Any changes during menstruation cause anxiety in women. Almost everyone has encountered the phenomenon of blood clots during menstruation. The reasons for this can be different - from completely harmless to serious diseases that require the intervention of doctors.

What happens during menstruation?

Every month, regardless of a woman’s wishes, her uterus prepares to receive a fertilized egg. Under the influence of hormones, the inner layer of the uterus, the endometrium, begins to thicken. If pregnancy does not occur, hormone levels decrease, blood supply to the mucous membrane inner surface the uterus stops, the endometrium is rejected and excreted through the genital tract to the outside. Thus, menstrual flow is a complex mixture consisting of blood, mucus, endometrial particles, and vaginal cells.

Blood clots during menstruation are normal

This phenomenon during menstruation does not always indicate the presence of pathology. It is quite possible that your periods are normal and there is no need to worry. As you know, these days the endometrium dies and is removed, which becomes loose and thick during the cycle. That is, the menstrual discharge itself is not liquid, since it consists not only of blood, but also of the tissues of the inner lining of the uterus and glandular secretions. In addition, their consistency and color change every day.

Usually, during menstruation, blood clots come out as soon as a woman gets out of bed after sleeping or from a chair after sitting for a long time. This is explained by the fact that the blood in the uterus, when lying down or sitting, stagnates and begins to coagulate, forming clots. As soon as the woman gets up, they come out, and this is not a deviation from the norm.

To make menstrual flow easier, special anticoagulant enzymes inhibit blood clotting. If the bleeding is heavy, the enzymes cannot cope with their task and some of the blood clots in the vagina. That's why it comes out in clumps.

Reasons

One of the reasons for the appearance of large clots in menstrual flow is endometrial hyperplasia

Possible causes of blood clots during menstruation are various diseases and conditions. These include the following:

• Hormonal imbalance. When the endocrine glands malfunction, a cycle disruption occurs, which is manifested by strong brown discharge with clots during menstruation.
• Uterine fibroids. This is a benign tumor that causes menstrual irregularities. In this case, the discharge is usually profuse, and blood can come out in large clots.
• Endometrial hyperplasia. With this pathology, the inner layer of the uterus grows, which may be due to hypertension, obesity, diabetes, hormonal imbalance. In this case, dark, large clots come out during menstruation.
• Endometrial polyposis. With this disease, the inner layer lining the uterine cavity grows, similar to the formation of polyps. In this regard, menstruation with blood clots is possible, and pain may appear in the lower abdomen.
• During the month after childbirth, a woman may experience huge clots, coming out along with the blood, which is normal occurrence. You should consult a doctor if your temperature rises: it is possible that fragments of the placenta remain in the reproductive organ.
• Intrauterine device. If there is a foreign body in the uterus during menstruation, blood clots may be released.
• Endometriosis. It is characterized by the growth of the endometrium outside the inner layer of the uterus. At the same time, periods become painful, longer, irregular, and the amount of blood released increases.
• Impaired functioning of the blood coagulation system. She begins to coagulate in the cavity reproductive organ, since factors that prevent hemocoagulation do not work.
• Clots may appear during infectious diseases accompanied by an increase in temperature, for example during ARVI.
• Malformations of the uterus. As a rule, they are genetically determined. These are pathologies such as intrauterine septum, uterine bend, double or unicornuate uterus and others. The formation of clots with such anomalies is explained by the fact that the exit of menstrual blood from the uterus is difficult due to the pathological structure of the organ, and coagulation begins in its cavity. In women with such defects, menstruation is usually quite painful.
• Ectopic pregnancy. With this pathology, brown discharge is possible, high temperature, severe abdominal pain.
• Copious discharge of blood with clots can be observed with infectious diseases of the pelvic organs.
• The cause of such discharge may be an excess of vitamin B in the body.

When to see a doctor?

If large clots appear during menstruation, you should consult a gynecologist, especially if the discharge is heavy, prolonged and accompanied by pain.

You should not worry if your periods come regularly and there is no or moderate pain.

It is necessary to go to the gynecologist about clots during menstruation in the following situations:

1. Menstruation lasts more than a week, the discharge is heavy.
2. Pregnancy is planned and attempts are made to conceive. In this case, the discharge may indicate that the egg has been rejected and a miscarriage has occurred.
3. Discharge during menstruation contains clots large sizes With unpleasant smell.
4. A woman experiences severe pain during her period. This may be a sign of inflammation or hormonal disorders.

In conclusion

Small clots that come out during menstruation are normal. Every woman reacts very sensitively to any changes occurring in the body and will immediately notice if the nature of the discharge has changed. If the bleeding is profuse, the clots are large, there are many of them, and they are also accompanied by painful sensations, which have not been observed before, you must definitely make an appointment with a gynecologist and be examined.

Work of organs reproductive system is very complex and depends on several factors - the presence/absence of infectious or inflammatory diseases, the use of certain vaginal and oral medications, the psychological state of the woman, bad habits, etc. However, hormones play the main role in this matter. They control reproductive functions and the menstrual cycle, and are responsible not only for the onset of menstruation, but also for their character. For example, women often notice blood clots during menstruation. Is their presence during this period the norm or does it indicate the development of various diseases? Let's try to figure this out.

A few words about physiology

Before talking about why blood clots come out of the vagina during menstruation, we must first talk about the processes that occur throughout the entire cycle.

Every month, follicles that contain eggs mature on the ovaries. During ovulation (it occurs 12–16 days after the start of the cycle), under the influence of progesterone, the eggs are released from the follicles. When they are fertilized, pregnancy occurs; if not, the body begins to prepare for the next menstruation.

But precisely at the moment when the egg is released from the follicle and increased production of progesterone is observed, the uterus begins to prepare itself to receive the fertilized egg, during which its inner layer of epithelium thickens. If pregnancy does not occur, the level of progesterone decreases, the abundant blood supply to the uterus stops, its “overgrown” walls cease to receive proper nutrition, die and are rejected. And they exit the uterus directly with menstrual blood.

