Clinical protocol for abnormal bleeding from the uterus and vagina. Causes and treatment of uterine bleeding Abnormal bleeding during the reproductive period

Every woman is familiar with bleeding from the genital tract. They appear regularly and last for several days. Monthly bleeding from the uterus is observed in all healthy women of fertile age, that is, capable of giving birth to children. This phenomenon is considered normal (menstruation). However, abnormal uterine bleeding also exists. They occur when disturbances occur in the body. Most often, such bleeding occurs due to gynecological diseases. In most cases, they are dangerous because they can have serious consequences.

Determination of abnormal uterine bleeding

Abnormal uterine bleeding is a condition in which a tear occurs in the vascular wall of the body or cervix. It is not associated with the menstrual cycle, that is, it appears independently of it. Bloody discharge may occur frequently. In this case, they occur in the period between menstruation. Sometimes abnormal uterine bleeding occurs infrequently, such as once every few months or years. This definition is also suitable for long menstruation lasting more than 7 days. In addition, 200 ml for the entire period of “critical days” is considered abnormal. This problem can occur at any age. Including in adolescents, as well as among women undergoing menopause.

Abnormal uterine bleeding: causes

The reasons for the appearance of blood from the genital tract can be different. However, this symptom is always a reason to urgently seek medical help. Often abnormal uterine bleeding occurs due to oncological pathologies or diseases preceding them. Due to the fact that this problem is one of the reasons for removing the reproductive organ, it is important to identify the cause in time and eliminate it. There are 5 groups of pathologies that may cause bleeding. Among them:

Diseases of the uterus. Among them: inflammatory processes, ectopic pregnancy or threatened miscarriage, fibroids, polyps, endometriosis, tuberculosis, cancer, etc.
Pathologies associated with the secretion of hormones by the ovaries. These include: cysts, oncological processes of the appendages, early puberty. Bleeding can also occur due to dysfunction of the thyroid gland, stressful situations, or taking contraceptives.
Pathologies of the blood (thrombocytopenia), liver or kidneys.
Iatrogenic causes. Bleeding caused by surgery on the uterus or ovaries, or insertion of an IUD. In addition, iatrogenic causes include the use of anticoagulants and other medications.
Their etiology is not completely clear. These bleedings are not associated with diseases of the genital organs and are not caused by other listed reasons. They are thought to occur due to hormonal imbalances in the brain.

The mechanism of development of bleeding from the genital tract

The pathogenesis of abnormal bleeding depends on what exactly caused it. The mechanism of development for endometriosis, polyps and oncological processes is similar. In all these cases, it is not the uterus itself that bleeds, but pathological elements that have their own vessels (myomatous nodes, tumor tissue). Ectopic pregnancy can occur as an abortion or a ruptured tube. The latter option is very dangerous for a woman’s life, as it causes massive intra-abdominal bleeding. Inflammatory processes in the uterine cavity cause tearing of endometrial vessels. When the hormonal function of the ovaries or brain is disrupted, changes occur in the menstrual cycle. As a result, several ovulations may occur instead of one or, conversely, a complete absence. The same mechanism applies to oral contraceptives. can cause mechanical damage to the organ, thereby leading to bleeding. In some cases, the cause cannot be established, so the mechanism of development also remains unknown.

Abnormal uterine bleeding: classification in gynecology

There are a number of criteria according to which uterine bleeding is classified. These include the cause, frequency, period of the menstrual cycle, as well as the amount of fluid lost (mild, moderate and severe). Based on etiology, there are: uterine, ovarian, iatrogenic and dysfunctional bleeding. DMKs vary in nature. Among them are:

Anovulatory uterine bleeding. They are also called single-phase DMKs. They arise due to short-term persistence or atresia of the follicles.
Ovulatory (2-phase) DMC. These include hyper- or hypofunction of the corpus luteum. Most often, this is how abnormal uterine bleeding occurs during the reproductive period.
Polymenorrhea. Blood loss occurs more often than once every 20 days.
Promenorrhea. The cycle is not broken, but the “critical days” last more than 7 days.
Metrorrhagia. This type of disorder is characterized by random bleeding without a certain interval. They are not related to the menstrual cycle.

