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Bleeding from the vagina

In healthy women aged 13 to 50 years (or so), bleeding is not something to worry about. You expect it - regularly, every month. If you don't menstruate, it's not normal.

But vaginal bleeding, which are either too strong, too small, or at the wrong timing can pose a problem. Various options depend on your age (especially if it's before or after menopause), whether you take birth control pills whether you are physically active depends on your health status.

If you have abnormal vaginal bleeding, it may be related to something else in the reproductive system and is the result of infection, hormonal changes and sometimes cancer. The risk of malignant growth increases with age. The likelihood of infection largely depends on your sex life. Hormone levels fluctuate in response to signals from the brain, ovaries, thyroid gland and adrenal glands. But make sure that the blood you see is actually from the vagina and not in the urine or stool.

Where can blood come from in the vagina?

Let's start with an overview of the different places in the female reproductive system where vaginal bleeding.

The labia at the entrance to the vagina can be damaged, most often during violent sexual intercourse. Sometimes, however, upon careful examination you will see a small polyp there, or a small ulcer, or a wart, or even varicose veins- any of this can bleed.

When the hymen is torn, expect the same; moderate bleeding.

The vagina itself may become inflamed, infected, or malignant growth, and all this will cause bleeding.

Foreign objects inserted into the vagina, usually during masturbation, can cause bleeding. (The amazing variety of such items indicates imagination rather than caution.)

After menopause, when the level of estrogen hormones drops sharply, the vaginal walls become dry, less lubricated during intercourse, and this causes pain and bleeding.

Moving higher up the vagina, we reach the cervix, the entrance to the uterus. It may bleed due to infection (which is quite common in this area), if it is injured by deep intercourse or after the insertion of an intrauterine contraceptive device.

Polyps and malignant tumors the cervix will also cause bleeding. (Women should have regular smear tests to detect such tumors on the most early stages when they are treatable).

Bleeding from the uterus often happen when pathological pregnancy, cancer, polyps or fibroids, abortion (spontaneous or induced). Foreign objects can also make their way here from the vagina. Fluctuating hormone levels, birth control pills, stopping or starting estrogen replacement can all cause uterine bleeding.

In women before menopause, the ovaries release an egg every month, which then travels into the fallopian tubes, where it meets sperm. The fertilized egg then travels down to the uterus where it implants. If it remains in the tube without entering the uterus, the result is an ectopic pregnancy. The egg has no future at this location and eventually causes the fallopian tube to rupture, accompanied by severe pain and bleeding. This is quite serious. More often, bleeding occurs when the fallopian tubes become infected and inflamed due to a sexually transmitted disease.

Malignant growth, infections or ovarian cysts can cause vaginal bleeding. They are also caused by decreased function of the thyroid gland, or a poorly functioning pituitary gland, or other disorders of the endocrine glands.

Trying to understand why you are abnormal vaginal bleeding, always remember that non-gynecological factors may play a role here - blood thinners, medications, clotting disorders: all will leave you vulnerable to abnormal bleeding not only from the vagina, but from any organ in the body.

Vaginal bleeding in menopausal women has many causes. Let's assume that you have either just entered menopause or have been in this state for a long time. You've almost forgotten what menstruation is when you suddenly see blood leaking from your vagina, or find it on your underwear. What could it be? Statistically, there is good evidence that the blood is the result of cervical or uterine cancer. Indeed, most cases of uterine cancer occur in menopausal women. The likelihood of such a tumor is greater when you bleed lightly rather than heavily and when you have never given birth. The tumor could, of course, be a benign polyp, but without a biopsy you won't be able to tell for sure.

Here's another scenario.

You recently turned 50 years old, and your periods have become so irregular that you are unable to accurately predict them. Moreover, you started having hot flashes, cold sweat and there are painless ones vaginal bleeding. It is very likely that you have simply entered the end of your period. The bleeding will stop over the next few months. But, if there is a high statistical probability of cancer, you should double check everything with your gynecologist.

If along with bleeding you feel pain in the lower abdomen, cancer is possible, but fibroids are almost as likely. These are big benign tumors in the wall of the uterus are a very common cause of bleeding in women before menopause and one of the main reasons for amputation of the uterus.

In premenopausal women, vaginal bleeding may simply reflect a variation of the normal 28-day menstrual cycle. This cycle can shorten to 24 or 25 days and lengthen to 30 or even 32 days. The bleeding period itself usually lasts from 3 to 7 days, and most women use four or five sanitary wipes per day. If a tampon is sufficient for your bleeding, it is probably normal in amount.

What does abnormal vaginal bleeding mean then?

Excessive bleeding during periods, even if they occur regularly every 28 days. Common causes are fibroids (more common in menopausal women, but by no means limited to this age) or an underactive thyroid (women with an overactive thyroid will have light monthly bleeding).

Vaginal bleeding between periods is not normal, but sometimes it’s difficult to figure it out if your cycles are very irregular.

Here are a few additional signs, which will help you figure out what happened.

If you are taking birth control pills, expect unpredictable bleeding.

The presence of clots in menstrual blood points to heavy bleeding in the uterus.

If your periods have always been normal and you suddenly start bleeding profusely, you may have been pregnant without knowing it—and you have suffered a spontaneous miscarriage.

“Blood spots” on underwear between menstruation may be due to cervical or uterine cancer or with a polyp.

If you are bleeding and have pain in your lower abdomen, you probably have a pelvic infection (especially if the pain comes on gradually and is accompanied by fever and vaginal discharge).

If you are an alcoholic and/or you have serious liver disease, there is too much estrogen in your body and this will cause vaginal bleeding.

Regardless of your own diagnosis, see your gynecologist when you are bleeding. While you wait for your appointment, consider a few additional items that you can bring to your doctor's attention.

Is your skin dry and rough? Do you feel tired and sleepy? If so, abnormal bleeding may be due to an underactive thyroid gland.

Have you ever had a fever that comes and goes? It often happens that when you visit a doctor you do not have a fever. So tell your doctor about it. A fever usually means an infection.

If you have small bleeds under your skin or bleed easily in other parts of your body, the condition may be general disorder coagulation system, and vaginal bleeding is only one of the manifestations.

After talking with you and a thorough external examination, the doctor can make any appointment - from a pregnancy test to a cervical smear, ultrasound examination or tomogram.

But by making all the observations described above, you will greatly simplify the process of making a diagnosis and shorten it.

– this is a condition in which blood is poured either into a natural cavity of the body (stomach, bladder, uterus, lungs, joint cavity, etc.), or into a space artificially formed by the flow of blood (retroperitoneal, intermuscular). Symptoms internal bleeding depend on its location and degree of blood loss, usually include dizziness, weakness, drowsiness, and loss of consciousness. Pathology is diagnosed based on external examination, radiography, CT, MRI and endoscopic examinations. Treatment - infusion therapy, prompt elimination source of bleeding.