And it turns out that the secret released from the vagina upon the onset of menstruation contains:

• Blood.
• Cervical mucus.
• Rejected epithelial layer of the uterus.

How to distinguish pathological clots from physiological ones?

The release of liver-like blood clots during menstruation often has nothing to do with pathologies. As mentioned above, the secretions contain various components that thicken them. The clot that a woman can observe is nothing more than the endometrium being shed in the uterus.

Consistency vaginal discharge and their hue is constantly changing. For the first few hours, they are thick and brownish in color, which indicates the onset of menstruation. Further, the volume of vaginal secretion increases and it becomes scarlet in color.

As a rule, the release of rejected uterine epithelium is observed only in the first day. Further, the appearance of clots is usually observed after prolonged lying or sitting on a chair. This is due to the fact that with this position of the body, the blood begins to stagnate in the uterus, coagulate and form clots. And as soon as the woman becomes erect, they begin to come out of the uterus.

But we must not forget that heavy periods can also occur with the development of various pathological conditions. Therefore, it is very important to know the symptoms that may indicate their presence.

To get rid of menstrual blood, the uterus begins to contract, which provokes spasms in the smooth muscles of the organ and the appearance of pain, which is easily eliminated after taking an antispasmodic drug.

But pain, as a rule, is also observed with the development of pathologies, and therefore the appearance of blood clots on the lining always frightens women. However, there is no need to worry ahead of time, as there are certain symptoms that indicate the normal course of menstruation. Among them are the following:

• In the first days, there is slight swelling of the mammary glands.
• Clots released from the vagina and similar in appearance to the liver are observed only in the first day.
• Abdominal pain is easily relieved with medications.
• Vaginal discharge does not have a foul odor and does not cause irritation in the intimate area(if there is an unpleasant odor and slight redness of the labia, this may indicate insufficient hygiene).
• Menstruation is not accompanied by an increase in temperature.
• Vaginal discharge has a uniform structure and its color may be red, scarlet or brownish.

In addition, during menstruation, women experience increased appetite, irritability and frequent change moods. All this is completely natural and is caused by hormonal fluctuations in the body. And in situations where menstruation is accompanied by numerous clots, pungent odor, temperature, weakness or any other unpleasant symptoms of a pronounced nature, you should immediately visit a doctor, since their presence indicates the development serious illnesses that require immediate treatment.

Pathological causes

If the number of clots is small and they are observed only in the first few days of menstruation, there is nothing to worry about. But if they appear constantly and are accompanied by severe pain in the abdomen, you should not hesitate to visit a doctor.

Especially dangerous occurrence blood clots occurs in cases where a woman was planning a pregnancy, purposefully engaged in unprotected sexual intercourse, had a delay and the test shows positive result. In this case, the discovery of uterine bleeding in early pregnancy can signal a miscarriage. In this case, first a large mucous piece with a blue-red tint may come out of the vagina, and then small dark clots may be observed.

Unfortunately, maintaining pregnancy in this case becomes impossible. However, this is not a reason for refusing to visit a specialist, since after a miscarriage a woman needs medical supervision, because she may experience bleeding at any time, which will be impossible to stop at home.

Moreover, if a woman has a delay, and then begins to smear with brown thick exudate, a painful syndrome appears in the abdomen and the temperature rises, then this may indicate the development of an ectopic pregnancy, which also requires immediate medical intervention. If it is not interrupted, it will lead to serious problems– the fallopian tube may burst, which will require emergency surgery.

Menstrual blood with clots can also be released as a result of the development of pathologies. The following reasons can provoke the presence of such inclusions:

• hormonal disorders;
• ovarian cyst;
• uterine fibroids;
• endometriosis;
• erosion;
• polyposis;
• thrombosis.

Hormonal disorders

In this case, women experience both long and heavy periods and scanty, thick periods. This is due to the fact that when the synthesis of hormones is disrupted, a disruption occurs in the menstrual cycle. Frequent delays lead to a strong thickening of the endometrium of the uterus, which causes not only the appearance of bloody clots, but also the occurrence of congestion, after which there is profuse bleeding.

As a rule, in these cases the clots are permanent, and their presence is often accompanied by abdominal pain. You should not delay the treatment of hormonal disorders, as this can lead not only to problems with conceiving a child, but also to the development of other diseases.

It is a hollow formation that forms on the surface or inside the appendage and contains serous fluid. In most cases, such teratomas resolve on their own. The release of their walls is observed just at the time of menstruation, which becomes the cause of dark clots in vaginal secretions.

Important! Cysts don't just appear. Most often they occur due to hormonal disorders. And bye negative factor not eliminated, cysts will appear again and again, and this will lead to disruption of the functionality of the ovaries.

A benign neoplasm that leads to congestion in the organ cavity. As a result of this, the blood begins to clot even before it is released, which causes the appearance of clots.

Important! With this disease, women usually have long periods. At the same time, they are accompanied by cramps and a feeling of heaviness in the abdomen.

Uterine fibroids can only be treated through surgery, which can be performed either laparotomically or laparoscopic method. If this disease is not treated, it can lead to cancer.

Endometriosis

It is characterized by pathological growth of the internal epithelial lining of the uterus beyond its limits, which is also rejected when the level of progesterone in the body decreases. Moreover, with endometriosis, many women often there's a mess going on brown outside of menstruation, which is accompanied by unpleasant nagging pain in the abdomen.

Important! Endometriosis can also lead to the development of cancer and infertility, and therefore you should not delay its treatment.

When this pathology develops, an ulcer forms on the cervical canal, which tends to grow, affecting healthy cells. The body tries to fight this phenomenon and begins to get rid of damaged epithelium, which leads to the formation of clots.

