Why can a woman bleed? How to recognize uterine bleeding. Pathological uterine bleeding: signs

Uterine bleeding manifests itself in the form of bloody discharge from the vagina, it can occur due to serious diseases in women. The essence of treatment lies in the diagnosis, in the correct and rapid therapy. After all, such a disease leads to difficult consequences and even to death.

What is uterine bleeding

Uterine bleeding - the discharge of blood from the uterus, differs from critical days in that the amount and time when the discharge occurs changes.

Rates of blood loss during menstruation

Menstruation is physiological process, which on average begins at 11 years old and ends at 55. It lasts for 3-7 days and occurs every 28-35 days. For one menstrual cycle the girl secretes from 50 to 80 ml of blood.

Regular critical days stop during childbearing and after childbirth. They may also be absent during breastfeeding.

Types and causes of bleeding from the vagina

The vagina may also bleed into certain periods woman's life:

1. Juvenile- the stage of sexual development;
2. reproductive- childbearing age;
3. Climacteric- at menopause.

According to the nature of blood secretions are divided into:

The main symptoms of hemorrhage

The main signs of vaginal blood loss:

• Dysfunctional hemorrhage is painless;
• After childbirth up to 2 months;
• Prolonged discharge after an abortion;
• Blood loss while taking hormonal contraception;
• With polyps in the uterus;
• Myoma inside the vagina;
• intrauterine pregnancy;
• Bleeding is associated with cancer.

What is dangerous bleeding from the uterus?

If uterine hemorrhage does not end long time, then it is difficult to stop, which is why such a pathology is very dangerous for women's health and has the following consequences:

• Anemia may develop (if the volume of blood that came out is more than 80 ml);
• Large blood loss due to hemorrhage, which is difficult to identify, most often requires surgical intervention;
• The risk of developing the underlying disease, which caused hemorrhage;
• Risk of hemorrhage in pregnant women or in the postpartum period

Signs of uterine bleeding in the reproductive period

In the childbearing period, there are a lot of factors that can cause pathology.

This happens due to:

• Disturbances in the production of hormones after termination of pregnancy;
• With stress;
• In the presence of infectious diseases;
• intoxication;
• When taking medication.

During the bearing of the baby, and especially on early dates, the uterus may bleed due to a miscarriage. In the later stages, the uterus may bleed due to placenta previa. It is especially dangerous when it bleeds during and after childbirth, then the amount of blood loss can be very large.

Also, the cause of bleeding can be such diseases:

• Myoma;
• Endometriosis of the body of the uterus;
• Tumors in the cervix;
• Chronic inflammation of the cervix.

Bleeding in an ectopic pregnancy

Symptoms ectopic pregnancy exactly the same as in the normal bearing of a child:

• Lack of menstruation;
• The uterus has increased;
• The chest is poured;
• Toxicosis;
• Change in taste preferences.

Hemorrhage during ectopic pregnancy is a common phenomenon, it happens due to the fact that pregnancy can become the main factor in the rupture of the tubes or when interrupted. The intensity of excretion does not always depend on the mechanism of abortion, although tubal ruptures are accompanied by greater blood loss than with medical interruption pregnancy.

Intrauterine hemorrhages with menopause in women

During menopause in women, hormonal changes body, so the vagina often bleeds. Great care must be taken with discharge during the period when menstruation has stopped. It is important to immediately consult a doctor at the first signs, since the treatment of neoplasms in the first stages is more successful.

Causes of uterine hemorrhage in menopause:

• Abundant blood discharge;
• Discharge with clots;
• Bleeding that occurs between critical days;
• The duration of discharge is longer than usual.

Why does vaginal bleeding occur on nerves?

Dysfunctional uterine blood loss is said to be when there is no reason for the appearance of blood discharge. They may be due to strong experiences, psychological and emotional stress and on nerves. The methods of therapy will be similar, perhaps the doctor will prescribe sedative medication to relieve stress.

Diagnostics

At the first suspicion of the development of the disease, it is important to immediately see a doctor.

In order to determine the source from which the pathology arose, the following measures are taken:

• Consultation with a gynecologist;
• Blood tests;
• ultrasound of the uterus;
• vaginoscopy;
• Biopsy of the cervix.

Accurate diagnosis is essential in the recovery process.

How to stop bleeding from the vagina?

In order to stop, you need to diagnose main factor the appearance of blood loss, then experts choose a way to stop it. Most often, hemostatic agents are used, with a large loss of blood, it is transfused. Also, another way to stop (during a miscarriage, abortion, or childbirth) is the curettage of the uterine cavity, if the bleeding has not been stopped, then doctors resort to surgical interventions.

You can stop bleeding at home by following these rules:

• Peace;
• Cold in the lower abdomen;
• Plentiful drink;
• Means that restore blood.

It is important after these measures to seek the advice of a specialist.

Principles of therapy in the hospital:

• Taking hemostatic drugs;
• Hormones Oxytocin;
• Hormonal contraceptives;
• Tampons.

Surgical methods:

• Scraping;
• Cryodestruction of the endometrium;
• Uterus removal.

Treatment of uterine bleeding

The main task of such therapy is to stop bleeding, eliminate the source of the disease and prevent treatment. Therapy is carried out in a hospital, first of all, specialists conduct diagnostics in order to find out what caused the pathology.

Methods of treatment directly depend on the source of the disease, age, severity of the patient's condition.

The following medicines are used:

• Hemostatic drugs;
• Means that reduce the uterus;
• With low hemoglobin levels - drugs that contain iron;
• Vitamins and drugs that strengthen blood vessels.

After the discharge has stopped, prophylaxis is carried out.

Hemostatic agents for bleeding from the vagina include:

• Dicynon;
• Etamzilat;
• Vikasol;
• Calcium preparations;
• Aminocaproic acid.

In addition to these drugs, the patient may also be prescribed drugs that reduce the uterus:

• Oxytocin;
• Pituitrin;
• Hyphotocin.