ICD-10

K92.2 S27.1 S06.4 O08.1

General information

Internal bleeding is a loss of blood in which the blood flows not outward, but into one of the cavities of the human body. The cause may be injury or chronic disease. The massive nature of blood loss, late patients seeking help and diagnostic difficulties in identifying this pathology increase the seriousness of the problem and turn internal bleeding into serious threat for the lives of patients. Treatment is carried out by specialists in the field of clinical traumatology, abdominal and thoracic surgery, neurosurgery, vascular surgery.

Reasons

The cause of internal bleeding can be either injury or some chronic diseases. Massive, life-threatening post-traumatic bleeding into the abdominal cavity can develop as a result of blunt trauma to the abdomen with damage to the spleen and liver, less commonly the pancreas, intestines or mesentery (due to an impact, a fall from a height, a car accident, etc.). Bleeding into the pleural cavity usually occurs with multiple rib fractures with damage to the intercostal vessels and pleura. In isolated cases, it is caused by fractures of 1-2 ribs.

Bleeding into the cranial cavity is one of the dangerous complications traumatic brain injury. Since the skull, unlike other natural cavities, has a rigidly fixed volume, even a small amount of spilled blood causes compression of the brain structures and poses a threat to the patient’s life. It should be taken into account that intracranial bleeding can develop not only immediately after injury, but also several hours or even days later, sometimes against the background of complete well-being.

Bleeding into the joint cavity can be caused by both an intra-articular fracture and a bruise. It is not immediately life-threatening, but if left untreated it can lead to serious complications.

A significant share of total number internal bleeding is bleeding into the cavity of an organ that develops as a result of chronic diseases gastrointestinal tract: malignant tumors, peptic ulcers of the stomach and intestines, erosive gastritis, varicose veins of the esophagus with cirrhosis of the liver, etc. surgical practice Mallory-Weiss syndrome is also common - cracks in the esophagus due to alcohol abuse or a single large meal.

Another fairly common cause of internal bleeding is gynecological diseases: ovarian ruptures, ectopic pregnancy, etc. In gynecological practice, internal bleeding occurs after abortion. Internal bleeding is also possible with placenta previa or premature abruption, postpartum bleeding with retained placenta, uterine rupture and birth canal.

Classification

There are several classifications of internal bleeding:

• Taking into account the cause of occurrence: mechanical (due to damage to blood vessels during trauma) and arrosive (due to damage to the vascular wall during necrosis, germination and disintegration of a tumor or destructive process). In addition, there are diapedetic bleedings that occur due to increased permeability of the walls of small vessels (for example, with scurvy or sepsis).
• Taking into account the volume of blood loss: light (up to 500 ml or 10-15% of the circulating blood volume), moderate (500-1000 ml or 16-20% of the bcc), severe (1000-1500 ml or 21-30% of the bcc), massive (more than 1500 ml or more than 30% of the bcc), fatal (more than 2500-3000 ml or more than 50-60% of the bcc), absolutely fatal (more than 3000-3500 ml or more than 60% of the bcc).
• Taking into account the nature of the damaged vessel: arterial, venous, capillary and mixed (for example, from an artery and vein or from a vein and capillaries). If blood flows from the capillaries of any parenchymal organ(liver, spleen, etc.), such bleeding is called parenchymal.
• Taking into account localization: gastrointestinal (into the cavity of the esophagus, stomach or intestines), into the pleural cavity (hemothorax), into the pericardial sac (hemopericardium), into the joint cavity, etc.
• Taking into account the location of the accumulation of spilled blood: abdominal (into the pleural, abdominal and other cavities) and interstitial (into the thickness of tissues with their impregnation).
• Taking into account presence or absence obvious signs bleeding: obvious, in which the blood, even after some time and in a changed form, “comes out” through natural openings (for example, turning the stool black), and hidden, in which it remains in the body cavity.
• Taking into account the time of occurrence: primary, occurring immediately after traumatic damage to the vascular wall, and secondary, developing some time after the injury. In turn, secondary bleeding is divided into early (develops on days 1-5 due to the slipping of the ligature or pushing out of a blood clot) and late (usually occurs on days 10-15 due to purulent melting of the blood clot, necrosis of the vessel wall, etc.) .

Symptoms of internal bleeding

Common early signs of this pathology are general weakness, drowsiness, pale skin and mucous membranes, dizziness, cold sweat, thirst, darkening of the eyes. Fainting is possible. The intensity of blood loss can be judged by changes in pulse and blood pressure, as well as others clinical signs. With low blood loss, a slight increase in heart rate (up to 80 beats/min) and a slight decrease in blood pressure are observed; in some cases, clinical symptoms may be absent.

Moderate internal bleeding is indicated by a drop in systolic pressure to 90-80 mm. Hg Art. and increased heart rate (tachycardia) up to 90-100 beats/min. The skin is pale, there is coldness in the extremities and a slight increase in breathing. Possible dry mouth, fainting, dizziness, nausea, adynamia, severe weakness, slow reaction.

In severe cases, a decrease in systolic pressure to 80 mm is observed. Hg Art. and lower, increased heart rate to 110 or higher beats/min. There is a strong increase and disturbance in the rhythm of breathing, sticky cold sweat, yawning, pathological drowsiness, tremors of the hands, darkening of the eyes, indifference, apathy, nausea and vomiting, a decrease in the amount of urine excreted, excruciating thirst, blackouts, severe pallor of the skin and mucous membranes, cyanosis limbs, lips and nasolabial triangle.

With massive internal bleeding, the pressure drops to 60 mm Hg. Art., there is an increase in heart rate to 140-160 beats/min. Characterized by periodic breathing (Cheyne-Stokes), absence or confusion of consciousness, delirium, severe pallor, sometimes with a bluish-gray tint, cold sweat. The look is indifferent, the eyes are sunken, the facial features are pointed.

With fatal blood loss, coma develops. Systolic pressure drops to 60 mmHg. Art. or not determined. Agonal breathing, sharp bradycardia with a heart rate of 2-10 beats/min, convulsions, dilated pupils, involuntary release of feces and urine. The skin is cold, dry, “marbled”. Then comes agony and death.

Treatment of internal bleeding

It is necessary to ensure that the patient is transported to a specialized care unit as quickly as possible. The patient needs to be kept at rest. If hemothorax or pulmonary hemorrhage is suspected, the patient is placed in a semi-sitting position; if there is blood loss in other areas, the patient is placed on a flat surface. Apply cold (such as an ice pack) to the area of ​​suspected bleeding. It is strictly forbidden to heat the painful area, give enemas, give laxatives or introduce drugs into the body that stimulate cardiac activity.

Patients are hospitalized in a hospital. The choice of department is made taking into account the source of internal bleeding. Treatment of traumatic hemothorax is carried out by traumatologists, non-traumatic hemothorax and pulmonary hemorrhage - by thoracic surgeons, intracranial hematomas - by neurosurgeons, uterine bleeding - by gynecologists. In case of blunt abdominal trauma and gastrointestinal bleeding, hospitalization is carried out in the general surgery department.