If you have heavy periods, there are too many clots in them, and discomfort in the abdomen, this may mean the development of polyposis, in which numerous polyps appear on the inner epithelial layer of the uterus. This disease cannot be ignored, as it can lead to cycle disruption, problems conceiving a child and oncology.

This pathology is characterized by the formation of blood clots in the vessels, which lead to impaired blood circulation. If it occurs in the veins of the small pelvis, it can lead to impaired circulation of the uterus and rejection of its internal epithelium.

Important! The disease is considered dangerous pathology, because if a blood clot breaks off and reaches the heart muscle through the bloodstream, this will lead to death.

Other reasons

Such changes in the nature of menstruation can be provoked by the following factors:

• Intrauterine device.
• Abrupt withdrawal of oral contraceptives.
• Stress.

More often, the appearance of clots occurs as a result of the fact that a woman began taking oral contraceptives, and then abruptly stopped doing so, which leads to hormonal imbalances. Against this background, vaginal secretion radically changes its character. It can be stretchy, slimy, thick or liquid, and also have a different shade (brown, red, pink) and contain clots. Moreover, such discharge may appear a week before menstruation or earlier.

When installing an IUD, severe trauma to the mucous membranes of the cervical canals occurs. Therefore, after its administration, bloody discharge is observed and clots may well be present in its composition. If they do not go away within a few days and severe abdominal pain is observed, this may indicate the development of inflammation in the cervical canal, which requires immediate treatment. therapeutic therapy. Folk remedies in such a situation, it is not recommended to use them, since they are ineffective and can cause the progression of inflammation and the further development of cervicitis.

Psychological factors also play an important role and can affect not only the duration of the menstrual cycle, but also the nature of the discharge, provoking the appearance of inclusions of coagulated blood in it.

You need to understand that there are many reasons why clots occur during menstruation. And to make sure there are no pathologies, you must definitely visit a doctor.

The menstrual cycle is a systematic process in the body of women of reproductive age, controlled by hormones (mainly progesterone and estrogen), having a certain cyclicity and aimed at conceiving a child. In healthy women, the regulative (menstrual) cycle can range from 28 to 32 days, but minor deviations from this range are not considered a pathology unless accompanied by painful symptoms and any violations. On the first day of the cycle, menstrual blood is released from the woman’s vaginal tract, which, in addition to blood itself, also contains enzymes that act as anticoagulants, mucus, particles of the epithelial layer and dead vaginal cells.

In some cases, a woman may notice that blood is coming out of the vagina with blood clots, in appearance resembling pieces of placenta. Such a symptom can be a manifestation of very serious diseases that require complex and urgent treatment (and sometimes surgical intervention), or a physiological norm, so it is important to be able to distinguish normal discharge from pathological signs.

Menstrual blood has a rather complex chemical composition, the basis of which is glandular fibers and secretory fluid produced by the glands of the vagina and cervix. Clots can form when there are a large number of endometrial cells - an epithelial layer with a mucous structure that lines the uterine walls from the inside and is necessary for the successful implantation of a diploid fertilized cell (zygote). Starting from the middle of the menstrual cycle, the endometrium changes its density and structure, becomes looser and thickens. If the amount of female sex hormones exceeds the required physiological threshold, during menstruation the endometrium may prematurely coagulate in the uterine cavity and form clots.

Thickening of menstrual fluid can also occur with insufficient activity of anticoagulation enzymes, as well as in cases where a woman does not lead enough active image life, promoting stagnation of blood circulation in the pelvic organs. This situation is typical for women holding office positions, having overweight, limiting the degree of mobility, or suffering from chronic disorders endocrine system. For the same reason, blood clots during menstruation can be observed in women who have undergone surgery or injury and are temporarily limited in movement.

Important! Bad habits (nicotine and alcohol addiction, use of narcotic and toxic substances) can also contribute to increased blood clotting due to changes in its chemical composition and neutralization of enzymes that regulate the consistency of menstrual fluid.

Video - Three questions about periods that women are embarrassed to ask

Diseases of the uterus are the main cause of intrauterine blood clotting

Uterine diseases are the largest group gynecological pathologies. Almost always, disturbances in the functioning of the organ are accompanied by changes in hormonal levels, therefore, in addition to standard diagnostic methods, a woman can undergo diagnostic curettage using a curette (a more gentle method is vacuum aspiration), followed by histological examination collected material in order to determine hormonal levels and exclude tumor processes.

The most common pathology of the uterus, various forms of which are diagnosed in every fifth woman aged 20 to 50 years, is uterine fibroids. Fibroids are formed by cells of the myometrium (the muscular layer of the uterus), can have a diffuse or nodular form and occur without any symptoms for several years. Myoma is a benign tumor, so in most cases, doctors choose a wait-and-see approach with careful monitoring of the patient and monitoring of changes in the myomatous nodes.

The symptoms of this type of tumor are quite sparse and may include the following signs:

• increased nagging pain a few days before the onset of menstruation and during menstruation;
• exceeding the physiological norm of secreted menstrual fluid (a volume of 50 to 80-100 ml is considered normal);
• blood clots during menstruation;
• promotion basal temperature.

Another reason related to the functioning of the uterus and that can cause premature blood clotting is congenital malformations of the uterus. They are formed during the period of intrauterine growth and development, most often caused by a genetic factor, but in some cases they can be a complication of inhalation or consumption of toxic products. Most often, girls and young women experience a bending of the uterus, which in 90% of cases leads to the inability to bear a child while maintaining the full scope of reproductive functions, as well as an intrauterine septum, a defect often associated with abnormal development renal system.

With these defects, the free exit of blood from the body of the uterus is difficult, which leads to its stagnation and the formation of small clots. Treatment of these defects is carried out only in foreign clinics, but is not accessible to most middle-class women due to the very high cost.

Pathologies associated with conception and pregnancy

Ectopic pregnancy is a serious pathology that can lead to heavy bleeding and the development of generalized inflammatory process. It can develop even in absolutely healthy women, but the main risk group includes patients suffering from obesity, diabetes mellitus, and those with a history of abortions or miscarriages.

