Still not clean on the ninth day of menstruation

Still not clean on the ninth day of menstruation may be related to endocrine disorders, uterine lesions, coagulation disorders and other factors. It is recommended to seek medical examination in time.

1. Endocrine disorders

Staying up late for a long time, being under great mental stress or excessive dieting may lead to insufficient luteal function and incomplete shedding of the endometrium. It can manifest as prolonged menstrual periods, reduced menstrual flow, accompanied by fatigue or mood swings. The diagnosis needs to be confirmed through six sex hormone tests. The doctor may recommend using progesterone capsules or dydrogesterone tablets to regulate the cycle, and at the same time improve living habits.

2. Uterine fibroids

Submucosal fibroids may affect uterine contractions, causing menstrual periods to last longer than 7 days, often accompanied by increased blood clots and lower abdominal distension. Ultrasound examination can confirm the diagnosis. For fibroids less than 5 cm in diameter, mifepristone tablets can be tried for tumor reduction. Larger fibroids require hysteroscopic resection.

3. Endometrial polyps

Polyps occupy space and hinder intimal repair, which can easily cause spotting and bleeding lasting for more than 9 days. In some patients, bleeding occurs after intercourse. Hysteroscopy is the gold standard. Polyp removal is required after diagnosis. Drospirenone and ethinylestradiol tablets can be taken for a short period of time after surgery to prevent recurrence.

4. Abnormal coagulation function

Thrombocytopenia or vitamin K deficiency can weaken the coagulation mechanism, causing thin and prolonged menstrual blood, which may be accompanied by gum bleeding. Four items of coagulation need to be tested. For mild abnormalities, tranexamic acid tablets can be supplemented. For severe cases, coagulation factors need to be infused.

5. Impact of intrauterine devices

Copper-containing IUDs may stimulate the endometrium to produce sterile inflammation, causing the menstrual period to extend to 9-10 days, usually within six months after placement. After ultrasonography excludes displacement, the patient can be observed for 3 months. If bleeding continues, the patient needs to be removed and replaced with a levonorgestrel sustained-release intrauterine system.

During prolonged menstruation, strenuous exercise and cold or raw food should be avoided, the vulva should be kept clean and dry, and pure cotton underwear should be changed every day. Iron-rich foods such as animal liver and dark green vegetables can be added in an appropriate amount to prevent anemia. If bleeding is accompanied by severe abdominal pain, fever or dizziness, emergency treatment is required immediately. Daily recommendations include recording menstrual cycles and bleeding characteristics to provide a reference for doctors’ diagnosis.