Symptoms of uterine bleeding

In most cases, it is impossible to immediately determine the cause of the appearance of blood from the genital tract, since the symptoms are almost the same for all DUB. These include pain in the lower abdomen, dizziness and weakness. Also, with constant blood loss, a decrease in blood pressure and pale skin are observed. To distinguish between DMKs, you need to calculate how many days it lasts, in what volume, and also set the interval. To do this, it is recommended to mark each menstruation in a special calendar. Abnormal uterine bleeding is characterized by a duration of more than 7 days and an interval of less than 3 weeks. Women of fertile age usually experience menometrorrhagia. During menopause, bleeding is profuse and prolonged. The interval is 6-8 weeks.

Diagnosis of bleeding from the uterus

To identify abnormal uterine bleeding, it is important to monitor your menstrual cycle and periodically visit your gynecologist. If this diagnosis is still confirmed, it is necessary to be examined. To do this, general urine and blood tests (anemia), a smear from the vagina and cervix are taken, and a gynecological examination is performed. It is also necessary to do an ultrasound of the pelvic organs. It allows you to determine the presence of inflammation, cysts, polyps and other processes. In addition, it is important to get tested for hormones. This applies not only to estrogens, but also to gonadotropins.

What are the dangers of bleeding from the uterus?

Abnormal bleeding from the uterus is a rather dangerous symptom. This sign may indicate a disturbed pregnancy, tumor and other pathologies. Massive bleeding leads not only to loss of the uterus, but even to death. They occur in diseases such as ectopic pregnancy, torsion of the tumor stalk or myomatous node, and ovarian apoplexy. These conditions require immediate surgical attention. Minor short-term bleeding is not so scary. However, their reasons may be different. They can lead to malignancy of the polyp or fibroids, and infertility. Therefore, examination is extremely important for women of any age.

How to treat uterine bleeding?

Treatment of abnormal uterine bleeding should begin immediately. First of all, hemostatic therapy is necessary. This applies to heavy blood loss. An ice pack is placed on the uterine area and red blood cells are injected intravenously. Surgical treatment is also performed (most often, removal of one of the appendages). For mild bleeding, conservative therapy is prescribed. It depends on the cause of DMC. In most cases, these are hormonal drugs (drugs "Jess", "Yarina") and hemostatic drugs (solution "Ditsinon", tablets "Calcium Gluconate", "Ascorutin").

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Abnormal uterine bleeding is a pathological condition that develops when blood vessels in the walls or cervix rupture. AUB do not depend on the phase of the menstrual cycle; they can have varying degrees of severity. Abnormal bleeding also includes prolonged heavy menstruation. The problem occurs in women of any age.

Causes

The development of abnormal uterine bleeding is promoted by:

Diseases of the internal genital organs. The most common include infectious inflammatory processes (endometritis, tuberculosis), endometriosis (pathology accompanied by thickening of the endometrium and its spread beyond the uterus), polyposis. Acyclic bleeding often becomes the only sign of cervical cancer.
Hormonal disorders. Bloody discharge occurs due to ovarian dysfunction, which disrupts the production of female sex hormones. The disorder is provoked by increased cyst growth, malignant tumors of the appendages, and early puberty. Extragenital endocrine disorders—increased activity of the thyroid gland or adrenal glands—can also lead to bleeding.
Chronic diseases of the liver and kidneys, disruption of hematopoietic processes. Blood clotting decreases, which is why various localizations occur.
Iatrogenic causes. Bloody discharge can be caused by postoperative complications, the use of intrauterine contraceptives, or the use of anticoagulants.
Diseases of the brain accompanied by disruption of hormonal regulation. These include injuries and tumors of the pituitary gland and hypothalamus.
Pregnancy. Bloody discharge occurs due to placental abruption or spontaneous abortion.

Classification and symptoms

The classification of abnormal uterine bleeding includes the following types of pathological conditions:

Anovulatory AUB. Refers to single-phase bleeding. They arise due to disruption of the processes of follicle maturation and egg release.
Ovulatory AUB. They occur against the background of hypo- and hyperfunction of the corpus luteum and are biphasic in nature. A similar symptom often occurs in women of childbearing age.
Polymenorrhea. Menstruation occurs more often than once every 3 weeks.
Promenorrhea. The menstrual cycle is not disrupted, but discharge is observed for 7 days or more.
Metrorrhagia. This type of pathology is characterized by the spontaneous occurrence of bleeding not associated with menstruation. In this case, there is no cyclicity.