On early stages intrauterine pregnancy is no different from normal: the woman also experiences all the manifestations of toxicosis, her mammary glands become enlarged, and the pregnancy test shows a positive result. When the gestation period reaches 4-6 weeks, symptoms and signs begin to appear, and if they appear, you should immediately consult a doctor. These include:

• bleeding mixed with blood clots;
• acute, sharp, severe nagging pain in the lower abdomen;
• temperature rise to 38.5° and above;
• vomit.

Pay attention! The appearance of blood clots in pregnant women is a very dangerous clinical symptom, which almost always indicates the onset of a miscarriage. Clots after childbirth are considered normal, but women with similar symptoms should be under the supervision of a specialist, since blood clots may be parts of the baby's placenta. Normally, such discharge should not last longer than 30 days, and should not be accompanied by severe pain or high fever.

Blood clots after insertion of an intrauterine device

Intrauterine device - a type hormonal contraceptives, which is installed inside the uterus around its cervix and is made of copper or plastic. Despite the fact that installation of the product is not a traumatic procedure, minor bleeding may occur after installation, which normally resolves within 3-5 days. If this does not happen, the bleeding becomes profuse, and during menstruation blood clots begin to be released from the vaginal tract, the coil should be removed.

It is necessary to remove the product even if side effects: itching, burning, headaches, skin rash and other symptoms described in the instructions for use. Such women should consult a gynecologist about more suitable methods contraception.

Endometrial diseases

The endometrium is a functional uterine layer that regulates the synthesis of hormones necessary for the onset and maintenance of pregnancy, as well as the growth of fetal development. Endometrial diseases belong to diseases of the uterus, but experts classify them as a separate group. The most typical for this clinical picture (blood clots during menstruation) are endometriosis and endometrial hyperplasia. Both pathologies are pathological growth cells and layers of the endometrium, but with endometriosis they can extend beyond the uterus and reach other organs, including the uterine appendages.

If the endometrial tissue becomes inflamed, the woman is diagnosed with endometritis. The disease is dangerous due to the rapid growth of pathogenic flora inside the uterus and the spread of infection to other pelvic organs. The symptoms of any endometrial pathology are almost always the same and include the following signs:

• intense pain in the lower abdomen with transition to the side walls (with ovarian endometriosis);
• heavy periods (menorrhagia) lasting more than 1 week;
• intermenstrual bleeding with blood clots;
• insufficient secretion of vaginal lubrication and resulting discomfort during intimacy;
• difficulty conceiving.

Treatment of endometrial diseases

Treatment of endometrial pathologies includes diagnostic curettage of the uterus, as well as taking medications used in standard treatment regimens. They cannot be used without a doctor’s prescription, as there may be individual contraindications.

Group of drugs	What medications should I take?	Image
Antispasmodics to relax the muscles of the uterus, eliminate spasms and pain	"Drotaverine" "Papaverine" (mainly rectally)
Oral contraceptives with varying levels of estrogen and progesterone to correct hormonal levels	"Chloe" "Janine" "Diane-35"
Anti-inflammatory drugs (for endometritis)	"Ibufen" "Ketorolac"
Antibiotics and antimicrobials for the prevention of complications and secondary infection	"Amoxicillin" "Tetracycline" "Cefazolin" (for severe cases)
Iron supplements for heavy blood loss for the prevention and treatment of anemia	"Ferrum Lek"

If a woman’s health is in order, but her periods are still accompanied by the release of clots, it is necessary to take tests for blood clotting, and also determine the level of B vitamins in the body. With their excess, blood clotting ability increases, which increases the risk of uterine vein thrombosis, so this condition also requires medicinal correction. A large number of vitamins of this group are found in rye and peeled flour, solid varnishes, legumes, as well as liver, eggs and many vegetables and fruits.

If a woman consumes enough of these products, there is no need to take additional vitamin complexes, which contain B vitamins, negatively affects the consistency and viscosity of menstrual fluid and promotes the formation of blood clots.

The nature of menstruation depends on many factors: general condition health, individual characteristics body, age-related changes hormonal background. At various diseases organs of the reproductive system there are significant deviations from the norm. It is important to pay attention to the appearance of unusual signs in a timely manner. If your periods are heavy, with clots, and there are accompanying symptoms that cause discomfort, this indicates a serious pathology. But at the same time, clots in menstrual flow can be normal.

If there are few of them, and the volume of menstruation does not exceed 80-100 ml, then, most likely, the formation of clots is caused by natural causes. Normal menstruation last no more than 5-6 days and are not overly painful, and the discharge does not have an unpleasant odor.

The appearance of clots in normal discharge can occur in the following cases:

1. In the uterine cavity there are adhesions and scars that interfere with the outflow of mucus and menstrual blood. Stagnant blood clots and is sometimes expelled from the uterus in the form of lumps.
2. Available congenital disorders the shape or position of the uterus (for example, the curvature of the cervix, the presence of partitions in the cavity), which contributes to the formation of blood clots.
3. Blood has increased viscosity (this condition occurs, for example, with insufficient fluid intake, the predominance of protein products in the diet, with diseases of the liver, kidneys, and blood vessels).
4. A woman sits or lies for a long time. Blood and mucus accumulate and thicken, and appear when standing up. copious discharge with lumps of mucus.
5. Blood clotting increases as a result of taking medications - coagulants (for nosebleeds, for example) or hormonal drugs. This helps reduce the duration and intensity of bleeding, but leads to the formation of blood clots in the discharge.
6. A contraceptive device is installed in the uterine cavity, which contributes to the formation of blood clots in menstrual blood.
7. A woman has an abortion that has just begun (at 1-2 weeks). After a short delay, heavy, long periods appear with clots of unevenly exfoliated endometrium.