Main tasks in in this case– urgent stop of internal bleeding, compensation of blood loss and improvement of microcirculation. From the very beginning of treatment, to prevent empty heart syndrome (reflex cardiac arrest due to a decrease in the volume of the bcc), restore the volume of circulating fluid and prevent hypovolemic shock, a jet transfusion of a 5% glucose solution, saline solution, blood, plasma and blood substitutes is performed.

Sometimes internal bleeding is stopped by tamponade or cauterization of the bleeding area. However, in most cases, emergency surgery under anesthesia is required. If there are signs of hemorrhagic shock or the threat of its occurrence at all stages (preparation for surgery, surgery, period after surgery) transfusion measures are carried out.

In case of pulmonary hemorrhage, bronchial tamponade is performed. For medium and small hemothorax, pleural puncture is performed; for large hemothorax, thoracotomy is performed with suturing of the lung wound or ligation of the vessel; in case of blood loss in abdominal cavity- emergency laparotomy with suturing of a wound to the liver, spleen or other damaged organ; for intracranial hematoma - craniotomy.

In case of a stomach ulcer, a gastric resection is performed; in case of an ulcer, duodenum– suturing of the vessel in combination with vagotomy. For Mallory-Weiss syndrome (bleeding from a fissure of the esophagus), endoscopic bleeding control is performed in combination with cold, the prescription of antacids, aminocaproic acid and blood clotting stimulants. If conservative treatment is ineffective, surgery (suturing cracks) is indicated.

Internal bleeding due to ectopic pregnancy is an indication for emergency surgery. In case of dysfunctional uterine bleeding, tamponade of the uterine cavity is performed; in case of massive bleeding due to abortion, birth trauma, and after childbirth, surgical intervention is performed.

If blood pressure cannot be normalized despite infusion therapy, dopamine, norepinephrine or epinephrine are administered after stopping the bleeding. Pentoxifylline, dipyridamole, heparin and steroid drugs are used to treat hemorrhagic shock. After eliminating the threat to life, the acid-base balance is corrected.

Uterine bleeding should be understood as the discharge of blood from the uterine cavity. They are distinguished from menstruation by the intensity, volume, duration of blood loss, as well as regularity.

Causes of uterine bleeding.
Uterine bleeding occurs due to a malfunction of the hypothalamic-pituitary-ovarian system, which regulates the functions of the ovaries; these are the so-called dysfunctional bleeding. Disruption of the process of production of gonadotropic hormones of the pituitary gland, which affect follicle maturation and ovulation, leads to disturbances in folliculogenesis and menstrual function. Moreover, the follicle in the ovary does not mature or matures without ovulation, but. This means that the corpus luteum is not formed. As a result, the uterus is affected by estrogens (hyperestrogenism), since the production of progesterone stops and its cycle is disrupted. Hyperplasia occurs (when the endometrium grows too much), and subsequently rejection of the endometrium, which is accompanied by uterine bleeding, which is profuse and prolonged.

It is important to note that hyperestrogenism with dysfunctional uterine bleeding greatly increases the risk of developing adenocarcinoma, fibrocystic mastopathy, diseases of the uterus and appendages, breast cancer.

Dysfunctional uterine bleeding is divided into ovulatory, that is, associated with menstruation (deviations in the volume and duration of blood loss during menstruation), and anovulatory - observed between menstruation and occurring after a delay or less than 21 days after the last menstruation. Ovarian dysfunction often provokes the development of infertility and miscarriage. By consulting a doctor in time, namely immediately after the appearance of menstrual irregularities, you will avoid dangerous consequences in the future.

Uterine bleeding can also be caused by diseases of the uterus and appendages, in particular fibroids, endometriosis, adenomyosis, and various tumors of a benign and malignant nature. Very in rare cases Diseases not related to the functioning of the genital organs, in particular liver diseases, blood disorders, and disorders of its coagulation, can contribute to the development of uterine bleeding). In this case, in addition to uterine bleeding, patients note other types of bleeding (nasal bleeding, bleeding gums, severe blood loss from minor cuts, etc.). Such bleeding is classified as organic, that is, associated with the political science of the genital organs or systemic diseases.

Uterine bleeding (profuse) can also occur with hypothyroidism (hyperthyroidism) or a malfunction of the thyroid gland.

Uterine bleeding is also observed as a complication of pregnancy and childbirth. Prolonged bleeding from the uterus can occur with anemia.

Iatrogenic bleeding observed as a result of the use of intrauterine contraceptives, the use of non-hormonal and hormonal contraceptives, and blood thinners should also be highlighted.

Symptoms of uterine bleeding.
The main manifestation of this pathological condition- This is the discharge of blood from the vulva. From normal menstruation Uterine bleeding is distinguished by:

• Increased volume of blood loss (normal up to 40-80 ml, pathology - over 80 ml). A woman may notice a pathology due to the need to change hygiene products more frequently (every half an hour to an hour and a half).
• Increasing the duration of bleeding (over seven days).
• Menstrual cycle disorders associated with a decrease or increase in its interval.
• The occurrence of bleeding after sexual intercourse.
• Observed uterine bleeding during the postmenopausal period, after the cessation of menstruation.

From here it can be noted following symptoms uterine bleeding:

• Menorrhagia (hypermenorrhea) - excessive and long-lasting menstruation while maintaining their regularity (21-35 days).
• Metrorrhagia – low-intensity spotting in the middle of the cycle.
• Menometrorrhagia is long-term bleeding of an irregular nature.
• Polymenorrhea is a cycle disorder, expressed in too frequent bleeding(less than 21 days). As a rule, prolonged and intense blood loss with this pathology provokes the development of iron deficiency anemia (low hemoglobin content in the blood), in which dizziness, weakness, pale skin, and shortness of breath are common symptoms.

Types of uterine bleeding.

Uterine bleeding during the newborn period.
They usually appear in the first week of life and are sparsely bloody. Their appearance is due to a sharp change hormonal levels. They go away quickly and go away on their own; usually no treatment is needed.

Uterine bleeding in the first decade (before puberty).
They are observed very rarely and are explained by the presence of ovarian tumors that can produce increased levels of sex hormones (so-called hormonally active tumors). The result is false puberty.

Juvenile uterine bleeding.
As a rule, they occur during puberty in girls (from 12 to 18 years). The main reason that causes bleeding during this period is considered to be ovarian dysfunction. Such failures may be caused by injuries psychological properties, chronic infections, excessive physical activity, frequent incidence of ARVI, poor nutrition. In addition, such a factor as seasonality plays an important role here. Winter and spring are the periods during which bleeding is most often observed, and, as a rule, they are anovulatory, that is, when ovulation does not occur. Very rarely, but such cases occur when tuberculous lesions of the genital organs, bleeding disorders, tumors of the ovaries, cervix and uterine body can provoke bleeding. Prolonged and severe uterine bleeding during this period provokes the development of anemia. Treatment of girls during this period is carried out only in inpatient conditions.