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Abnormal uterine bleeding (AUB)

0 RUB

Abnormal uterine bleeding (AUB)

This is bleeding that differs from normal menstruation in duration and volume of blood loss and/or frequency. Normally, the duration of the menstrual cycle varies from 24 to 38 days, the duration of menstrual bleeding is 4-8 days, and total blood loss ranges from 40 to 80 ml. In reproductive age, BUN is 10 - 30%, in perimenopause it reaches 50%.

AUB are one of the main causes of iron deficiency anemia and reduce the performance and quality of life of women. AUB ranks second among the reasons for hospitalization of women in gynecological hospitals and serves as an indication for 2/3 of hysterectomies and endometrial ablations.

Causes

The causes of AUB have age-related characteristics. In young girls, AUB is more often associated with hereditary disorders of the hemostatic system and infections. Approximately 20% of adolescents and 10% of women of reproductive age with heavy menstruation have blood diseases (coagulopathies), such as von Willebrand disease, thrombocytopenia, and less commonly, acute leukemia, and liver disease.

In reproductive age, the causes of AUB include organic disorders of the endo- and myometrium (submucous uterine fibroids, adenomyosis, polyps, hyperplasia and endometrial cancer), as well as inorganic pathology (disorders of the blood coagulation system, intrauterine devices, chronic endometritis, ovulatory dysfunction, taking medications drugs - some antibiotics, antidepressants, tamoxifen, corticosteroids). In many cases, the cause is endocrinopathies and neuropsychic stress (for example, polycystic ovary syndrome, hypothyroidism, hyperprolactinemia, obesity, anorexia, sudden weight loss or extreme sports training). Breakthrough bleeding while taking hormonal drugs is more often observed in women who smoke, which is associated with a decrease in the levels of steroids in the bloodstream due to increased metabolism in the liver.

In perimenopause, AUB occurs against the background of anovulation and various organic pathologies of the uterus. With age, the likelihood of malignant lesions of the endo- and myometrium increases.

Clinical manifestations

Depending on the nature of the disorders, various symptoms of AUB are distinguished:

Irregular, prolonged uterine bleeding (menometrorrhagia);

Excessive (more than 80 ml) or prolonged menstruation (more than 8 days) with a regular interval of 24-38 days (menorrhagia (hypermenorrhea);

Irregular, intermenstrual bleeding from the uterus, usually (often not intense) (metrorrhagia);

Frequent menstruation less than 24 days apart (polymenorrhea)

Diagnosis of abnormal uterine bleeding

Examination by a gynecologist-endocrinologist, assessment of patient complaints. Many women misinterpret the amount of blood loss during menstruation. For example, 50% of women with normal menstrual blood loss complain of increased bleeding. In order to clarify the presence of AUB, the patient is asked the following questions:

A laboratory examination is necessary to determine the presence of anemia and hemostasis pathology. Transvaginal ultrasound of the pelvic organs is considered as a 1st line diagnostic procedure for assessing the condition of the endometrium. Sonohysterography has high diagnostic significance; it is performed when transvaginal ultrasound is insufficiently informative to clarify focal intrauterine pathology. Hysteroscopy and endometrial biopsy continue to be considered as the “gold” standard for diagnosing intrauterine pathology, primarily to exclude precancerous lesions and endometrial cancer. It is recommended for suspected endometrial pathology, the presence of risk factors for uterine cancer (obesity, PCOS, diabetes mellitus, family history of colon cancer), in patients with AUB after 40 years.

MRI is recommended in the presence of multiple uterine fibroids to clarify the topography of the nodes before planned myomectomy, uterine artery embolization, FUS ablation, as well as in cases of suspected adenomyosis or in cases of poor visualization of the uterine cavity to assess the condition of the endometrium.

Treatment methods for abnormal uterine bleeding

Treatment of AUB at the Center for Obstetrics, Gynecology and Perinatology named after. IN AND. Kulakov of the Ministry of Health of Russia is carried out on the basis of modern international and Russian clinical recommendations, in the development of which scientific staff took an active part Department of Gynecological Endocrinology. The principles of treatment for AUB pursue 2 main goals: stopping bleeding and preventing its relapse. In each specific case, when prescribing drug therapy, not only the effectiveness of the drugs is taken into account, but also possible side effects, the woman’s age, interest in pregnancy or contraception. For AUB not associated with organic pathology, non-surgical treatment methods are used.