The norm is the appearance of lumps during the first menstruation after an abortion, when the discharge may contain remnants of the fertilized egg. The hormonal shift that occurs in the body after abortion and childbirth is the reason that periods become heavy. Hormones also affect the production of enzymes that regulate blood clotting.

At various periods of a woman’s life, associated with natural changes in hormonal levels (development of the reproductive system, onset of sexual activity, menopause), deviations in the nature of menstruation are also possible. Scanty discharge may alternate with abundant ones. The appearance of lumps is explained by changes in the structure of the mucous membranes.

Hypothermia, malnutrition, and bad habits contribute to the appearance of deviations in the nature of menstruation.

Addition: Alcohol increases blood viscosity. After its accumulation in the blood, menstruation may contain large blood clots.

Video: Why blood clots form during menstruation

Causes of pathological heavy menstruation with clots

Abundant and prolonged discharge blood during menstruation can cause iron deficiency anemia. Large blood loss leads to a decrease in hemoglobin levels, that is, to a lack of oxygen supply to the body's cells. Symptoms of this dangerous condition include dizziness and headache, loss of strength, pallor, decrease blood pressure. This inevitably affects the production of hormones, as well as the functioning of the hematopoietic organs, which leads to disruption of the homogeneity of the composition of menstrual secretions and the appearance of clots in them.

Pathological heavy periods with clots can be a symptom of various hormonal disorders and diseases reproductive organs.

Signs of pathology

The fact that heavy periods of heterogeneous consistency are pathological can be judged by the following signs:

1. In addition to increased blood loss during menstruation, bleeding or brown spotting is observed in between periods.
2. Menstruation comes too often (cycle length less than 21 days) or with long delays(later than 35 days). It is possible to alternate long and shortened cycles.
3. Blood loss is 100-150 ml or more.
4. The duration of menstruation is 8 or more days.
5. Blood discharge has pungent odor, they contain impurities of purulent mucus.
6. Menstruation is accompanied by severe pain in the lower abdomen.

Only after gynecological examination and with an ultrasound, the doctor will be able to tell what was the cause of heavy periods.

Diseases that cause abnormal periods

The appearance of thick impurities in menstrual discharge may be due to improper development endometrium, which is renewed with each menstrual cycle. The reason for their formation is also damage to tissues and blood vessels, the formation of obstacles to the exit of secretions from the uterus.

Uterine fibroids. This benign tumor develops in the muscles of the uterine wall and can grow towards its outer lining. If it fills the uterine cavity, then various cycle disorders occur. The cause is compression and damage to blood vessels, stretching of the uterus. The tumor blocks the exit from the cavity to the cervix, which leads to the formation of blood clots. Heavy periods with blood clots, as well as an enlarged abdomen and nagging pain below the navel are characteristic signs of fibroids.

Endometrial hyperplasia. The result of hormonal imbalance in the body, as well as damage to the endometrium during an abortion or curettage, is a disruption of its development and structure. The mucous membrane thickens, swells, and uneven exfoliation occurs. At the same time, dense particles appear in menstruation. Blood loss from damaged vessels increases.

Endometriosis. The disease is associated with an increase in the volume of the endometrium inside the cavity, its growth into the tubes and ovaries, cervix, and peritoneal area. In this case, all processes of the menstrual cycle are disrupted. Menstruation becomes profuse, comes irregularly, and contains particles of destroyed tissue.

Polyps in the cavity and cervix. These neoplasms are growths on the inner walls. They are easily injured when the endometrium leaves the uterus during menstruation. Volume increases bloody discharge, they contain particles of decaying tissue.

Cervical erosion. Damage to the mucous membranes in the area cervical canal and at the entrance to the vagina leads to the appearance of ulcers and microcracks in this area. The cause of cervical erosion is damage during childbirth, abortion, or curettage of the uterine cavity. The wounds may fester. Bacteria easily penetrate the internal genital organs, causing inflammatory processes. All this leads to cycle disruption and the appearance of heavy periods with clots.

Infectious diseases of the genital organs. They lead to inflammatory processes, causing disruption structures of the uterine cavity. In addition, microorganisms secrete substances that, when released into the blood, can change its acidity and viscosity. This causes clots to form.

Warning: Heavy bleeding with clots may be a sign of formation cancerous tumor in the uterus. Therefore, if there is obvious discomfort due to clots during menstruation, you should immediately undergo a gynecological examination.

Reason pathological discharge during menstruation there may be an abnormal metabolism, diabetes mellitus, dysfunction of the pituitary gland, thyroid gland and other organs of the endocrine system.

Video: Heavy periods with endometriosis

What to do during periods with clots

If there are obvious signs of pathology, then you need to contact a gynecologist. You may need to consult an endocrinologist or oncologist. If the blood loss is too great, there are large clots, and the discharge is bright red, you must call an ambulance. Uterine bleeding can sometimes be stopped only by complete removal endometrium. It is unacceptable to self-medicate or use home remedies to stop bleeding.

Sometimes in a woman’s life the problem of heavy periods with clots arises, which makes it impossible to lead a full life. What kind of disease this is and how to deal with it can be understood by considering the problem from all sides.

Significant blood loss during menstruation can be: separate disease, and a symptom of a disorder women's health. Heavy periods 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 caused by the presence of pathology of the pelvic organs, systemic diseases or disruption of pregnancy.

ICD-10 code

N92 Heavy, frequent and irregular menstruation

Epidemiology

Heavy periods with clots can occur at any time in a woman’s life, regardless of her age, place of residence and race. During the hot season, the risk of bleeding increases significantly due to the increased load on the cardiovascular system. There is also the influence of differences atmospheric pressure on the development of menstrual irregularities.

Causes of 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 liver diseases, heart vascular system etc.;
• Hormonal imbalance;
• Previous gynecological operations;
• Infectious diseases of the pelvic organs;
• Radiation exposure;
• Congenital anomalies of the development of the genital organs.

Risk factors

Varied unfavorable factors have an impact on the female body different periods development, formation, formation and extinction 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 stress;
• Acute and chronic diseases of infectious origin.