If bleeding occurs, you should definitely call an ambulance, and at this time the girl must be provided with complete rest and bed rest. She should take a hemostatic drug (this could be aminocaproic acid, Dicynon, Vicasol (one tablet), on bottom part put a cold heating pad on your stomach. In inpatient settings, treatment is symptomatic. Mainly used are hemostatic drugs, drugs whose action is aimed at contracting the uterus (Oxytocin). If this is not enough, hormonal drugs are prescribed to stop the bleeding.

Curettage for this type of bleeding is not performed, with the exception of severe and life-threatening bleeding that even the doctor could not stop. hormonal treatment. In order to prevent the development of repeated bleeding, vitamin therapy, iron supplements, as well as some physiotherapeutic procedures and acupuncture are prescribed.

After the bleeding has been stopped, specialists prescribe estrogen-progestin drugs, the purpose of which is to restore normal menstrual cycle. During the recovery period, physical exercise, a balanced diet, and treatment of existing chronic infections play a special role.

Bleeding during the reproductive period (ages 18 to 45 years).
During this period, there may be many reasons for the development of uterine bleeding. Mainly influenced by dysfunctional factors associated with impaired production of sex hormones due to previous abortions, endocrine diseases (obesity, diabetes mellitus etc.) and infectious nature, severe stress, various intoxications, as well as taking certain medications. Bleeding of a dysfunctional nature can be observed at absolutely any age, from puberty to the menopausal period.

Dysfunctional uterine bleeding is often observed during pregnancy, in particular in the early stages of pregnancy, this is most often due to the threat of miscarriage and ectopic pregnancy (pain in the lower abdomen, delayed menstruation and usual signs pregnancy), and in later stages this condition occurs due to placenta previa or hydatidiform mole. At the first signs of bleeding during pregnancy, no matter at what stage, you need to go to the doctor. On early stages With timely treatment and appropriate therapy, pregnancy can be saved, but in later stages there is often a need for curettage.

At the end of the second and beginning of the third trimesters of pregnancy, bleeding can threaten the lives of both mother and baby, so prompt contact with a specialist plays a huge role here. Bleeding is often observed against the background of placenta previa (when the entrance to the uterus is partially or completely blocked), placental abruption, and also in case of uterine rupture. In these situations, bleeding can be internal and external in nature, and therefore requires emergency surgery caesarean section. Representatives of the fair sex who are at risk of developing similar conditions should be regularly monitored by specialists. During labor, the occurrence of bleeding (mainly due to placental abruption, atony or hypotension of the uterus) is especially dangerous, since it is accompanied by large volumes of blood loss.

After delivery, the main causes of bleeding are:

• poor uterine tone and weak ability to contract;
• not fully expelled parts of the membranes;
• blood clotting disorder.

During the childbearing period, uterine bleeding can also be provoked by diseases of the uterus: fibroids, endometriosis, tumors of various natures, chronic inflammation (endometritis), hormone-dependent ovarian tumors.

Uterine bleeding during menopause.
During menopause, such conditions develop due to disruption of hormone production or against the background of diseases of the genital organs. Since hormonal changes occur in the body during this period, bleeding is common, however, it is important to consult a doctor, since they can be harbingers of malignant or benign neoplasms. This is especially true for the postmenopausal period. Remember, timely consultation with a doctor (at the first symptoms and manifestations) is the key to the success of further treatment.

For accurate diagnosis, separate diagnostic curettage canal of the cervix and body of the uterus, after which a histological examination of the scraping is prescribed in order to determine the cause of the bleeding. For dysfunctional uterine bleeding, optimal therapy with hormonal drugs is prescribed.

Breakthrough uterine bleeding.
Such bleeding develops against the background of hormonal disorders. It is the hormones that are responsible for the normal menstrual cycle, as they maintain the balance between estrogen and progesterone. If all is well, then menstruation always begins on time and is not heavy. When the hormonal balance is disturbed, the endometrium begins to grow strongly, against which its rejection occurs in parts, and the result is breakthrough bleeding. Hormonal imbalances are most often observed in girls during adolescence and in women during the menopausal period.

Breakthrough bleeding may occur when taking hormonal oral contraceptives, which is explained by adaptation to the drug used. In this situation, you should consult your doctor regarding changing the dose used. If increasing the dosage does not stop the bleeding or it becomes more profuse, it is necessary to be examined for the presence of diseases of the reproductive organs. In addition, such conditions can develop against the background of damage to the walls of the uterus by an intrauterine contraceptive device (IUD). In this situation, the woman is advised to remove the intrauterine device.

Diagnostics.
At the first suspicion of uterine bleeding, you should seek help. It's very good if a woman leads menstrual calendar, noting the intensity, duration and nature of bleeding. This calendar will help you further doctor in diagnosis and prescribing optimal therapy. For diagnostic purposes, smears from the cervix are tested for cancer and tests for the presence of uterine bleeding. Required passage ultrasound examination, as well as measuring the inner layer of the endometrium (its thickness). They also do general analysis blood, “for hormones.” Subject to availability excess weight When a woman approaches menopause, a biopsy of the inner layer of the uterus is performed (a small fragment of the endometrium is pinched off and examined under a microscope). Accurate diagnosis is of primary importance for prescribing further optimal therapy.

Treatment of uterine bleeding.
Therapy for such conditions has four main goals: stopping bleeding, replenishing blood loss, eliminating the root cause and prevention. I note that uterine bleeding of any nature can be treated in a hospital setting. The techniques used for this take into account the patient’s age, the cause of the bleeding, and the severity of the condition.

The main method of stopping bleeding is surgical diagnostic curettage, which also makes it possible to find out the cause of their occurrence. The use of hormonal therapy is another method of stopping bleeding. For these purposes, mainly estrogen or combined oral contraceptives, among them Marvelon, Mercilon, etc. For symptomatic treatment, hemostatic drugs are used to contract the uterus, iron supplements (for low hemoglobin levels) or blood components, vitamins and vascular strengthening drugs (Ascorutin, Folic acid, vitamins C, B6, B12). After uterine bleeding has been stopped, preventive measures.
In case of dysfunction, hormonal therapy with combined oral contraceptives or gestagen-based drugs is prescribed, or a hormonal intrauterine device is installed. If intrauterine pathologies are detected during the diagnosis, appropriate treatment is prescribed.

Treatment folk remedies.
Methods can be used to treat uterine bleeding traditional medicine, only first you should consult a doctor and identify their cause. To stop uterine bleeding, decoctions and extracts based on raspberry leaves, yarrow, nettle, burnet, shepherd's purse, etc. are effective. Here are some recipes:

Yarrow infusion: buy a box of yarrow herb at the pharmacy. Take two teaspoons of dry herb per glass of boiling water, cover the container with the liquid and leave for an hour, then strain. Drink the finished infusion four times during the day (before meals), the dosage is 50 ml or 1/4 cup.

Yarrow decoction: pour one tablespoon of the herb into a faceted glass of boiling water, simmer over low heat for ten minutes from the moment of boiling. Next, cool the broth, strain and drink. This should be done before meals three times a day, 1/3 cup. Shows its hemostatic effectiveness both in internal and external uterine bleeding.