Presentation description: Abnormal uterine bleeding: modern treatment approaches and slides

Abnormal uterine bleeding: modern approaches to treatment and prevention, obstetrician-gynecologist, 1st category, Ph.D. n. , assistant at the Department of Obstetrics and Gynecology No. 1, ONMed. From O. M. Kalanzhov

ABNORMAL UTERINE BLEEDING (AUB) is any uterine bleeding that does not meet the parameters of normal menstruation in a woman of reproductive age. NB! AUB includes exclusively bleeding from the body and cervix, but not from the vagina and vulva. Washington (2005) - revision of the term “MQM”. With the support of WHO, FIGO, ASRM, ACOG, RCOG, ECOG, a comprehensive term “ABNORMAL UTERINE BLEEDING” (AUB) has been introduced, which is understood in various countries, medical schools, clinical guidelines and training manuals. Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the uterus that is not associated with systemic diseases, organic pathology of the pelvic organs, or pregnancy complications.

CHARACTERISTICS OF THE MENSTRUAL CYCLE characteristics regularity (days) frequency (days) duration (days) volume of blood loss norm regular ± 5 24 -38 4.5 -8 normal (80.0 -120.0 ml) deviation option 1 (polymenorrhea) more than ± 20 8 excessive variant of deviations 2 (opsomenorrhea) absent > 38< 4, 5 сниженный

Hypothalamus Pituitary gland (anterior lobe) Ovaries Gonadotropic releasing hormones (Gn. RG) Gonadotropic hormones (FSH, LH) Uterus Cyclic changes in the endometrium. Regulation of the menstrual cycle Steroid hormones (E, Pg, A, inhibin)

Frequency of occurrence of AUB in the structure of gynecological diseases, taking into account the age gradation of women: 1. Juvenile uterine bleeding - 10% 2. AUB in active reproductive age - 25 -30% 3. AUB in late reproductive age - 35 -55% 4. AUB in postmenopause − 55 -60%

Classification of AUB based on the etiological factor (Malcolm Murno - XIX FIGO Congress) 1. AUB caused by uterine pathology: endometrial dysfunction (ovulatory bleeding, chronic endometritis); diseases of the uterine body (uterine fibroids, endometrial polyp, adenomyosis, endometrial hyperplastic processes, endometrial cancer, endometritis, genital TVS, arteriovenous anomaly of the uterus); diseases of the cervix (cervical endometriosis, endocervical polyp, cervical cancer, atrophic cervicitis, uterine fibroids - cervical variant); associated with pregnancy (spontaneous abortion, placental polyp, trophoblastic disease, impaired ectopic pregnancy).

Classification of AUB based on the etiological factor (Malcolm Murno - XIX FIGO Congress) 2. AUB not associated with uterine pathology: anovulatory bleeding (in puberty or perimenopause, polycystic ovaries, thyroid dysfunction, hyperprolactinemia, stress, eating disorders); diseases of the uterine appendages (bleeding after ovarian resection, oophorectomy); against the background of hormonal therapy (COCs, progestins, HRT).

Classification of AUB, based on the etiological factor (Malcolm Murno - XIX FIGO Congress) 3. AUB, due to systemic pathology: (diseases of the blood system, liver, kidneys, nervous system). 4. AUB associated with iatrogenic factors: (resection, electrical or cryodestruction of the endometrium; bleeding from the cervical biopsy area, taking anticoagulants). 5. AUB of unknown etiology.

AUB of a functional nature 2. Associated with ovarian dysfunction 1. Not associated with organic or systemic pathology OMT Anovulatory bleeding Ovulatory bleeding Estrogenic bleeding Progestin bleeding Breakthrough bleeding Withdrawal bleeding - absolute hyperestrogenia (follicle persistence) - profuse acute bleeding - relative hyperestrogenia (follicular atresia) - long-term bleeding - bilateral oophorectomy - withdrawal of estrogen drugs - irradiation of mature follicles - high progesterone/estrogen ratio (taking long-acting gestagens, low-dose COCs with low estrogen levels) - a sharp decrease in progesterone levels (normal menstruation, discontinuation of progesterone use - test for amenorrhea )