IN reproductive age:

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

During menopause:

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

Pathogenesis

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

The following concepts are used in medicine:

• Hyperpolymenorrhea is a disorder of menstrual function, which is manifested by regular heavy bleeding exceeding the total blood loss of 80 ml per menstruation.
• Acute menorrhagia is unexpected heavy uterine bleeding not associated with the cycle.
• Metrorrhagia is heavy, prolonged, irregular bleeding between menstruation.

Heavy menstruation may indicate such disorders of women's health as: the presence of uterine fibroids, cervical tumors, pathological menopause, pregnancy complications, etc.

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

The female reproductive system is built according to 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 luteinizing hormone (LH). The hypothalamus is one of the main structural formations 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. Directly involved in the regulation of the menstrual cycle are gonadotropins - pituitary hormones such as: prolactin (PRL) - a lactation hormone, follitropin (FSH) - a hormone for growth and maturation of follicles, and lutropin (LH) - a hormone corpus luteum. The ovaries synthesize estrogens, gestagens and androgens - hormones that have a vegetative (development and vital activity of the genital organs) and generative (hormonal background) effect on the female body. Thus, if at least one of the links - the cycle regulators - falls out or is disrupted, the hormonal levels will fail and the proliferation of the endometrium of the uterus will change. 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 rejected continuously and non-simultaneously, one area after another, which in turn is accompanied by heavy uterine bleeding with long-term clots.

Symptoms of heavy periods with clots

Depending on the cause of bleeding from the genital tract, a woman may be bothered different symptoms, ranging from pain to dizziness and loss of consciousness. In more detail regarding the cause of occurrence, a detailed description of the symptoms, first signs and complaints is 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 painful sensations aching character in the lower abdomen with irradiation into anus. The cause of this symptom complex may be a disrupted pregnancy or the use of an oral contraceptive. Determining the level of human chorionic gonadotropin in the blood will help determine the cause. Even with a complete spontaneous abortion, its numbers, for some time, remain high level. This occurs due to the fact that the non-viable embryo is rejected by the prepared endometrium and is accompanied by a large number blood loss. In this case, the woman experiences weakness, dizziness, nausea, and sometimes vomiting. If you have such symptoms, you must immediately call an ambulance for hospitalization in a specialized medical facility.

Heavy periods with clots during pregnancy

The appearance of bleeding from the genital tract in a pregnant woman usually indicates a spontaneous abortion. In this case, the first symptom is a nagging pain in the lower sections abdomen, which extends to the rectum, in the second half of pregnancy the pain can be cramping. Bloody discharge, however, in significant quantities with clots of varying intensity. Depending on the stage of pregnancy, vacuum aspiration of the uterine contents is performed 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 prescribe uterotonics to accelerate the expulsion of uterine contents.

In later pregnancy, vaginal bleeding may indicate placenta previa. In this case, bleeding varies in intensity and is absolutely painless. If a woman is more than 20 weeks pregnant, this condition occurs, she should 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 is completely reduced to normal size. After this, if the woman in labor breastfeeds her newborn, she does 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 occur in a woman’s body, such as shortening of the cervix, dilation 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, heavy bleeding with clots may occur due to the presence of placental remnants in the uterine cavity. In this case, bloody discharge is bright scarlet in color with an unpleasant odor and is accompanied by pain in the lower abdomen radiating to the lower back. In this case, you must contact a qualified medical care, since infection of the remnants of the placenta and the development of endometritis - inflammation of the uterus - are possible.

Heavy periods with clots after cesarean section

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

Heavy periods with clots after curettage of the uterine cavity

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 carried out with a curette, removing the endometrium with the fertilized egg layer by layer. If during such a procedure the surgeon missed any part of the cavity, bleeding with scarlet clots may develop on days 2-4, accompanied by aching pain in the lower abdomen. In this case, you need to 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 experience bleeding of varying intensity, pain in the lower abdomen, low-grade fever and nausea. To eliminate this symptom complex in a hospital gynecological department Against the background of adequate antibiotic therapy, repeated curettage of the uterine cavity is performed, with further prescription of oral contraceptives.

Heavy periods with clots after hysteroscopy

Hysteroscopy is a gynecological procedure using optical device, with the help of which the doctor has the opportunity not only to visualize the inside of the uterus, but also to take material without traumatizing the entire uterine cavity, as during curettage. Hysteroscopy is performed both for diagnostic purposes and for therapeutic purpose. However, in the case of diagnostic hysteroscopy, there are no changes in the menstrual cycle. As for surgical hysteroscopy, here the cycle lengthens, and often periods become heavier than usual. But sometimes bloody discharge changes the smell, clots appear in it and their color changes, which may indicate an infection. If heavy bleeding has acquired a black color against the background of pronounced pain syndrome, this may 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 outside it. In this case, the woman is bothered by severe pain in the first days of menstruation. Accurate diagnosis The doctor will determine after additional diagnostic examinations.

Heavy periods with clots due to fibroids

Uterine fibroids are a benign formation that consists of connective tissue or muscle elements. If the structure of education is dominated by muscle fibers, we're talking about about fibroids, if predominant connective tissue– about fibromyoma. One of the first symptoms of uterine fibroids is heavy menstruation. The nature of the discharge depends on the location of the myomatous node in the uterus. So, when it is located in the submucosal layer from the very beginning of its formation, the woman is bothered by abundant, long periods with clots, which is also associated with impaired uterine tone.

Sometimes the growth of a submucosal myomatous node in the uterine cavity is directed towards the cervical canal, which over time 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, provision of assistance is possible only in conditions medical institution. The main goal of treatment in this case is to stop uterine bleeding, pain relief and surgical removal of the nascent myomatous node, followed by curettage of the uterine cavity.