Infusion of shepherd's purse herb: add a tablespoon of prepared herb (in dry form, purchase at a pharmacy), pour a glass of boiling water, wrap thoroughly and wait an hour. Then, after infusing the mixture, strain it and you can take the infusion one tablespoon at a time. This must be done three times a day before meals.

Stinging nettle infusion: pour a tablespoon of the raw material with a glass of boiling water, hold over low heat for ten minutes, then cool and strain. Also take a tablespoon four times a day before meals. To prevent the development of uterine bleeding, you can take an extract of this plant; it is easy to find in a pharmacy. The dosage is as follows: 30-40 drops half an hour before meals, dilute the drops with water (1/4 cup).

Pour the peels of six large oranges into one and a half liters of water, cook over low heat until the liquid reduces to 500 ml. After this, drain the broth and take four teaspoons three times a day.

Prevention of uterine bleeding.
Most the best prevention Regular visits to a gynecologist (at least once a year) are considered full course treatment of existing sexual ailments, adherence to personal hygiene rules and daily routine, regular sex life, and with one partner (permanent), healthy image life and strengthening the immune system.

The causes of bleeding in women depend on age. These could be hormonal imbalances, pregnancy pathologies, or neoplasms. Consultation with a gynecologist is necessary.

Causes of bleeding in women of different age groups

Vaginal bleeding in women is an alarming symptom that can indicate a variety of diseases and emergency situations. The causes of bleeding in women can be varied and depend on age.

In order to simplify the diagnosis, bleeding is conventionally divided into two groups depending on the affected system:

• pathology of the reproductive system;
• extragenital pathology.

An important point in the diagnosis of vaginal bleeding is the connection with pregnancy. After all, it could be an early miscarriage, a threatened miscarriage, or an ectopic pregnancy.

All systems and organs interact with each other. An illness of one system can affect another, manifesting various symptoms. Extragenital causes of vaginal bleeding:

• changes in thyroid function (hypothyroidism, hyperthyroidism);
• diseases of the heart and blood vessels (hypertension);
• hepatitis, cirrhosis;
• blood diseases;
• hypovitaminosis (lack of vitamins affecting the condition of blood vessels and blood clotting);
• various infectious diseases;
• prolonged stress and emotional overload, physical exhaustion.

These causes are a specific manifestation of the underlying disease and require primary care treatment.

Bleeding in women involving the reproductive system

If pregnancy has not yet been established, then early miscarriage or ectopic pregnancy should be assumed. Other causes may include endometriosis, uterine fibroids,. Due to the fact that oncopathology is recent years I’m younger, we shouldn’t forget about cervical cancer. A peculiarity of bleeding in cervical cancer is that the discharge has a specific smell and appears more often after sexual intercourse.

In the later trimesters of pregnancy, causes may include:

• placenta previa;
• premature placental abruption;
• eclampsia;
• gestosis;
• scar on the body of the uterus.

During pregnancy, if there is bleeding of any nature or intensity, the woman is advised to immediately seek medical attention. medical care go to the antenatal clinic or call an ambulance.

Causes of blood loss not related to pregnancy:

• neoplasms of the uterus and ovaries;
• ovarian apoplexy;
• various inflammatory diseases;
• injuries;
• cervical erosion;
• endometriosis.

Women with the above pathology should be systematically examined by doctors.

Uterine bleeding at different ages

All uterine bleeding is divided into pathological and physiological. Therefore, first of all, the chronological stage of individual development of the reproductive system is determined.

Bleeding is conventionally divided into age periods:

• juvenile (from 10 to 18 years);
• reproductive (fertile period from 18 to 50 years);
• menopausal period (time of decline of ovarian function);
• postmenopausal (final completion of menstruation).

Most often, signs of uterine bleeding in women occur from 28 to 40 years old, but can appear at any age. The main cause of uterine bleeding most often at this age is a violation of the ovulation process.

The ongoing shift in the hormonal system provokes the growth of the mucous membrane in the uterus, resulting in stagnation and accumulation of blood, thereby disrupting blood circulation. Once vascular permeability changes, conditions arise for the development of bleeding. The uterus becomes a place where blood accumulates.

If the platelet count decreases, causing the blood to become thinner, this increases blood loss and worsens posthemorrhagic anemia. After all, a lot of blood can be lost. At least female body adapted to certain monthly expenses and subsequent replenishments.

For each age period, the reasons may be different, since each age has certain characteristics. But we can highlight the main points that have an equally bad effect, despite age.

Factors that negatively affect the hormonal system:

• infectious diseases of acute and chronic nature;
• lack of vitamins and microelements;
• psychological trauma and emotional stress;
• physical exhaustion;
• diseases of the thyroid gland (hypothyroidism, hyperthyroidism);
• inflammatory diseases of the genitourinary system;
• complicated childbirth and abortion.

In a certain age category there are risks for one or another disease. For example, hypovitaminosis is characteristic, to a greater extent, of young people and those who are in the postmenopausal period. Accordingly, abortions for women with complete menstrual function are casuistry.

Differences between bleeding and normal menstruation

With normal periods, 70-100 ml for the entire period, but again, they can be more intense. With menorrhagia, about 120 ml more may be lost per day. How can you understand that this is not just menstruation, but true blood loss?

Signs of uterine bleeding:

• impotence accompanied by dizziness;
• marbling of the skin;
• There may be vomiting and nausea, but not necessarily;
• fainting or pre-fainting;
• weak pulse, rapid heartbeat, tachycardia;
• hypotension, blood pressure decreases;
• presence of vaginal blood;
• During menstruation, clots and pads are released, and tampons fill up very quickly;
• at night you have to change hygiene products more often than twice;
• the duration of such bleeding is more than eight days, and;
• not accompanied by pain;
• may appear after sex;
• most often do not coincide with menstruation.

Bleeding that occurs after a missed period is usually associated with functional character. If the discharge is abundant in volume and cyclical, then this may indicate uterine fibroids and systemic pathologies blood. , that is, a year after the last menstruation in women is interpreted as obvious pathology. In this case, it is necessary to urgently exclude a malignant neoplasm. But, as a rule, discharge at this age is quite scanty and occurs due to atrophy of the vulva and vagina.

Summing up

The presence of bleeding is alarming and can indicate many diseases. The problem of bleeding remains relevant today. If timely medical care is not provided, everything can end tragically.

For the purpose of prevention, it is necessary to visit a gynecologist once a year, and, if necessary, a hematologist and endocrinologist. In addition, strengthen your body, adhere to rational nutrition and perform measured physical activity.

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We recommend similar articles Uterine bleeding is the release of blood from uterus. Unlike menstruation, with uterine bleeding, either the duration of discharge and the volume of blood released changes, or their regularity is disrupted.