Video: dysfunctional uterine bleeding

Blood is the basis of life human body. Any blood loss potential danger for human life and health. In women, uterine bleeding is the most common cause of blood loss. The incidence of uterine bleeding ranges between 12 and 30%, with the likelihood of uterine bleeding increasing with a woman's age and decreasing with an increase in the number of births and the length of periods breastfeeding. And although in most cases, uterine bleeding does not pose an immediate danger to a woman's life, they often lead to the development of anemia, worsen a woman's well-being, appearance and mood, and limit her sexual, physical and social activity.

Uterine bleeding is normal

Physiological (normal) uterine bleeding includes only menses (period). Normally, the duration of menstruation is 3-5 days, the interval between the first day of the previous menstruation and the first day of the next menstruation (menstrual cycle) is 21-35 days (average 28 days). As a rule, the first 1-2 days of menstruation are meager, the next 1-2 days are more abundant and last days- again scarce. The total blood loss during menstruation should not exceed 50-80 ml (the total volume of discharge, together with the shedding layer of the endometrium, which looks like mucus - no more than 150 ml - about 8-10 pads). Blood loss exceeding 80 ml is fraught with the development of iron deficiency anemia.

Menstruation should be painless. The first menstruation comes at the age of 11-15 years. The menstrual function lasts the entire reproductive period of a woman, interrupted by periods of pregnancy, childbirth and breastfeeding. Completion of menstrual function (onset of menopause) occurs on average at the age of 45-55 years.

Important! The appearance of "menstruation" in girls before puberty (up to 10-11 years old) and in women after menopause (cessation of menstrual function) is a pathological symptom that requires immediate medical consultation (children's, adolescent or adult gynecologist). In most cases, such spotting is a symptom of a serious illness.

Uterine bleeding - between norm and pathology

Bloody discharge in the middle of the menstrual cycle can be considered as a variant of the norm. The reason for such exclusions is sharp fluctuation hormone levels during ovulation (immediately after it), which leads to an increase in the permeability of the walls uterine vessels sweating through vascular walls erythrocytes and the appearance of blood in the vaginal discharge. Usually such discharge is scarce, lasting no longer than 1-2 days. However, in some cases, the appearance of spotting in the middle of the cycle is a manifestation of a hormonal failure or an inflammatory process, therefore, at the first appearance of such discharge, it is necessary to consult a gynecologist to exclude these diseases.

Another almost normal type of bleeding from the vagina that is not associated with menstruation is implantation bleeding occurring on the 7th day after conception. The cause of implantation bleeding is the introduction of the embryo into the wall of the uterus, during which there is a partial destruction of the structures of the mucous membrane of the uterus, which can lead to the appearance of minor spotting. However, in some cases uterine bleeding during this period, it may be a manifestation of a deficiency of the hormone progesterone and a sign of a threatened abortion.

Important! Even if, in your opinion, you have one of the two indicated types of bleeding, it is better to consult a doctor (planned) and make sure that everything is really in order with your health.

Uterine bleeding - pathology

All other types of uterine bleeding are pathological. Depending on the reason causing development bleeding, uterine bleeding are divided into functional (or rather dysfunctional), organic and bleeding associated with systemic diseases (for example, diseases of the blood, liver, kidneys, thyroid gland). The last category of uterine bleeding is relatively rare.

Dysfunctional uterine bleeding- this is abnormal (often occurring, excessively profuse or prolonged) bleeding from the uterus, which is based on a violation hormonal regulation menstrual cycle. The reason for the violation of the hormonal regulation of the menstrual cycle is often psychological stress, induced abortion (as a cause of hormonal stress), the use of certain medicines(for example, sleeping pills or antidepressants), inadequate and irrational nutrition, mental and physical overwork. Most sensitive to impact adverse factors female body becomes during puberty and before menopause, when ovarian function is unstable, prone to fluctuations. Bleeding is caused by insufficient or over-education female sex hormones - estrogens and progesterone, which have a decisive influence on the state of the uterus and the processes occurring in it. Dysfunctional uterine bleeding is divided into ovulatory (in which ovulation persists) and anovulatory (in which ovulation is absent).

ovulatory uterine bleeding often occur in the background inflammatory processes in the genitals or adhesions in the pelvis. Such a violation of the menstrual cycle is characterized by a shortening or lengthening of the interval between menstruation, followed by abundant long periods. Very often, women suffering from ovulatory bleeding have spotting before and after menstruation, as well as spotting in the middle of the menstrual cycle. Ovulatory uterine bleeding is often accompanied by infertility and miscarriage as manifestations of hormonal imbalance in a woman's body. Ovulatory bleeding occurs mainly in women of childbearing age.

Anovulatory uterine bleeding occur about 10 times more often than ovulatory ones. As already mentioned, with this type of uterine bleeding, ovulation does not occur, corpus luteum and during the entire menstrual cycle in the body of a woman only one sex hormone is produced - estrogen, and progesterone is absent. This state of affairs during long-term existence leads to the development of hyperplasia (excessive growth) of the uterine mucosa, the development of fibroids, endometriosis, and eventually endometrial cancer. Anovulatory uterine bleeding very often occurs in women in the premenopausal period (premenopause), somewhat less often in adolescent girls, and even less often in women of reproductive age. Anovulatory uterine bleeding is characterized by the occurrence of bleeding after a delay in menstruation and a longer than normal duration of bleeding. Bleeding can be profuse or moderate, but due to its long duration, it almost always leads to the development of anemia, which is externally manifested by pale skin, weakness, increased fatigue, drowsiness, impaired appetite, lowering blood pressure and increased heart rate.

Important! Any increase in the duration or intensity of menstrual bleeding is absolute reading to visit a gynecologist (this recommendation does not depend on the age of the woman, it applies to adolescents and adult women). The more abundant and prolonged bleeding, the sooner medical attention is needed. In case of heavy bleeding, it is necessary to call " ambulance”and agree to hospitalization in a gynecological hospital.

Organic uterine bleeding associated with the presence of diseases such as endometriosis, uterine fibromyoma, endometrial polyp, cancer of the body or cervix, inflammatory diseases of the uterus and appendages. With these diseases, uterine bleeding occurs on any day of the menstrual cycle, has a different intensity, nature of discharge and duration. This type of uterine bleeding is chronic and along with the main disease quickly depletes the compensatory reserves of the female body.