Heavy periods with clots after 45-50 years

During premenopause, women often experience heavy uterine bleeding. This is due to the aging of the hypothalamus, in which hormonal levels are disrupted towards hyperestrogenism against the background of reduced levels of progesterone, 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 menstruation lengthens. Treatment of this category of patients is mainly surgical and is presented in the form of curettage of the uterine cavity and cervical canal. In the future, hormonal therapy is prescribed to suppress menstrual function.

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 you have such a symptom, you must immediately contact a gynecologist to carry out the necessary examinations. Such bleeding occurs for no 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 estrogen in the blood, which leads to thinning of the vaginal mucosa and increased vulnerability. Such bleeding occurs after physical activity, heavy lifting or sexual intercourse. In any case, if bloody discharge from the genital tract appears, you should seek medical help from a gynecologist.

Heavy, prolonged periods with clots

Menorrhagia, or prolonged heavy periods, can occur in the presence of pathology of the uterus, endometriosis, endometrial hyperplasia, diseases of endocrine origin and blood clotting disorders. This symptom may also be caused by intrauterine contraceptive or an incorrectly selected oral contraceptive. The disease can occur at any age and is not cyclical. This condition is dangerous because, against the background of prolonged heavy bleeding, anemia usually develops, which is difficult to correct due to the presence of a genital cause of bleeding. If recurring episodes of prolonged periods occur, you should contact a gynecologist who will prescribe the necessary diagnostic procedures and treatment.

Heavy, painful periods with clots

Algodysmenorrhea is a disease that plagues a large number of women and is manifested by painful, heavy cyclic menstruation. There are many reasons for this disease. Painful periods can bother women with uterine fibroids, endometriosis, intrauterine contraceptives, abnormal development of the genital organs, as well as inflammatory diseases 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 begins on the first day of the menstrual cycle or the day before it. Pain of a cramping, spastic nature, radiating to the rectum, lower back, and ovarian region. Sometimes, with severe pain and bleeding, a woman experiences nausea, vomiting, and dizziness. This symptom complex leads to temporary disability and requires drug treatment.

Complications and consequences

The main complication that occurs as a result of heavy periods with clots is anemia. Due to the significant amount of blood loss, the reserves of hematopoietic cells are depleted, erythropoiesis is disrupted, which leads to persistent anemia with all the ensuing 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 resume, with the exception of conditions after hysterectomy.

Diagnosis of heavy periods with clots

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

Diagnostics of this disease carried out by an obstetrician-gynecologist, upon initial contact with him with complaints of heavy menstruation with clots. First of all, the doctor collects a detailed somatic anamnesis (history): the presence of diseases of the liver, cardiovascular and endocrine systems, trauma and surgery on the female genital organs. Then menstrual and gynecological history: age at which menarche began, cycle quality, onset of sexual life, sexual activity, gynecological diseases and methods of contraception. It is also important to take medications such as estrogens, antidepressants, anticoagulants, corticosteroids, digoxin and propranolol, which could cause heavy bleeding from the genital tract.

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

Laboratory examination

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

General blood test biochemical analysis blood, coagulogram are carried out to determine the degree of anemia in the body for further correction of anemia.

Hormonal examination over time is recommended for all women suffering from heavy periods to determine their hormonal status. To do this, the levels of FSH, prolactin, LH, testosterone, progesterone and estradiol in the blood serum are determined over time. It is important to examine thyroid and adrenal hormones.

Instrumental diagnostics

Pelvic ultrasound and hysteroscopy are reliable and available methods diagnosis of pathologies of the female reproductive organs. Sometimes hysterosonography is performed (filling the uterine cavity saline solution under the control of an ultrasound machine), which makes it possible to identify submucosal myomatous nodes of the uterus, endometrial polyps, etc.

Diagnostic curettage of the cervical canal and uterine cavity is performed on all menopausal women who have 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 if there are indications for them.

Differential diagnosis

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

So in puberty differential diagnosis carried out with diseases of the hematopoietic system, accompanied by blood clotting disorders and bleeding; dysfunction of the liver and gastrointestinal tract, abnormal development of the genital organs, diseases of the endocrine system (adrenal glands, thyroid gland), foreign bodies of the genital tract and vaginal neoplasms.

Differential diagnosis in reproductive age is carried out with ectopic pregnancy, uterine fibroids, adenocarcinoma, endometrial hyperplasia, endometrial injury from intrauterine contraceptives.

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

Treatment of 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 bleeding, which can be done surgically or medically.

How to stop heavy periods?

The first thing you should do is calm down, as when excited they expand blood vessels and 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, and call an ambulance. It is allowed to take the tablet form of ethamsylate "Ditsinon" 1-2 tablets with water.

For other reasons for 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 helps to narrow blood vessels and reduce bleeding.
• Drink plenty of fluids to replace blood loss.
• Taking medications that stop bleeding, such as: Dicinone 1-2 tablets, maximum 4 tablets per day, 0.25 mg each, Tincture of water pepper, 25 drops 3 times a day, Extract shepherd's purse 25 drops 3 times a day., Calcium gluconate 1-2 tablets 3 times a day.

Further treatment will be prescribed by the gynecologist in accordance with 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 in a drip of 100 ml of a 5% solution of no more than 8 g per day or orally 30 ml 4 times a day. Contraindications for use are coagulopathy, tendency to thrombosis, disorders cerebral circulation history of coronary heart disease. The drug should be prescribed with caution with estrogen-containing contraceptives, which increases the risk of thromboembolism.

Tranexam is an antifibrinolytic drug with local and systemic hemostatic effects. 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 at a dose of 15 mg/kg every 6 hours no faster than 1 ml/min. Contraindications for use are subarachnoid bleeding, renal failure. Prescribed with caution for deep vein thrombophlebitis and thromboembolic syndrome. Side effects occur when the recommended doses are increased or in case of individual hypersensitivity to active substance drug, and may manifest itself as nausea, vomiting, dizziness, development of thrombosis, tachycardia, skin rash, itching, urticaria.

