which provides a blood-stopping effect. The effect of the drug occurs 15 minutes after intravenous administration. Assign the drug intravenously drip 100 ml of a 5% solution of not more than 8 grams per day or oral 30 ml 4 times a day. Contraindication to use is coagulopathy, a tendency to thrombosis, a history of cerebral circulation, ischemic heart disease. With caution appoint a drug with estragensoderzhaschimi contraceptives, which increases the risk of thromboembolism.

Traneksam is an antifibrinolytic drug with a local and systemic blood-restoring effect. The effect of the drug comes in 3 hours after ingestion and remains up to 17 hours. Apply 1 tablet 4 times a day for 4 days. Intravenously, the transex is administered a drop of 15 mg / kg every 6 hours no faster than 1ml / min. Contraindications for use are subarachnoidal hemorrhage, renal insufficiency. With caution appoint with thrombophlebitis deep veins, thromboembolic syndrome. Side effects occur with increasing recommended doses or with individual hypersensitivity to the active substance of the drug, and may manifest as nausea, vomiting, dizziness, thrombosis, tachycardia, skin rash, itching, urticaria.

2. Hormonal therapy is indicated for prescription based on age and survey results.

During puberty, hormones are prescribed if there is no effect on the haemostatic therapy. Preference is given to combined oral contraceptives: Microinone, Lindineth 20, Yarina 2-3 tablets per day with a gradual dose reduction to 1 tablet for 21 days.

Probably the appointment of gestagens: Dyufaston, Norkolut, Utrozhestan, 2 tablets per day with a subsequent dose reduction.

In the reproductive age, only nulliparous women should be given if, with ultrasound, the M-echo of the endometrium does not exceed 8 mm. The drugs of choice are: 17OPK 12.5% 2 ml IM once a day for 7 days, Dufaston 1 tablet 3-5 times a day, Norkolut 1 tablet 3-5 times a day, followed by a gradual decrease to 1 tablet per day .

17 OPC (oxyprogesterone capronate) - synthetic progesterone, of progestational progenesis in high doses depresses the secretion of gonadotropins, which helps to reduce bleeding and has a prolonged gestagenic effect. The drug is administered intramuscularly 2.0 ml of 12.5% solution every day until the relief of bleeding and 0.5-1.0 ml for 21 days to prevent the development of rebleeding. After intramuscular injection, the drug starts in 5 hours and lasts up to 14 days. Contraindications to the introduction of 17OPK is a violation of the liver, a tendency to thrombosis, malignant formations of the pelvic organs and mammary glands.

In the climacteric, women over 45 years of age are not recommended to carry out hormonal hemostasis. It is permissible to prescribe progestins, such as: 17OPK 250 mg on the 14th and 21st day of the menstrual cycle, Depot Provera 200 mg on days 14 and 21.

In the event of bleeding associated with impaired ovarian function, intramuscular progesterone administration is prescribed at 5-15 mg / day for 7 days, followed by a decrease in dose with positive dynamics.

Gonadotropin-releasing hormone agonists, such as Goserelin and Diferelin, are not often used to relieve exaggerated periods with clots, but are well established in regimens for further treatment of uterine bleeding. The fact is that with the 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 injected subcutaneously into the anterior abdominal wall 1 time in 28 days, which ensures maintenance of the effective concentration of the drug in the body. The drug is contraindicated in pregnant, lactating and children. The drug is well tolerated. In rare cases, headaches, mood changes, dryness of the vaginal mucosa, cessation of menstruation, demineralization of bone tissue can occur.

3. Vitaminotherapy. Prolonged, abundant uterine bleeding, as a rule, leads to depletion of vitamins and microelements of the body. First and foremost, iron deficiency arises and as a result, iron deficiency anemia develops. For its elimination and replenishment of iron appoint:

• Vitamin B12 is 200 μg / day.
• Folic acid by 0.001g 2-3 r / day.
• Totem 1-5 ampoules per day orally.
• Globirone 1 tablet once a day.
• Sorbifer durules 1 tablet 1 p / day.
• Maltofer 1 tablet 1 p / day.
• Venofer intravenously drip.

The duration of iron supplementation depends on the degree of anemia and is controlled by blood counts.

Vitamin B6 and B1 with alternation for intramuscular injection are justified from vitamin preparations. Also recommended the appointment of vitamin E at 200 mg per day and routine at 200 mg 3 r / day.