Examination and treatment for uterine bleeding

Uterine bleeding in adolescence

The examination includes a consultation with an adolescent gynecologist, pediatrician, neuropathologist, hematologist, endocrinologist. The gynecologist conducts a gynecological examination (for virgins - through the rectum), evaluates the structure of the internal genital organs. Tests in progress functional diagnostics, a blood test for the level of sex hormones, ultrasound of the pelvic organs is performed, general and biochemical analysis s blood, according to indications (if diseases of the liver, kidneys, blood, etc. are detected), the examination is expanded.

In the treatment of uterine bleeding in adolescents, drugs are prescribed that reduce the uterus, hemostatic agents and strengthen the vascular wall, vitamins, herbal preparations, iron preparations, and in some cases hormonal preparations are prescribed ( oral contraceptives) to regulate the menstrual cycle.

Uterine bleeding in reproductive age

Diagnostic measures for detecting uterine bleeding in a woman of reproductive age begin with curettage of the walls of the uterine cavity and cervical canal followed by histological examination of the obtained scraping. Curettage not only allows you to identify the causes of bleeding, it also has healing effect- removal of an inferior layer of the endometrium, blood clots, as well as a mechanical effect on the walls of the uterus leads to a contraction of the uterine muscles and the cessation of bleeding. Additional examination methods for uterine bleeding in adult women are ultrasound of the pelvic organs, hysteroscopy and hysterosalpingography, as well as a general and biochemical blood test, a blood test for hormone levels, and consultations of related specialists.

Treatment of uterine bleeding in reproductive age(in addition to scraping the walls of the uterine cavity, which is performed in 100% of cases to exclude precancerous and cancerous processes in the body and cervix), it also consists in prescribing hormonal drugs, the action of which is aimed at restoring the normal regulation of the menstrual cycle and preventing recurrent bleeding. From medical methods The same drugs are used for treatment as for the treatment of bleeding in adolescents. If the cause of uterine bleeding is an organic disease of the organs of the reproductive system ( nodal shape uterine endometriosis, uterine fibromyoma, uterine cancer, recurrent endometrial hyperplasia) is performed surgery removal of the uterus with or without appendages.

Examination and treatment for uterine bleeding in premenopause carried out similarly to those for bleeding in the reproductive period.

Because the postmenopausal uterine bleeding in the vast majority are a manifestation of oncological pathology in the body, cervix or ovaries, treatment is carried out mainly surgically(removal of the uterus with appendages).

Uterine bleeding and pregnancy

A few stand out uterine bleeding associated with pregnancy. These bleedings occur mainly in the reproductive period in the presence of sexual contacts with men in the life of a woman. The most common causes of bleeding associated with pregnancy are miscarriage, ectopic pregnancy, bleeding from the vessels of the cervix in the presence of its diseases, placenta previa, premature detachment of a normally located placenta.

Miscarriage leads to the development of uterine bleeding, which is preceded and accompanied by cramping pains in the lower abdomen. The color of the blood during a miscarriage is bright red or dark red, the intensity of bleeding is often quite strong. As a rule, bleeding associated with a miscarriage occurs against the background of a delay in menstruation and the presence of other indirect signs pregnancy ( morning sickness, changes in appetite, mood, etc.).

Bleeding in an ectopic pregnancy also occurs after a delay in menstruation. Pain in the lower abdomen at the same time are cramping or constant in nature and are very intense. Often pain and bleeding are accompanied by nausea, vomiting, cold sweat, fainting. Bloody discharge has dark color, with clots.

Bleeding from damaged vessels of the cervix often it is contact - that is, it occurs after sexual intercourse, an ultrasound scan with a vaginal sensor, gynecological examination. Such bleeding often occurs in the presence of pseudo-erosion of the cervix. As a rule, contact bleeding has the character of small spotting, sometimes it is the appearance of blood streaks in the composition of the mucous membranes. vaginal discharge. However, in some cases, bleeding can be quite heavy. Only a doctor can distinguish contact bleeding from the cervix from uterine bleeding that has arisen for another reason. Therefore, even small spotting during pregnancy should be a reason to seek medical help.

Uterine bleeding caused by placenta previa, develops in the 2nd or 3rd trimester of pregnancy. The cause of the bleeding is abnormal low position placenta, which in this case is located in the lower part of the uterus and closes the exit from it. Bleeding develops against the background full health, not accompanied painful sensations, is often very abundant, which poses a threat to the life and health of the pregnant woman and her fetus.

In the second half of pregnancy, life-threatening uterine bleeding associated with premature detachment normally located placenta. This bleeding is often preceded by threatened miscarriage, excessive exercise stress, a blow to the stomach. Bleeding can have a different intensity (in some cases, most of the blood remains between the placenta and the uterine wall, increasing the detachment, impregnating the walls of the uterus and aggravating the condition of the woman and fetus), accompanied by an increase in uterine tone, abdominal pain, increased activity fetus.

Important! Bleeding from the genital tract during pregnancy is potentially very dangerous. Therefore, when even slight bleeding occurs, it is necessary to quit everything, call an ambulance and wait for the doctor, taking horizontal position.

Finally

As you probably already understood, uterine bleeding can be the result of huge amount reasons, to understand which only by the amount, appearance of the released blood and the accompanying bleeding general symptoms almost impossible. Therefore, any bleeding from the genital organs that differs from normal menstruation by the time of occurrence, intensity, duration or nature of the discharge should be a danger signal for a woman of any age, a girl and a girl, and a reason for an immediate appeal to a gynecologist. Take care of your health!

Abnormal vaginal bleeding includes:

• menstruation that is excessively heavy (menorrhagia or hypermenorrhea) or too frequent (polymenorrhea);
• bleeding that is not associated with menstruation, occurring irregularly between periods (metrorrhagia);
• bleeding that is excessive during menstruation and occurs irregularly between periods (menometrorrhagia);
• postmenopausal bleeding (i.e. more than 6 months after the cessation of the last menstruation.

Vaginal bleeding can also occur in early or late pregnancy.

Most abnormal vaginal bleeding is due to:

• with hormonal disorders in the hypothalamic-pituitary-ovarian system (the most common cause);
• structural, inflammatory or other gynecological diseases(for example, tumors);
• bleeding disorders (rare).