1. Hormone therapy indicated for use based on age and examination results.

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

It is possible to prescribe gestagens: Duphaston, Norkolut, Utrozhestan, 2 tablets per day, followed by a dose reduction.

During reproductive age it should be carried out only nulliparous women if during ultrasound the M-echo of the endometrium does not exceed 8mm. The drugs of choice are: 17OPK 12.5% ​​2 ml IM 1 time per day for 7 days, Duphaston 1 tablet 3-5 times per day, Norkolut 1 tablet 3-5 times per day, followed by a gradual reduction to 1 tablet per day .

17 OPC (oxyprogesterone capronate) is a synthetic progesterone of gestagenic origin in high doses that 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 day 21 to prevent the development of recurrent bleeding. After intramuscular administration, the effect of the drug begins after 5 hours and lasts up to 14 days. Contraindications to the administration of 17OPK are liver dysfunction, a tendency to thrombosis, and malignant formations of the pelvic organs and mammary glands.

During menopause, women over 45 years of age are not recommended to undergo hormonal hemostasis. It is acceptable 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 impaired ovarian function, intramuscular administration of progesterone is prescribed at a dose of 5-15 mg/day for 7 days, followed by a dose reduction if the dynamics are positive.

Gonadotropin-releasing hormone agonists, such as Goserelin and Diferelin, 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, LH synthesis decreases and the concentration of estradiol in the blood decreases. This helps 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 Once every 28 days, which ensures that the effective concentration of the drug in the body is maintained. The drug is contraindicated in pregnant women, lactating women and children. The drug was well tolerated. In rare cases, headaches, mood swings, dryness of the vaginal mucosa, cessation of menstruation, and demineralization of bone tissue may occur.

1. Vitamin therapy. Prolonged, heavy uterine bleeding, as a rule, leads to depletion of the body's resources of vitamins and microelements. 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 r/day.
• Totema 1-5 ampoules per day orally.
• Globiron 1 tablet once a day.
• Sorbifer Durules 1 tablet 1 time per day.
• Maltofer 1 tablet 1 time per day.
• Venofer intravenous drip.

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

Among vitamin preparations, it is justified to prescribe vitamins B6 and B1 alternating for intramuscular administration. It is also recommended to prescribe vitamin E 200 mg per day and routine 200 mg 3 times a day.

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

• Dry nettle leaves pour half a liter of water and boil for 10 minutes, leave for 30 minutes. Take 1 tbsp internally. spoon 5 times a day.
• Shepherd's purse grass 50g, knotweed grass 50g, mistletoe grass 50g. Pour the mixture of herbs into 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 menstruation.
• Buckthorn bark 30g and raspberry bark 30g. Pour boiling water over the collection, leave and drink 1 glass morning and evening.

In folk medicine, to treat heavy periods with clots, not only herbal infusions are used, but also other components for the preparation of medicinal potions.

• A decoction of orange peels has good hemostatic properties. Boil the peels of 5 oranges in 1 liter of water for 1 hour over 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 your period ends.
• Brew 30g of dried and finely chopped herbs and parsley 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.

1. Physiotherapy.

In treatment regimens for heavy uterine bleeding with clots, they are widely used. the following types physiotherapeutic treatment:

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

1. Homeopathy.

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

• Ovarium compositum. It is a complex homeopathic remedy that regulates hormonal levels. It has metabolic, sedative and anti-inflammatory functions. Prescribed 2.2 ml intramuscularly 2 times a week, from the third week 1 time every 5 days. The course of treatment is 10 injections. Contraindications – hypersensitivity to the components of the drug, childhood up to 12 years old. 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 discontinue it.
• Mulimen is a complex homeopathic drug, the action of which is aimed at regulating the balance of gonadotropic and steroid hormones, normalizing vegetative nervous system and stabilization mental state women. Has hormone-regulating, antispasmodic, sedative and drainage properties pharmacological properties. Indicated for use in menstrual irregularities, mastopathy, treatment of side effects hormonal contraception, premenstrual and menopausal syndrome. Prescribed 10-12 drops 2 times a day during the intermenstrual period and on menstrual days 10-15 drops 3-5 times a day, depending on the degree of bleeding. Take 15-20 minutes before meals, holding briefly oral cavity. 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; allergic reactions may occasionally occur.

With the development of heavy periods with clots against the background of an inflammatory process of the pelvic organs, the following are additionally prescribed:

• Gynekoheel is a basic anti-inflammatory agent with vasotonic, anti-edematous and analgesic pharmacological properties. Promotes completion of the inflammatory process, restoration of microcirculation and the formation of new tissue at the site of inflammation. Reduces the risk of complications. Has a regulating effect on the menstrual cycle. Prescribed 10 drops 3 times a day every day, except for menstrual days. Course of treatment 3 cycles. The drug is contraindicated for persons who are allergic to the venom of bees, wasps and bumblebees. No side effects were identified.
• Traumeel S is the first choice drug for any damage to body tissue. It has anti-inflammatory, anti-exudative, regenerating and analgesic pharmacological properties. The drug is contraindicated for use in persons with hypersensitivity to the components of the drug, those suffering from tuberculosis, leukemia, or AIDS. Prescribed 1 tablet 3 times a day. Possible adverse reactions in the form of redness and rash on the skin.

1. Surgical treatment.

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

Therapeutic and diagnostic curettage of the walls of the uterine cavity is carried out under general anesthesia, followed by sending the resulting scraping for pathohistological examination, which makes it possible to determine the cause of bleeding in 80% of cases. After the operation, the patient is prescribed hemostatic and antibacterial therapy.

Endometrial ablation – surgical method Treatment of uterine bleeding, which is carried out using a laser or electrode under the control of a hysteroscope, involves removing the entire layer of the endometrium.

Hysterectomy is radical surgical intervention and consists of removing the uterus. It is the last stage of treatment for uterine bleeding, when the condition cannot be treated with other methods.