Anovulatory estrogenic breakthrough bleeding Hyperestrogenic anovulation FOLLICLE PERSISTENCE One or more follicles reach a certain stage of maturity, but ovulation does not occur and the corpus luteum does not form. Progesterone is not synthesized. The follicle exists from several days to several months, producing a significant amount of estrogens. High level of estrogen (absolute hyperestrogenism) + Progesterone deficiency Hypoestrogenic anovulation FOLLICULAR ATRESIA With follicular atresia, estrogens are produced for a long time, but in relatively small quantities Low (below normal), but constant level of estrogen (relative hyperestrogenism) + Progesterone deficiency

Ovulatory AMK Shortening of the 2nd phase of MC, according to basal temperature data (< 10 дней) Уменьшение параметров желтого тела, по данным УЗИ, на 21 -23 день МЦ 1. Недостаточность лютеиновой фазы (НЛФ) Уменьшение концентрации прогестерона и эстрогена на 7 -8 день после овуляции Недолгосрочное и минимальное действие гестагенов 2. Недостаточная секреторная трансформация эндометрия Скудные кровянистые выделения, возникающие за 7 -10 дней до предполагаемой менструации Обильные кровотечения на фоне укороченного (реже удлиненного) МЦ 3. Неадекватное отторжение эндометрия

Diagnosis of AUB Confirmation of the presence of bleeding based on assessing the truth of complaints of metrorrhagia (Jansen’s method) Stage 1 Conducting a differential diagnostic search and establishing a diagnosis of AUB: - medical history (somatic history, menstrual history, exclusion of EGP and coagulopathies); — assessment of thyroid function; -examination in the speculum, cytological examination of the cervix, ultrasound of the pelvic organs, hysteroscopy, hysteroscopy of the endometrium (exclusion of organic pathology OMT) 2nd stage Establishment of the clinical and pathogenetic variant of AUB 3rd stage

Clinical and pathogenetic variants of AUB Parameters Ovulation Anovulation NLF Hypoestrogenic (relative hyperestrogenism) Hyperestrogenic (absolute hyperestrogenism) Characteristics of MC regular irregular Duration of MC (days) 22 -30 35 Endometrial thickness on days 21 -23 MC (mm)< 10 14 Максимальный диаметр фолликула (мм) 16 -18 25 Уровень прогестерона на 21 -23 день МЦ (нмоль/л) 15 -20 < 15 Уровень эстрадиола на 21 -23 день МЦ (пг/мл) 51 -300 301 Гистологическое исследование эндометрия Неполноценная секреторная трансформация Атрофические или пролиферативные изменения Гиперпластические процессы

Treatment of AUB Hippocrates: “You cannot treat until you have made a diagnosis” NB! Treatment of various clinical and pathogenetic variants of AUB should be strictly individual Stage I - stopping bleeding (HEMOSTASIS) Stage II - anti-relapse therapy and its tasks: 1. restoration of the HPA system 2. restoration of ovulation 3. restoration of deficiency of sex steroid hormones

Stage I - stopping bleeding (HEMOSTASIS) hemostasis 3. Surgical hemostasis 2. Hormonal hemostasis 1. Non-hormonal hemostasis

Stage I - stopping bleeding (NON-HORMONAL HEMOSTASIS) antifibrinolytic drugs (plasminogen - plasmin) NSAIDs (inhibit PG synthetase, PG balance F 2 a/E 2)

Stage I - stopping bleeding (HORMONAL HEMOSTASIS) gestagens BUT...!!! the effect is achieved more slowly (3 -5 tablets / day - until hemostasis, reducing the dose by 1 tablet - every 3 days, the total duration of use is at least 10 days, withdrawal of gestagens, after MP bleeding - the formation of a new MC) monophasic COCs (4 -6 tab/d - until hemostasis, 3 tab/d - 3 days, 2 tab/d - 3 days, 1 tab/d - up to 21 days)

Stage I - stopping bleeding (SURGICAL HEMOSTASIS) - hysteroscopy - FDV of the cervical canal and uterine cavity METHOD OF CHOICE IN PATIENTS: PUBERTY (profuse uterine bleeding, life-threatening, secondary anemia - hemoglobin 70 g/l and below, endometrial polyp according to ultrasound) LATE REPRODUCTIVE AGE Climacteric PERIOD!!! DAMAGE TO UTERUS RECEPTORS – HORMONE-RESISTANT AUB