Causes of uterine bleeding

Causes of uterine bleeding may be different. They are often caused by diseases of the uterus and appendages, such as fibroids, endometriosis, adenomyosis), benign and malignant tumors. Bleeding can also occur as a complication of pregnancy and childbirth. In addition, there are dysfunctional uterine bleeding - when without visible pathology on the part of the genital organs, their function is impaired. They are associated with a violation of the production of hormones that affect the genital organs (disorders in the hypothalamic-pituitary-ovarian system).

Much less often, the cause of this pathology can be so-called extragenital diseases (not related to the genital organs). Uterine bleeding can occur with liver damage, with diseases associated with blood clotting disorders (for example, von Willebrand's disease). In this case, in addition to the uterine, patients are also worried about nosebleeds, bleeding gums, the appearance of bruises with minor injuries, prolonged bleeding for cuts and others symptoms.

Symptoms of uterine bleeding

The main symptom of this pathology is bleeding from the vagina.

Unlike normal menstruation, uterine bleeding is characterized by the following features:
1. Increased blood volume. Normally, during menstruation, 40 to 80 ml of blood is released. With uterine bleeding, the volume of blood lost increases, amounting to more than 80 ml. This can be determined if there is a need to change hygiene products too often (every 0.5 - 2 hours).
2. Increased duration of bleeding. Normally, during menstruation, discharge lasts from 3 to 7 days. In case of uterine bleeding, the duration of bleeding exceeds 7 days.
3. Irregularity of discharge - on average, the menstrual cycle is 21-35 days. An increase or decrease in this interval indicates bleeding.
4. Bleeding after sexual intercourse.
5. Bleeding in postmenopause - at an age when menstruation has already stopped.

Thus, the following symptoms of uterine bleeding can be distinguished:

• Menorrhagia (hypermenorrhea)- excessive (more than 80 ml) and prolonged menstruation (more than 7 days), their regularity is maintained (occurs after 21-35 days).
• Metrorrhagia– irregular bleeding. They occur more often in the middle of the cycle, and are not very intense.
• Menometrorrhagia– prolonged and irregular bleeding.
• Polymenorrhea– menstruation occurring more frequently than every 21 days.

In addition, due to the loss of rather large volumes of blood, very common symptom This pathology is iron deficiency anemia (decreased amount of hemoglobin in the blood). It is often accompanied by weakness, shortness of breath, dizziness, and pale skin.

Types of uterine bleeding

Depending on the time of occurrence, uterine bleeding can be divided into the following types:
1. Uterine bleeding during the newborn period is scanty bleeding from the vagina, occurring most often in the first week of life. They are connected with what happens during this period abrupt change hormonal background. They go away on their own and do not require treatment.
2. Uterine bleeding in the first decade (before the onset of puberty) is rare and is associated with ovarian tumors that can secrete increased amount sex hormones (hormonally active tumors). Thus, so-called false puberty occurs.
3. Juvenile uterine bleeding - occurs at the age of 12-18 years (puberty).
4. Bleeding during the reproductive period (ages 18 to 45) can be dysfunctional, organic, or associated with pregnancy and childbirth.
5. Uterine bleeding during menopause is caused by impaired hormone production or diseases of the genital organs.

Depending on the cause of occurrence, uterine bleeding is divided into:

• Dysfunctional bleeding(can be ovulatory or anovulatory).
• Organic bleeding- associated with pathology of the genital organs or systemic diseases (for example, diseases of the blood, liver, etc.).
• Iatrogenic bleeding– arise as a result of taking non-hormonal and hormonal contraceptives, blood thinning drugs, due to the installation of intrauterine devices.

Juvenile uterine bleeding

Juvenile uterine bleeding develops during puberty (age 12 to 18 years). The most common cause of bleeding is this period is ovarian dysfunction - the proper production of hormones is adversely affected by chronic infections, frequent acute respiratory viral infections, psychological trauma, physical activity, and poor nutrition. Their occurrence is characterized by seasonality - winter and spring months. Bleeding in most cases is anovulatory – i.e. due to disruption of hormone production, ovulation does not occur. Sometimes the cause of bleeding can be bleeding disorders, tumors of the ovaries, body and cervix, tuberculosis of the genital organs.
The duration and intensity of juvenile bleeding may vary. Heavy and prolonged bleeding leads to anemia, which is manifested by weakness, shortness of breath, pallor and other symptoms. In any case of bleeding in adolescence treatment and observation should take place in a hospital setting. If bleeding occurs at home, you can ensure rest and bed rest, give 1-2 tablets of Vikasol, put a cold heating pad on the lower abdomen and call an ambulance.

Treatment, depending on the condition, can be symptomatic - the following remedies are used:

• hemostatic drugs: dicinone, vikasol, aminocaproic acid;
• uterine contractants (oxytocin);
• iron supplements;
• physiotherapeutic procedures.

If symptomatic treatment is insufficient, bleeding is stopped with the help of hormonal drugs. Curettage is performed only in cases of severe and life-threatening bleeding.

To prevent recurrent bleeding, courses of vitamins, physiotherapy, and acupuncture are prescribed. After bleeding has stopped, estrogen-progestin agents are prescribed to restore the normal menstrual cycle. Great value in recovery period has hardening and physical exercises, good nutrition, treatment of chronic infections.

Uterine bleeding during the reproductive period

During the reproductive period, there are quite a few reasons that cause uterine bleeding. These are mainly dysfunctional factors - when a violation of the proper production of hormones occurs after abortion, against the background of endocrine, infectious diseases, stress, intoxication, taking certain medications.

During pregnancy, in the early stages, uterine bleeding can be a manifestation of miscarriage or ectopic pregnancy. In the later stages, bleeding is caused by placenta previa and hydatidiform mole. During childbirth, uterine bleeding is especially dangerous; the amount of blood loss can be large. A common cause of bleeding during childbirth is placental abruption, atony or hypotension of the uterus. In the postpartum period, bleeding occurs due to parts of the membranes remaining in the uterus, uterine hypotension or bleeding disorders.

Often, various diseases of the uterus can be the causes of uterine bleeding during the childbearing period:

• myoma;
• endometriosis of the uterine body;
• benign and malignant tumors of the body and cervix;
• chronic endometritis (inflammation of the uterus);
• hormonally active ovarian tumors.

Bleeding associated with pregnancy and childbirth

In the first half of pregnancy, uterine bleeding occurs when there is a threat of interruption of a normal or ectopic pregnancy. These conditions are characterized by pain in the lower abdomen, delayed menstruation, as well as subjective signs of pregnancy. In any case, if there is bleeding after pregnancy is established, you should urgently seek medical help. In the initial stages of spontaneous miscarriage, with prompt and active treatment, pregnancy can be maintained. In the later stages, the need for curettage arises.

An ectopic pregnancy can develop in fallopian tubes, cervix. At the first signs of bleeding, accompanied by subjective symptoms of pregnancy against the background of even a slight delay in menstruation, it is necessary to urgently seek medical help.