With hormonal disorders, ovulation does not occur or occurs infrequently. With anovulation, the corpus luteum does not form and, therefore, does not occur normally. cyclic secretion progesterone. Without progesterone, estrogen stimulates the proliferation of the endometrium, increasing its blood supply. The endometrium then sheds unevenly and bleeds, sometimes for a long time.

Common Causes of Vaginal Bleeding in Children

• foreign body
• Vulvovaginitis
• Trauma related or not related to sexual abuse
• premature puberty
• Hemorrhagic cystitis
• Hemorrhagic diathesis
• Tumors
• urethral prolapse
• Exposure to exogenous sex hormones

The reasons for adults and children may be different.

In general, the main causes in adult women who are not pregnant are as follows:

• complications of early undiagnosed pregnancy;
• anovulatory bleeding;
• submucosal fibroids;
• bleeding in the middle of the cycle associated with ovulation;
• breakthrough bleeding while taking contraceptives.

foreign body - common cause vaginal bleeding in children. Bleeding with foul-smelling discharge is suspicious of a foreign body in the vagina. Ultrasound is often helpful. The diagnosis is confirmed by vaginoscopy. Flushing with liquid often removes foreign body and troubleshooting.

Poor hygiene often predisposes to recurrent vulvovaginitis. Adequate advice on personal hygiene is needed.

Most injuries to the genital area happen by accident (unintentionally). However, if a vaginal injury is suspected, violence should be considered. sexual in nature. Blunt trauma causes hematoma formation. A small vaginal hematoma can be treated with local pressure. Recommend the use of analgesics.

A penetrating injury to the vagina requires a very thorough examination and serious consideration of the possibility of child sexual abuse. If you suspect sexual abuse, you should urgently contact the pediatricians of the hospital. If necessary, other services are involved - the police and social services. If sexual abuse is suspected, the child should be examined by a pediatrician who specializes in child sexual abuse in order to collect information with minimal discomfort for the child.

In young girls, vaginal bleeding is the first manifestation precocious puberty. This is discussed in detail in the corresponding section.

Two common causes hemorrhagic cystitis - adenovirus infection and toxic effect drugs (cyclophosphamide). Ordinary Clinical signs- sterile hematuria, dysuria, imperative urge to urinate. Viral infection resolves on its own, drug toxicity disappears after discontinuation of the drug.

Blood diseases. For diagnosis, a detailed history taking and a general examination with a detailed blood test and screening tests of the coagulation system are used. Treatment depends on the underlying cause.

Blood disorders in children that may cause vaginal bleeding

urethral prolapse - known cause urethral bleeding, although rare. It is characterized by prolapse of the mucosa through the urethra in the form of a bleeding formation in the vulva. With a large "education" dysuria occurs. Helps often topical application estrogen.

Benign and malignant tumors vulvae are manifested by vaginal bleeding. Botrioid sarcoma is a vaginal cancer that occurs primarily in girls under 2 years of age (90% - up to 5 years). Mesonephric cancer usually affects girls older than 3 years. Clear cell adenocarcinoma is often associated with antenatal exposure to diethylstilbestrol. If any of these conditions is suspected, an urgent referral to a pediatric oncologist is necessary for confirmation of the diagnosis, treatment, and counseling.

Capillary venous malformation of the labia majora has been described as a cause of vaginal bleeding in children. Differential Diagnosis- between capillary hemangioma and other vascular defects. The malformation is locally excised.

Diagnosis of bleeding from the vagina

Undiagnosed pregnancy should be suspected in women of childbearing age because some causes of bleeding during pregnancy (eg, ectopic pregnancy) are life-threatening.

Story. History of present illness should include quantification (number of pads used per day or per hour) and duration of bleeding, as well as the relationship of bleeding to menstruation. It is necessary to evaluate menstrual function; including date of last normal menses, age of menarche and menopause, length and regularity of cycle, number and duration of menstrual bleeding, previous episodes of abnormal bleeding, including frequency, duration, amount and pattern of bleeding.

Review. Look for symptoms, including missed periods, breast swelling, and nausea (bleeding associated with pregnancy); abdominal pain, dizziness and fainting (ectopic pregnancy or ovarian cyst rupture), chronic pain and weight loss (cancer); and easy bruising, bleeding gums when brushing teeth, minor wounds, or venipuncture (impaired hemostasis).

Medical history should identify the cause of bleeding, including recent spontaneous or induced abortions and structural disturbances(eg, uterine fibroids, ovarian cysts). Doctors should look for risk factors for endometrial cancer, including obesity, diabetes, hypertension, and long-term use estrogens without progesterone) and polycystic ovary syndrome. Specific questions about hormone use should be included earlier.

Physical research. Signs of hypovolemia (eg, tachycardia, tachypnea, hypotension) are considered.

During a general examination, doctors should look for signs of anemia (eg, pale conjunctiva) and signs of possible causes bleeding, which includes:

• warm and wet or dry skin, blurred vision, tremors, impaired reflexes, goiter (thyroid disease);
• hepatomegaly, jaundice, asterixis, splenomegaly (liver disease);
• discharge from the nipple (hyperprolactinemia);
• low body mass index and loss subcutaneous fat(possibly anovulation)
• High body mass index and excess subcutaneous fat;
• hirsutism, acne, obesity and enlarged ovaries;
• easily formed bruises, petechiae, purpura, bleeding of mucous membranes, such as gums (impaired hemostasis);
• in children, the development of mammary glands and the presence of pubic and axillary hair (puberty).

The abdomen is examined for bloating, tenderness, and the presence of masses (particularly an enlarged uterus). If the uterus is enlarged, you should listen to the fetal heartbeat.

A complete gynecological examination is performed in all cases except late dates pregnancy; in the latter case, bimanual examination is contraindicated until the location of the placenta is established. In all other cases, speculum examination is helpful in identifying lesions in the urethra, vagina, and cervix. A bimanual examination is done to assess the size of the uterus and ovaries. If there is no blood in the vagina, a rectal examination is needed to determine if GI disease is causing the bleeding.

Warning signs. The following signs are of particular concern:

• hemorrhagic shock (tachycardia, hypotension);
• perimenarchal and postmenopausal vaginal bleeding;
• vaginal bleeding in pregnant women.