4. Widespread use in the treatment of ample menstruation with clots found medicinal herbs and alternative medicine.

• Dry leaves of nettle pour half a liter of water and boil for 10 minutes, insist 30 minutes. Use inside for 1 tbsp. Spoon 5 times a day.
• Grass shepherd's bag 50g, herb mountaineer bird's 50g, grass mistletoe white 50g. A mixture of herbs pour 200 ml of water, 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. Morning and evening from the 1st day of the month.
• Bark buckthorn 30g and raspberry bark 30g. Collect the boiling water, insist and drink in the morning and in the evening for 1 glass.

In alternative medicine for the treatment of plentiful menstruation with clots, not only herbal preparations, but also other components for the preparation of medicinal potions are used.

• Decoction of orange peels has a good haemostatic property. Rind 5 oranges to boil in 1 liter of water for 1 hour on low heat. Add a little sugar and drink 1 tablespoon three times a day.
• Berries of fresh mountain ash and mint leaves are mixed 1: 1 and brewed in the form of tea. Such tea should be drunk 3 times a day before the end of the month.
• 30 g of dried and finely chopped herbs and parsley roots brew with boiling water in 400 ml of water and boil for 15 minutes, then strain. Take half a glass three times a day for 15 minutes before eating.

5. Physiotherapy.

In the treatment of copious uterine bleeding with clots, the following types of physiotherapy are widely used:

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

6. Homeopathy.

If the cause of abnormal periods with clots are functional disorders, the following drugs are used for treatment:

• Ovarium compositum. It is a complex homeopathic remedy, regulates the hormonal background. It has metabolic, sedative and anti-inflammatory functions. Assigned to 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. Precautions are given to pregnant and lactating women. Among the side effects noted increased salivation, in which case it is recommended to reduce the dose of the drug or to cancel it.
• Mulimen is a complex homeopathic drug whose action is aimed at regulating the balance of gonadotropic and steroid hormones, normalizing the autonomic nervous system and stabilizing the woman's mental state. Has hormone-regulating, spasmolytic, sedative and draining pharmacological properties. It is indicated for use in disorders of the menstrual cycle, mastopathy, treatment of side effects of hormonal contraception, premenstrual and climacteric syndrome. It is prescribed for 10-12 drops 2 times a day in the intermenstrual period and on menstruation days for 10-15 drops 3-5 times a day, depending on the degree of bleeding. Take before meals for 15-20 minutes, delaying briefly in the oral cavity. Contraindicated at the age of 12 years and with increased sensitivity to the components of the drug. Precautions are given to pregnant and lactating women. The drug is usually well tolerated, occasionally there may be allergic reactions.

With the development of abundant periods with clots against the background of the inflammatory process of the pelvic organs,

• Gynecochel is a basic anti-inflammatory drug that has vasotonic, anti-edematous and analgesic pharmacological properties. Promotes the completion of the inflammatory process, the restoration of microcirculation and the formation of a new tissue in the focus of inflammation. Reduces the risk of complications. Has a regulating effect on the menstrual cycle. It is prescribed for 10 drops 3 times a day daily, except for the days of menstruation. The course of treatment is 3 cycles. The drug is contraindicated in people who are allergic to the poison of bees, wasps and bumblebees. No adverse events were detected.
• Traumeel C is the first choice for any damage to body tissues. Has anti-inflammatory, antiexudative, regenerating and analgesic pharmacological properties. The drug is contraindicated in people with hypersensitivity to the components of the drug, suffering from tuberculosis, leukemia, AIDS. It is prescribed for 1 tablet 3 times a day. Possible adverse reactions in the form of redness and rash on the skin.

7. Operative treatment.

Surgical intervention in case of copious periods with clots, regardless of the cause, is performed with a haemostatic purpose to stop bleeding.

Treatment and diagnostic curettage of the walls of the uterine cavity is carried out under general anesthesia followed by the direction of the scrap obtained for pathohistological examination, which makes it possible to establish the cause of bleeding in 80%. After the operation, the patient is assigned hemostatic and antibacterial therapy.

Endometrial ablation is a surgical method for treating uterine bleeding, which is performed with a laser, or an electrode under the control of a hysteroscope, to remove the entire layer of the endometrium.

Hysterectomy is a radical surgery and is to remove the uterus. It is the last stage in the treatment of uterine bleeding, when the condition is not amenable to treatment by other methods.

Prevention

Prevention of the development of relapses of copious periods with clots last, as a rule, during 3-6 cycles. For this purpose, the regime of work and rest is organized, nutrition is balanced, sedatives, vitamins and hormones are prescribed.

[29],

Forecast

With timely treatment, the prognosis is usually favorable. Against the backdrop of hormone therapy, it is possible to achieve normalization of the hormonal background and stabilization of the general state of women's health.