Stage II - anti-relapse therapy for AUB. Principles of therapy for AUB. Pathogenetic approach - anovulatory, AUB - ovulatory AUB. Consideration of risk factors for the occurrence of gestagen intolerance syndrome. Identification and recording of endocrine diseases and metabolic disorders. Reproductive intentions

Combined oral contraceptives (COCs) (monophasic) Therapeutic effect for AUB: decrease in hormonal activity of the ovaries, suppression of endometrial growth Undesirable effects: suppression of gonadotropin secretion

Progestogens Therapeutic effect in AUB: Progestogenic effect on the endometrium Stopping estrogen-induced endometrial growth Stabilization of endometrial vascularization and stopping uncontrolled vascular growth Initiation of the coagulation cascade Hemostatic and antifibrinolytic effect Inhibition of the activity of matrix metalloproteinases Undesirable effects: systemic effect of gestagens and their metabolites on the woman’s body - intolerance syndrome gestagens

IUD - LNG Therapeutic effect for AUB: reversible severe suppression of endometrial growth, up to amenorrhea Undesirable effects: intermenstrual bleeding of ovarian cysts

AGONISTS – Mr. RG Therapeutic effect in AUB: decreased sensitivity of adenohypophysis receptors to Gn. RG - decrease in the synthesis of gonadotropins by the pituitary gland - hypoestrogenia Undesirable effects: drug-induced menopause (hot flashes, hypertension, dyspareunia, osteoporosis) high cost of drugs

Progestins Available for patients Easy monitoring of the therapeutic effect Effective timely correction of therapy is acceptable at any stage of treatment Long-term use is acceptable

Long-term use of gestagen (dydrogesterone) is possible due to: 1. Maximum binding to progesterone receptors 2. Selective antiestrogenic activity in relation to the endometrium 3. Non-hepatotoxic No mutagenic, teratogenic and carcinogenic potential

Progestogen intolerance syndrome Psychopathological disorders Metabolic disorders Physical manifestations Anxiety Irritability Aggression Panic attacks Depression Attention disorders Forgetfulness Mood lability Lethargy Excess weight Lipid metabolism Glucose/insulin disorders Acne Seborrhea Flatulence Edema Dizziness Headaches Mastalgia

Morphological transformation of the endometrium against the background of taking gestagens Dydrogester on Progesterone 100% - the optimal level of the morphological state of the endometrium in the secretory phase* Without progesterone Norethisterone Levonogestr ate MPA!!! in women of reproductive age.

Pathogenetic approaches to anti-relapse therapy of AUB Order No. 582 of the Ministry of Health of Ukraine COCs in a cyclic mode (for the purpose of contraception) HRT (minimum level of estrogen and adequate progesterone levels) Anovulatory hypoestrogenic AUB (follicular atresia) Selective gestagens (dydrogesterone) in a cyclic mode from the 11th on the 25th day of MC (10-20 mg/day) for 3-6 months Anovulatory hyperestrogenic AUB (follicle persistence) Selective gestagens (dydrogesterone) in a cyclic mode from the 11th to 25th day of MC (20 mg/day) days) for 3-6 months In case of pronounced hyperproliferative processes of the endometrium - selective gestagens from the 5th to 25th day of MC (10-20 mg/day) for 3-6 months Ovulatory AUB against the background of NLF

Pathogenetic approaches to anti-relapse therapy of AUB Order No. 582 of the Ministry of Health of Ukraine COCs in a cyclic mode Selective gestagens (dydrogesterone) in a cyclic mode from the 11th to the 25th day of MC (10-20 mg/day) for 3-6 months Juvenile uterine bleeding Selective action gestagens (dydrogesterone) in a cyclic mode from the 11th to the 25th day of MC (20 mg/day) for 3-6 months. Constant monitoring is preferable!!! IUD, agonists – Gn. RG (uterine fibroids, adenomyosis) Contraindications in the use of gestagens (TE diseases, gastrointestinal diseases in the acute stage, severe varicose veins) AUB in the premenopausal period > 45 years of age LDV in order to exclude organic pathology AUB in postmenopause

Lack of effect from conservative therapy for AUB Surgical treatment: 1. Endoscopic technologies (Nd: YAG laser thermo- and cryoablation, radio wave ablation and, if necessary, endometrial resection) 2. Hysterectomy 3. Panhysterectomy

The effectiveness of adequate, pathogenetically substantiated therapy for AUB 1. Restoration of normal MC 2. Implementation of the patient’s reproductive plans 3. Prevention of hyperplastic processes of the edometrium 4. Prevention of extensive surgical interventions

NB! Treatment of AUB associated with progesterone deficiency should be pathogenetically justified. The treatment method for AUB is highly effective in both therapy and prevention of this pathology.