In the second half of pregnancy, bleeding is great danger for the life of the mother and fetus, so they require urgent medical attention. Bleeding occurs with placenta previa (when the placenta is not formed according to back wall uterus, and partially or completely blocks the entrance to the uterus), abruption of a normally located placenta or rupture of the uterus. In such cases, the bleeding may be internal or external, and requires an emergency caesarean section. Women at risk of such conditions should be under close medical supervision.

During childbirth, bleeding is also associated with placental previa or placental abruption. In the postpartum period, common causes of bleeding are:

• decreased uterine tone and ability to contract;
• parts of the placenta remaining in the uterus;
• bleeding disorders.

In cases where bleeding occurs after discharge from hospital maternity hospital, you need to call an ambulance for urgent hospitalization.

Uterine bleeding during menopause

During menopause, hormonal changes in the body occur, and uterine bleeding occurs quite often. Despite this, they can become a manifestation of more serious illnesses, such as benign (fibroids, polyps) or malignant neoplasms. You should be especially wary of the appearance of bleeding in postmenopause, when menstruation has already completely stopped. It is extremely important to see a doctor at the first sign of bleeding because... in the early stages tumor processes respond better to treatment. For diagnostic purposes, separate diagnostic curettage of the cervical canal and the uterine body is performed. Then a histological examination of the scraping is carried out to determine the cause of the bleeding. In case of dysfunctional uterine bleeding, it is necessary to select the optimal hormonal therapy.

Dysfunctional uterine bleeding

Dysfunctional bleeding is one of the most common types of uterine bleeding. They can occur at any age - from puberty to menopause. The cause of their occurrence is a violation of hormone production endocrine system– malfunction of the hypothalamus, pituitary gland, ovaries or adrenal glands. This complex system regulates the production of hormones that determine the regularity and duration of menstrual bleeding. Dysfunction of this system can be caused by the following pathologies:

• acute and chronic inflammation of the genital organs (ovaries, appendages, uterus);
• endocrine diseases (thyroid dysfunction, diabetes, obesity);
• stress;
• physical and mental fatigue;
• climate change.

Very often, dysfunctional bleeding is a consequence of artificial or spontaneous interruptions pregnancy.

Dysfunctional uterine bleeding can be:
1. Ovulatory – associated with menstruation.
2. Anovulatory – occurs between menstruation.

With ovulatory bleeding, deviations occur in the duration and volume of blood released during menstruation. Anovulatory bleeding is not associated with the menstrual cycle and most often occurs after a missed period, or less than 21 days after the last menstrual period.

Ovarian dysfunction can cause infertility and miscarriage, so it is extremely important to consult a doctor promptly if any menstrual irregularities occur.

Breakthrough uterine bleeding

Uterine bleeding that occurs while taking hormonal contraceptives is called breakthrough bleeding. Such bleeding may be minor, which is a sign of a period of adaptation to the drug.

In such cases, you should consult a doctor to review the dose of the drug used. Most often, if breakthrough bleeding occurs, it is recommended to temporarily increase the dose of the drug taken. If the bleeding does not stop or becomes more profuse, additional examination should be carried out, since the cause may be various diseases of the reproductive system. Bleeding can also occur if the walls of the uterus are damaged by the intrauterine device. In this case, it is necessary to remove the spiral as soon as possible.

Which doctor should I contact if I have uterine bleeding?

If uterine bleeding occurs, regardless of the age of the woman or girl, you should contact gynecologist (make an appointment). If uterine bleeding begins in a girl or young girl, it is advisable to contact pediatric gynecologist. But if for some reason it is impossible to get to one, then you should contact a regular gynecologist antenatal clinic or a private clinic.

Unfortunately, uterine bleeding can be a sign not only of a long-term chronic disease of a woman’s internal genital organs, which requires routine examination and treatment, but also of symptoms emergency. Emergency conditions mean acute diseases, in which a woman needs urgent qualified medical care to save her life. And if such help emergency bleeding will not be provided, the woman will die.

Accordingly, you need to contact a gynecologist at a clinic for uterine bleeding when there are no signs of an emergency. If uterine bleeding is combined with signs of an emergency condition, then you should immediately call an ambulance or use your own transport to as soon as possible get to the nearest hospital with a gynecological department. Let's consider in what cases uterine bleeding should be considered as an emergency.

First of all, all women should know that uterine bleeding at any stage of pregnancy (even if the pregnancy is not confirmed, but there is a delay of at least a week) should be considered an emergency condition, since the discharge of blood, as a rule, is provoked by threats to the life of the fetus and future mothers with conditions such as placental abruption, miscarriage, etc. And in such conditions, a woman should be provided with qualified assistance to save her life and, if possible, preserve the life of the gestating fetus.

Secondly, uterine bleeding that begins during or some time after sexual intercourse should be considered a sign of an emergency. Such bleeding may be due to pregnancy pathology or severe trauma to the genital organs during previous intercourse. In such a situation, help for a woman is vital, since in her absence the bleeding will not stop, and the woman will die from blood loss incompatible with life. To stop bleeding in such a situation, it is necessary to sutured all ruptures and injuries to the internal genital organs or terminate the pregnancy.

Thirdly, uterine bleeding, which turns out to be profuse, does not decrease over time, and is combined with severe pain in the lower abdomen or lower back, causes a sharp deterioration in health, paleness, decreased blood pressure, palpitations, increased sweating, and possibly fainting. A general characteristic of an emergency condition during uterine bleeding is the fact sharp deterioration a woman’s well-being when she cannot perform simple household and everyday actions (she cannot stand up, turn her head, it is difficult for her to speak, if she tries to sit up in bed, she immediately falls, etc.), but literally lies flat or is even unconscious.

What tests and examinations can a doctor prescribe for uterine bleeding?

Although uterine bleeding can be caused by various diseases, when they appear, the same examination methods are used (tests and instrumental diagnostics). This is due to the fact that pathological process with uterine bleeding, it is localized in the same organs - the uterus or ovaries.

Moreover, at the first stage, various examinations are carried out to assess the condition of the uterus, since most often uterine bleeding is caused by the pathology of this particular organ. And only if, after the examination, the pathology of the uterus was not detected, methods of examining the functioning of the ovaries are used, since in such a situation the bleeding is caused by a disorder of the regulatory function of the ovaries. That is, the ovaries do not produce the required amount of hormones in different periods menstrual cycle, causing bleeding as a response to hormonal imbalance.

So, in case of uterine bleeding, first of all the doctor prescribes the following tests and examinations:

• General blood test;
• Coagulogram (indicators of the blood coagulation system) (sign up);
• Gynecological examination (make an appointment) and inspection in mirrors;
• Ultrasound of the pelvic organs (sign up).

A complete blood count is needed to assess the extent of blood loss and whether the woman has developed anemia. Also, a general blood test allows you to determine whether the body has inflammatory processes, can cause dysfunctional uterine bleeding.

A coagulogram allows you to evaluate the functioning of the blood coagulation system. And if the coagulogram parameters are not normal, then the woman should consult and undergo the necessary treatment with hematologist (make an appointment).