Interpretation of symptoms. Significant hypovolemia or hemorrhagic shock is unlikely, except for a disturbed ectopic pregnancy or, less commonly, a ruptured ovarian cyst (especially in the presence of a tender mass in the pelvis).

In children, breast development and growth of pubic and axillary hair suggests precocious puberty and premature menstruation. In the absence of these signs, the possibility of sexual abuse should be assessed, except in the presence of easily explained lesions or foreign bodies.

In women of reproductive age, gynecological or other pathological foci may be found, indicating the causes of bleeding. If young patients on hormone therapy, have no obvious abnormalities, bleeding is likely due to hormonal therapy. If the problem is only excessive menstrual bleeding, it is necessary to consider causes such as uterine pathology or hemorrhagic diathesis. Hereditary disorders of hemostasis may initially manifest as heavy menstrual bleeding at menarche or during adolescence.

In postmenopausal women, cancer should be suspected.

Dysfunctional uterine bleeding, the most common cause in the reproductive years, is a diagnosis of exclusion after other causes have been excluded; usually requires additional testing.

Study. All women of reproductive age should have a urine test for pregnancy.

In early pregnancy (before 5 weeks), a urine pregnancy test may not give a positive result. Contamination of urine with blood can give an incorrect result. A serum test for the β-hCG subunit ((5-hCG) should be performed if the urinalysis shows a negative result, but pregnancy is suspected.

Testing should include a CBC if bleeding is more than normal (eg, more than 1 pad or tampon per hour) or lasts for several days, or if anemia or hypovolemia is suspected. In the case of anemia that is not clearly associated with iron deficiency (as indicated by microcytic and erythrocyte indices), it is necessary to analyze the level of iron in the blood.

Thyroid-stimulating hormone and prolactin levels are usually measured, even if there is no galactorrhea.

If hemostasis is suspected, the von Willebrand factor, platelet count, PT and PTT should be determined.

If a symptom of polycystic ovaries is suspected, the level of testosterone and dehydroepiandrosterone sulfate (DHEA) should be established.

Imaging includes transvaginal ultrasound procedure, if:

• woman >35 years old,
• There are risk factors for endometrial cancer
• bleeding continues despite hormone therapy.

Local endometrial thickening detected on ultrasound may require hysteroscopy or sonohysterography to detect small intrauterine formations(eg, endometrial polyp, fibroids).

Other studies include endometrial sample analysis and ultrasound in women over 35 years of age who are at risk for cancer or endometrial thickening greater than 4mm. Endometrial sampling can be done by aspiration or, if the cervical canal requires dilatation, by curettage.

Treatment of vaginal bleeding

Carry out treatment hemorrhagic shock. Women with iron deficiency anemia may be required additional reception iron preparations.

The choice of treatment for vaginal bleeding depends on the cause.

Fundamentals of Geriatrics

Postmenopausal bleeding (more than 6 months after the onset of menopause) is abnormal and requires further investigation to rule out cancer.

In women not taking exogenous hormones, the most common cause of postmenopausal bleeding is atrophy of the endometrium or the lining of the vagina. In some older women, vaginal examination can be difficult due to a lack of estrogen, which leads to mucosal fragility and stenosis. For such patients, examination with a pediatric speculum may be more comfortable.

Acute pathological uterine bleeding is a common problem faced by practicing gynecologists. Even one-time such cases sometimes require immediate medical intervention. The causes of this pathology are numerous. To solve the problem and understand how to stop uterine bleeding, it is necessary to take into account the woman's age, her menstrual function and medical history, risk factors for endometrial pathology and blood coagulation.

Etiology of acute abnormal uterine bleeding

The etiology of uterine bleeding can be multifactorial. This pathology is classified as associated with structural abnormalities of the uterus and disorders in the blood coagulation system. This happens for reasons:

• polyp;
• hyperplasia;
• adenomyosis;
• leiomyomas;
• cancerous processes of the body and cervix;
• coagulopathy;
• ovulatory dysfunction;
• endometriosis;
• pregnancy;
• iatrogenic factors.

Determination of the most probable etiology has importance in choosing the most appropriate and effective way bleeding control for a particular patient and is achieved by taking an anamnesis, physical and gynecological examination and blood tests.

Clinical examination of hemostasis disorders in a woman with excessive menstrual bleeding

Initial screening for an underlying disorder of hemostasis in such women should be based on their medical history. Positive result research includes the following:

• heavy menstrual bleeding, starting with menarche;
• postpartum hemorrhage;
• operations accompanied by blood loss;
• violations of the coagulation system in the treatment of teeth.

In this case, the following conditions must be taken into account:

• hematomas once or twice a month;
• frequent nosebleeds;
• persistent bleeding from the gums;
• symptoms of coagulopathy in close relatives.

History or anamnesis

Obtaining a thorough anamnesis is necessary to focus on the circumstances of the bleeding. This takes into account concomitant symptoms and past causes of menstrual irregularities, details of gynecological and medical history and data from relevant laboratory and radiological tests.

Up to 13% of women with severe menstrual bleeding have a variant of von Willebrand disease and up to 20% of patients may have bleeding disorders. Other causes of coagulopathy, such as decreased clotting factors, hemophilia, and platelet dysfunction, can occur in any age group. In addition, at systemic diseases such as leukemia and liver failure, and when taking medications such as anticoagulants or chemotherapy drugs, clotting may decrease and this may cause bleeding. All this is taken into account in the development of tactics for solving the upcoming question: how to stop uterine bleeding.

Physical examination

Physical examination of a patient with uterine bleeding should begin with an assessment of acute blood loss and the main symptoms, which are hypovolemia, anemia, and findings that suggest an etiology of the disease. The woman's condition should be assessed so that the doctor can determine that she has uterine bleeding and not bleeding from other areas of the genital tract. Thus, a gynecological examination, including examination of the cervix in the mirrors and bimanual palpation, should be performed by a gynecologist in order to identify any injuries to the genitals, vagina, or cervix. All this allows us to draw conclusions, which was the cause that caused vaginal bleeding. Gynecological examination will also determine the volume, intensity of bleeding, the condition of the uterus, internal genital organs or structural lesions of the reproductive organ (leiomyoma).