Abnormal uterine bleeding is a general term that includes any discharge of blood from the reproductive organ that does not correspond to the normal parameters of menstruation for women in their reproductive years. This pathology is considered one of the most common in medical practice and requires immediate placement of the woman in a medical facility. It is important to understand that the appearance of abnormal bleeding that occurs during the intermenstrual period poses a serious threat to the female body.

Features of the pathology

If blood discharge does not correspond to normal menstruation, then experts talk about abnormal uterine bleeding. With this pathological condition of the female body, menstruation is released from the genital tract for a long period and in large quantities. In addition, such heavy periods cause exhaustion of the patient’s body and provoke the development of iron deficiency anemia. Specialists are especially concerned about blood from the reproductive organ, which appears during the intermenstrual period for no reason.

In most cases, the main reason for the development of such a pathological condition in the patient’s body is changes in hormonal levels. It is important that a woman can independently distinguish abnormal discharge from normal menstruation, which will help her promptly seek help from a specialist.

Young girls are often diagnosed with dysfunctional uterine bleeding, which is accompanied by menstrual irregularities. In patients of reproductive age, such discharge is often observed during the progression of various inflammatory processes and endometriosis in the body.

Dangerous to a woman’s health is the appearance of abnormal uterine discharge during menopause, when the functioning of the reproductive system has already ended and menstruation has completely stopped. In most cases, the appearance of blood is considered a dangerous signal that a dangerous disease, and even oncology, is progressing in a woman’s body. Not the least important role in the development of this pathological condition is occupied by hormonal disorders that develop due to the influence of estrogens.

Experts classify abnormal uterine bleeding as the appearance of blood discharge due to a disease such as fibroids. With this pathology, menstruation becomes profuse and can occur in the middle of the menstrual cycle.

Types of pathology

There is a medical classification that identifies several types of abnormal bleeding from the reproductive organ, taking into account the etiological factor:

Blood discharge that is associated with the pathological condition of the uterus. The reasons for the development of such uterine bleeding may be associated with pregnancy and cervical pathologies. In addition, such discharge develops with the progression of various diseases of the reproductive organ in the female body and with dysfunction of endometrioid tissue.
Bleeding from the uterus, which is in no way related to the pathological condition of the reproductive organ. The reasons for the development of such an unpleasant condition may be different. This is the progression in the female body of various diseases of the appendages of the genital organ, ovarian tumors of various types and premature puberty. A woman taking hormonal contraceptives. Frequent anovulatory bleeding
Abnormal discharge from the uterus that develops as a result of various systemic diseases. Most often, this pathological condition of the female body develops with pathologies of the circulatory and nervous systems, as well as with disorders of the liver and kidneys.
Discharge of blood from the reproductive organ, which is closely related to iatrogenic factors. The reasons for the development of such a pathological condition of the female body are biopsies and cryodestruction. In addition, the release of large amounts of blood may be the result of taking neurotropic drugs and anticoagulants.
Abnormal bleeding from the uterus of unknown etiology

Taking into account the nature of the disorder, abnormal bleeding from the reproductive organ may have the following manifestations:

Discharge of blood that begins along with menstruation at the right time or after a slight delay.
The appearance within 1-2 months of minor bleeding or heavy blood loss, which provokes the development of anemia and requires immediate medical attention.
The appearance of discharge from the reproductive organ with clots, which can be large in size.
The development of iron deficiency amenorrhea in a woman, which causes the appearance of characteristic symptoms in the form of increased pallor of the skin and unhealthy appearance.

The development of any bleeding from the reproductive organ is considered a dangerous pathological condition of the female body, which can result in the death of the woman.

The specific treatment for this disease is determined by:

The reasons that caused the appearance of blood from the reproductive organ.
The degree of blood loss.
General condition of the woman.

For abnormal discharge from the uterus, treatment is aimed at solving the following problems:

Stopping further blood loss.
Carrying out preventive measures to prevent relapse.

In order to find out the cause of bleeding, a specialist will prescribe laboratory tests and a procedure such as colposcopy.