A gynecological examination allows the doctor to feel with his hands various neoplasms in the uterus and ovaries and determine the presence of an inflammatory process by changes in the consistency of the organs. And examination in the mirrors allows you to see the cervix and vagina, identify neoplasms in the cervical canal or suspect cervical cancer.

Ultrasound is a highly informative method that allows you to identify inflammatory processes, tumors, cysts, polyps in the uterus and ovaries, endometrial hyperplasia, as well as endometriosis. That is, in fact, ultrasound allows you to identify almost all diseases that can cause uterine bleeding. But, unfortunately, the information content of ultrasound is not sufficient for a final diagnosis, since this method only provides guidance in the diagnosis - for example, ultrasound can detect uterine fibroids or endometriosis, but it is possible to establish the exact location of the tumor or ectopic foci, determine their type and assess the condition of the organ and surrounding tissues - it is impossible. Thus, ultrasound allows one to determine the type of existing pathology, but to clarify its various parameters and determine the causes of this disease it is necessary to use other examination methods.

When a gynecological examination, speculum examination, ultrasound, and a general blood test and coagulogram will be performed, it depends on what pathological process was identified in the genital organs. Based on these examinations, the doctor may prescribe the following diagnostic procedures:

• Separate diagnostic curettage (sign up);
• Hysteroscopy (sign up);
• Magnetic resonance imaging (sign up).

So, if endometrial hyperplasia, polyps of the cervical canal or endometrium, or endometritis are detected, the doctor usually prescribes separate diagnostic curettage followed by histological examination of the material. Histology allows us to understand whether there is a malignant tumor or malignancy of normal tissue in the uterus. In addition to curettage, the doctor may prescribe a hysteroscopy, during which the uterus and cervical canal They are examined from the inside with a special device - a hysteroscope. In this case, hysteroscopy is usually performed first, and then curettage.

If fibroids or other uterine tumors are detected, the doctor prescribes hysteroscopy in order to examine the organ cavity and see the tumor with the eye.

If endometriosis has been identified, the doctor may prescribe magnetic resonance imaging in order to clarify the location of ectopic foci. In addition, if endometriosis is detected, the doctor may prescribe a blood test for the content of follicle-stimulating, luteinizing hormones, and testosterone in order to clarify the causes of the disease.

If cysts, tumors or inflammation have been identified in the ovaries, additional examinations are not carried out, as they are not needed. The only thing the doctor can prescribe in this case is laparoscopic surgery (make an appointment) for removal of tumors and conservative treatment for the inflammatory process.

In the case when, according to the results Ultrasound (sign up), gynecological examination and speculum examination did not reveal any pathology of the uterus or ovaries; dysfunctional bleeding is assumed due to a hormonal imbalance in the body. In such a situation, the doctor prescribes the following tests to determine the concentration of hormones that can affect the menstrual cycle and the appearance of uterine bleeding:

• Blood test for cortisol (hydrocortisone) levels;
• Blood test for the level of thyroid-stimulating hormone (TSH, thyrotropin);
• Blood test for triiodothyronine (T3) level;
• Blood test for thyroxine (T4) level;
• Blood test for the presence of antibodies to thyroid peroxidase (AT-TPO);
• Blood test for the presence of antibodies to thyroglobulin (AT-TG);
• Blood test for follicle-stimulating hormone (FSH) levels;
• Blood test for luteinizing hormone (LH) levels;
• Blood test for prolactin level (sign up);
• Blood test for estradiol levels;
• Blood test for dehydroepiandrosterone sulfate (DEA-S04);
• Blood test for testosterone levels;
• Blood test for sex hormone binding globulin (SHBG) levels;
• Blood test for the level of 17-OH progesterone (17-OP) (sign up).

Treatment of uterine bleeding

Treatment of uterine bleeding is aimed primarily at stopping bleeding, replenishing blood loss, as well as eliminating the cause and preventing it. All bleeding is treated in a hospital setting, because first of all it is necessary to carry out diagnostic measures to find out their cause.

Methods to stop bleeding depend on age, its cause, and the severity of the condition. One of the main methods for surgically stopping bleeding is separate diagnostic curettage - it also helps to identify the cause this symptom. To do this, a scraping of the endometrium (mucous membrane) is sent for histological examination. Curettage is not performed for juvenile bleeding (only if severe bleeding does not stop under the influence of hormones and is life threatening). Another way to stop bleeding is hormonal hemostasis (use of large doses of hormones - estrogen or combined oral contraceptives Mirena). When identifying intrauterine pathology– treat chronic endometritis, endometrial polyps, uterine fibroids, adenomyosis, endometrial hyperplasia.

Hemostatic agents used for uterine
bleeding

Hemostatic agents are used for uterine bleeding as part of symptomatic treatment. Most often prescribed:

• dicinone;
• ethamsylate;
• vikasol;
• calcium preparations;
• aminocaproic acid.

In addition, drugs that contract the uterus - oxytocin, pituitrin, hyfotocin - have a hemostatic effect during uterine bleeding. All of these drugs are most often prescribed in addition to surgical or hormonal methods stop bleeding.

Dicinone for uterine bleeding

Dicynone (etamsylate) is one of the most common drugs used for uterine bleeding. Belongs to the group of hemostatic (hemostatic) drugs. Dicynone acts directly on the walls of capillaries (the smallest vessels), reduces their permeability and fragility, improves microcirculation (blood flow in the capillaries), and also improves blood clotting in places where small vessels are damaged. However, it does not cause hypercoagulation (increased blood clot formation) and does not constrict blood vessels.

The drug begins to act within 5-15 minutes after intravenous administration. Its effect lasts 4-6 hours.

Dicinone is contraindicated in the following cases:

• thrombosis and thromboembolism;
• malignant blood diseases;
• hypersensitivity to the drug.

The method of administration and dose is determined by the doctor in each specific case of bleeding. For menorrhagia, it is recommended to take dicinone tablets, starting on the 5th day of the expected menstruation and ending on the fifth day of the next cycle.

What to do with prolonged uterine bleeding?

With prolonged uterine bleeding, it is important to seek medical help as soon as possible. If signs of severe anemia appear, it is necessary to call an ambulance to stop the bleeding and further observation in the hospital.

Main signs of anemia:

• severe weakness;
• dizziness;
• decreased blood pressure;
• increased heart rate;
• pale skin;

Folk remedies

As folk remedies for the treatment of uterine bleeding, decoctions and extracts of yarrow, water pepper, shepherd's purse, nettle, raspberry leaves, burnet and other medicinal plants are used. Here are some simple recipes:
1. Infusion of yarrow herb: 2 teaspoons of dry herb are poured with a glass of boiling water, left for 1 hour and filtered. Take 4 times a day, 1/4 cup of infusion before meals.
2. Infusion of shepherd's purse herb: 1 tablespoon of dry herb is poured with a glass of boiling water, left for 1 hour, pre-wrapped, then filtered. Take 1 tablespoon, 3-4 times a day before meals.
3.