Laboratory research

Laboratory evaluation of patients with this disease is necessary. All adolescents and women are carefully examined for hemostasis disorders. Taking into account clinical picture it is required to take into account the pathology of the thyroid gland, liver dysfunction, sepsis, leukemia, etc. Endometrial tissue sampling should be performed in all women. This is especially true for patients over 45 years of age. Endometrial biopsy should also be performed in women younger than 45 years of age with a history of exposure to unconjugated estrogens (eg, observed in patients with obesity or polycystic ovary syndrome), a primary bleeding event, or with persistent such manifestations. The decision as to whether to perform a pelvic ultrasound should be based on clinical assessment data.

Initial laboratory testing requires:

• determination of the group and Rh factor;
• pregnancy test;
• registration of activated partial thromboplastin time;
• prothrombin time;
• determining the amount of fibrinogen;
• initial testing for von Willebrand disease;
• determining the level of thyroid-stimulating hormone;
• detection of serum iron, total iron-binding capacity and ferritin;
• liver function tests;
• detection of chlamydia trachomatis.

Control of acute abnormal uterine bleeding in non-pregnant women of reproductive age

The initial assessment of a patient with acute abnormal uterine bleeding should be to test her for signs of hypovolemia and potential hemodynamic instability. Measures to stop bleeding are intravenous administration conjugated estrogens, combined oral contraceptives, oral progestins and tranexamic acid. Decisions should be based on the patient's medical history and contraindications to therapy. Surgery should be considered for those women who are not clinically stable. The choice of surgical intervention should be based on the patient's underlying comorbidities underlying the pathology and the woman's desire to have children in the future. Once an acute episode of bleeding has been resolved, transition to long-term maintenance therapy is recommended.

Uterine bleeding is defined as bleeding from the body of the uterus if it is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy. This pathology can be acute or chronic. Acute bleeding is a situation that requires immediate intervention to prevent further blood loss. An acute process can occur spontaneously or in conditions of chronic spotting or bleeding. Overall rating patient who has this pathology must go through three steps:

• determination of the amount of blood loss;
• clarification of the most probable etiology;
• choosing the right treatment.

Treatment

Limited evidence, expert opinion and recommendations decide how to quickly stop uterine bleeding. The choice of the method of therapy in this case depends on the clinic and etiology, taking into account the main medical problems. The two main goals of management are to stop bleeding and control to reduce menstrual blood loss in subsequent cycles. Medical therapy is considered the preferred option primary treatment. However, certain situations may necessitate surgical intervention.

Basic drugs

How to stop uterine bleeding? The drugs that are used for this purpose are hormonal agents. They are considered the first line of medical therapy for patients with acute bleeding. Treatment options include combined oral contraceptives and oral progestins.

Antifibrinolytic drugs such as tranexamic acid are used to prevent fibrin degradation and are effective in treating patients with any form of bleeding. Tranexamic acid effectively reduces the rate of intraoperative blood loss and removes indications for blood transfusion in surgical patients.

Patients with coagulation disorders or those who are suspected of bleeding may develop unpredictable reactions to hormonal and non-hormonal treatments. For such patients, consultation with a hematologist is recommended, especially if the bleeding is difficult to control or the gynecologist cannot cope with this pathology on his own. Desmopressin may help treat patients with von Willebrand's disease if the woman is known to respond to this drug. It can be administered as an intranasal inhalation, intravenously or subcutaneously. This remedy should be used with caution due to the risk of fluid retention and hyponatremia. It should not be given to patients with massive bleeding receiving intravenous resuscitation. Recombinant factor VIII and von Willebrand factor are also available and may need to be monitored serious bleeding. Other disadvantage factors may require factor-specific substitutions.

Patients with bleeding disorders or platelet dysfunction should avoid non-steroidal anti-inflammatory drugs because of their effect on platelet aggregation and their interaction with substances that can affect liver function and the production of blood clotting factors.

Surgery

How to stop uterine bleeding with endometrial hyperplasia or with myoma? Need surgical treatment based on the clinical stability of the patient, the severity of bleeding, the presence of contraindications for therapeutic treatment, lack of response to medications and concomitant pathology. Surgical Options include dilatation and curettage of the endometrium, its ablation, embolization uterine arteries and hysterectomy. The choice of the method of surgical intervention is made on the basis of the above factors plus the desire of the patient to maintain fertility in the future.

Specific procedures such as hysteroscopy, polypectomy, myomectomy may be required if structural abnormalities are suspected as the cause of the identified pathology. And so the question of how to stop uterine bleeding with myoma or polyposis is decided in favor of surgical methods. Dilation and curettage alone (without hysteroscopy) is an inadequate tool for evaluating uterine dysfunction and may provide only temporary relief from bleeding. If they are performed with concomitant hysteroscopy, then this may be important for those patients in whom intrauterine pathology suspected, or desirable to obtain a tissue sample to identify certain processes. Case reports of uterine artery embolization and endometrial ablation have shown these procedures to be successful in managing bleeding. Endometrial ablation, although readily available at most centers, should only be considered if other treatments have failed or are contraindicated. This procedure should only be performed when the woman has no plans for future childbearing and uterine cancer has been reliably excluded as the cause. Hysterectomy is used as the definitive treatment for profuse bleeding, which may be necessary for patients who do not respond to drug therapy.

Thus, it was listed in what ways and how to stop uterine bleeding in the hospital.

Special cases

In most cases, a woman does not know why she has bleeding, and does not suspect that she has certain predisposing factors for the development of this uterine pathology. But sometimes there are diseases that the patient knows about, and it is her information, as well as additional methods Examinations help in clarifying the diagnosis and choosing a specific treatment strategy.

Bleeding during pregnancy

During perimenopause, the most common cause of abnormal bleeding is hormonal changes that prevent ovulation. Regular but much more hard periods very common in the years leading up to menopause. For women in their 40s, low-dose birth control pills can also help control heavy uterine bleeding. How to stop it and deal with other perimenopausal symptoms, including hot flashes, night sweats, premenstrual syndrome and headaches? This will help the use of tableted contraceptives when used on an ongoing basis. After the age of 50, with hormone replacement therapy (which consists of lower doses of estrogen and progesterone than pills), it is possible to eventually wean the patient off hormones altogether if the menopausal symptoms gradually decrease.

In perimenopause, some choose not to take birth control pills, so they can be used in this case other conservative methods to stop bleeding. The progesterone-IUD is one such option, and it provides a great opportunity for birth control that can last five years. The device secretes progesterone, a hormone that works in the lining of the uterus, resulting in menstruation without complications. An IUD is the preferred option for women who need reversible methods of contraception.

How to stop uterine bleeding surgically? Removal of the endometrium is a minimally invasive procedure that has proven effective in treating severe perimenopausal bleeding and may even help some patients avoid hysterectomy. Ablation procedures have been used quite successfully to reduce the amount of bleeding, in some cases leading to a complete cessation of the menstrual cycle. This procedure is not a method of birth control and is used only for women who have completed childbearing.

For patients who have not responded to drugs and less invasive options, this perimenopausal surgery may be the best option to address the issue of how to stop uterine bleeding. For endometriosis, fibroids, hyperplasia, polyps, hysterectomy is the most preferred method for women with such changes. At the same time, amputation of the uterus is possible with the help of various options. The doctor should know the concomitant diseases of such a woman.

How to stop uterine bleeding at home

Bleeding in any case requires a visit to a doctor to determine the cause and purpose adequate treatment. Before the arrival of the ambulance, it is necessary to take a horizontal position and raise the legs at the same time. You can put a heating pad with ice on the lower abdomen. Compresses and warming procedures are strictly contraindicated. How to stop uterine bleeding at home, what decoctions and preparations can be used? This is well known to older women. "Vikasol", "Ditsinon", "Oxytocin", "Tranexamic acid" - these are the drugs that should be in every woman's first aid kit. These medicines help in deciding how to stop uterine bleeding at home.

Folk remedies

Recipes traditional medicine used in the treatment of many diseases. How to stop uterine bleeding folk remedies? This question interests both young girls and older women. Most often, in this case, a decoction of nettle leaves, yarrow, shepherd's purse, tincture of water pepper is used. Decoctions are also prepared from cucumber lashes, yasnotki, pepper mountaineer. However, this treatment can only be used as helper method and only after consulting a doctor.

Periodic blood loss accompanies a woman from early adolescence. Regular menstruation from the age of 9–15 indicates the maturity of the reproductive system, becomes habitual and does not cause unrest. But with a change in the nature and frequency of bleeding in women, it can be difficult to independently understand what is happening - normal process or there is danger. Abundant periods or bleeding, how to identify and recognize the pathology in time? After all, many women, not knowing exactly the difference, taking one for the other, risk their health, and sometimes their lives.

What is considered the norm?

Gynecologists call normal only a few types of bleeding from the uterus:

• ovulation (in the middle of the cycle when the egg is released);
• implantation (at the time of attachment of the fetus in the uterus);
• regular menstruation.

The first two types of discharge do not occur in all women, they are short-term, not abundant and indicate a normal course reproductive processes. Menstruation that occurs regularly is a sign of the maturity of the reproductive organs and ensures that the body is ready for conception.

Any other blood loss is considered abnormal and requires medical attention. To determine dangerous symptoms, you should clearly know the boundaries of the norm, for any deviations from which it is worth contacting a gynecologist.

Normal periods

Signs that menstruation occurs without pathologies:

1. The period through which normal menstruation, ranges from 21 to 35 days. Any deviation up or down requires additional examination.
2. Normal discharge lasts from 3 days to a week. Sometimes longer periods (up to 10 days) are also not a sign of deviation, but the gynecologist should establish this fact.
3. From the beginning to the middle of menstruation, the amount of allocated blood increases, then gradually decreases.
4. The color of discharge from bright red to brown, even black, is considered a physiological norm.
5. The presence of clots of a darker shade indicates exfoliation of sections of the uterine epithelium during its renewal. The absence of such clots should alert, as well as their excessive number.

The amount of discharge for the entire menstruation does not always correspond average rate in 100 ml. If a fully filled pad has to be changed more than once every 2 hours, such periods are considered heavy.

Abundant periods

Regular discharge in a large volume does not yet indicate any violation. If such menstruation is habitual and not accompanied by other unpleasant symptoms then you don't have to worry. It is worth seeking advice from a gynecologist if there has been a noticeable change in the amount of blood released, and this is not a typical menstruation for a woman.

Additional factors for going to the doctor are pallor of the skin, weakness, loss of working capacity. This may be a symptom that bleeding has begun, and anemia has occurred due to blood loss.

"Disguised" blood loss that opens during menstruation often goes unnoticed. In itself, such uterine bleeding may be a symptom of more dangerous disease. Heavy periods or bleeding began, how to determine the difference on your own?

bleeding symptoms

There are several signs of how to distinguish heavy or irregular menstruation from uterine bleeding. The main symptoms of pathology:

• The pad or tampon is completely filled within an hour;
• the color of the discharge is scarlet, there are no clots at all or there are more of them than usual;
• on the third day of menstruation, the amount of blood does not decrease or the discharge continues for more than 7 days a month;
• severe pain, fatigue, constant weakness.

Menstrual blood contains enzymes that prevent its clotting and are responsible for the specific smell of secretions. With abnormal bleeding, this smell is absent.

Abnormal discharge may begin in the middle of the cycle, immediately, or during menstruation. Therefore, with any of the symptoms, you should consult a doctor to establish accurate diagnosis and eliminate the causes of vaginal bleeding.

Classification and reasons

Distinguish between chronic and acute abnormal bleeding. Chronic include all types of atypical bleeding from the uterus, lasting more than six months, not requiring immediate medical attention.

To acute condition include sudden heavy (profuse) bleeding that occurred against the background of chronic or occurred for the first time. Acute uterine blood loss requires urgent medical attention.

Bleeding is not a disease itself, but only a symptom that a certain failure has occurred in a woman's body. Simply by stopping the blood, without understanding the causes of the anomaly, the problem cannot be solved. The cause of bleeding can be both organic disorders (diseases) and functional disorders without visible physical changes.

Dysfunctional uterine bleeding (DUB)

The causes of the pathology in this case may be disturbances in the work of the pituitary gland, hypothalamus, ovaries, as a result of which the balanced production of hormones is disturbed. Organic lesions tissues and organs may not be detected.

Two types of DMC are diagnosed:

1. Ovulatory. Allocations can be scanty, spotting, occur before menstruation, after it ends, or in the middle of the cycle. Ovulation occurs, but conception and pregnancy can be problematic due to hormonal disruptions. It is characterized by various violations of the menstrual cycle, deviations in duration, frequency, amount of discharge in any direction from the norm.
2. Anovulatory. The monthly cycle passes without ovulation. Abundant, prolonged bleeding after a delay or occurring as a continuation of normal menstruation is characteristic.

To hormonal reasons bleeding in women also include functional disorders of the thyroid gland with an increase or decrease in the production of thyroid hormones.

organic bleeding

Diseases of the internal organs or pathological changes in the structure of tissues capable of provoking abnormal discharge blood:

• pathology of the endometrium (hyperplastic process);
• ovarian tumors;
• polyps;
• inflammation and infection;
• malignant formations of different localization;
• systemic diseases affecting hematopoiesis.

The classification of uterine bleeding according to the causes of occurrence is conditional. At comprehensive examination several causes of both organic and dysfunctional nature can be diagnosed simultaneously.

Breakthrough bleeding

Iatrogenic bleeding, otherwise called "breakthrough", occurs while taking hormonal drugs (including contraceptives), anticoagulants, or other drugs. Surgical interventions or trauma to the uterus when the intrauterine device is displaced can provoke the same reaction.

Iatrogenic bleeding does not differ in dangerous abundance or duration, but requires immediate consultation with the attending gynecologist to change drug treatment or immediate removal of the coil.

Unlike breakthrough bleeding, profuse bleeding develops rapidly, blood loss can be large. A distinctive feature of the profuse process is painlessness.

Age classification

The most common causes of vaginal bleeding in women differ by age. There are three age groups in relation to reproductive function.

Juvenile bleeding

This pathology is observed from the time of the first menstruation (menarche) and is typical for girls under 18 years of age. Not knowing how abnormal bleeding differs from physiological norm, it is easy to confuse them.

At this age, the cause of vaginal bleeding most often lies in the immaturity of the reproductive system. Hormonal balance only established, the menstrual cycle is not regular. Impaired production of progesterone, estrogen, or follicle-stimulating hormones can cause bleeding. Having become permanent, they lead to anemia, further improper formation of the reproductive function in girls and hormonal infertility among women.

Disorders in the thyroid gland (hyperthyroidism, hypothyroidism) can also cause blood loss both at a young age and in older adults. mature women. But, most often, the cause of pathology in girls is severely transferred infectious diseases considered "children's": measles, chicken pox, mumps, tonsillitis or influenza.

Bleeding before menarche in girls is extremely rare and requires special attention, as they can be a sign of malignant tumors.

It's important to know! If a hormonal disorders in puberty(during puberty) are not diagnosed and not cured, this affects reproductive health in childbearing age. Later, in menopause, problems with gynecology give serious complications up to oncology. The violation has a successive character, with age it does not “outgrow”, but worsens.

Bleeding in reproductive age

One third of all women of childbearing age experience abnormal uterine bleeding. Violation normal function ovaries are the most common cause.

Among the factors that can provoke ovarian pathology in reproductive age, gynecologists note:

• stress and nervous tension;
• increased physical activity;
• harmful working and living conditions;
• change of climate zone;
• obesity or underweight;
• sexual infections and inflammatory processes;
• chronic diseases of the reproductive organs: endometritis, endometriosis, fibroids, polyps, tumors;
• endocrine diseases.

Termination of pregnancy (surgical, medical, spontaneous) can also provoke various gynecological disorders accompanied by blood loss.

Bloody discharge during pregnancy indicates a threat to life for both the mother and the fetus. Such pathological conditions are considered separately.

Bleeding in menopause

In the period preceding menopause (menopause), a decrease in the production of female hormones can cause profuse bleeding immediately after timely menstruation. Such conditions, recurring periodically in women over 40, are the first signs of approaching menopause, before other symptoms appear.

The naturalness of the process of attenuation of the fertile (childbearing) function does not mean that such concomitant phenomena can be ignored. Profuse bleeding can continue for a long time and threaten with serious blood loss. In addition, sometimes it indicates the presence or possible development of other organic disorders.

During the period of the most pronounced symptoms of menopause, bleeding can occur due to excessive growth of the endometrium of the uterus and require surgical intervention. Without treatment, the process (adenomyosis, HPE) can spread to neighboring organs and lead to malignant degeneration of the endometrium.

Note! Any bleeding in postmenopause (when menstruation is absent for more than a year) should cause a woman to urgently see a doctor. Oncological danger at this age is especially great.

Bleeding during pregnancy

There are only a few cases when discharge during pregnancy mixed with blood does not pose a threat:

1. The moment of implantation of the egg in the uterus.
2. Waste of the mucous plug before the onset of labor.

Such secretions are not dangerous, provided they are scarce (spotting), painless, pink or brown, run out quickly. Any other discharge of blood from the vagina during pregnancy - dangerous signal. Urgent appeal per medical assistance required at any time.

Possible causes of bleeding during pregnancy life threatening woman and fetus:

• ectopic attachment of the fetus;
• spontaneous abortion (miscarriage);
• uterine rupture;
• detachment of the placenta;
• blood clotting disorders in the mother;
• polyp of the cervical canal.

After childbirth, the placenta separates and exits, and the uterus contracts. These processes are accompanied by abundant blood secretions Lochia that lasts up to 6 weeks.

Any changes in color, smell lochia, sharp increase their number, the absence of clots may indicate the beginning pathological bleeding from the uterus. An abnormal postpartum process is usually accompanied by fever, headaches, low blood pressure, signs of anemia.

The state of the reproductive organs of a woman of any age has great importance and atypical discharge should be diagnosed in time. With heavy periods or bleeding, it is imperative to accurately determine the cause, and after stopping the discharge, eliminate this violation. Without curing the root of the problem, uterine bleeding recurs, the disease becomes chronic and entails the development of new pathologies.