Bleeding from the female genital organs - Causes, Diagnosis, Emergency care. Vaginal bleeding

Abnormal vaginal bleeding includes:

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

Vaginal bleeding can also occur in early pregnancy or later.

Most abnormal vaginal bleeding is associated with:

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

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

Common Causes of Vaginal Bleeding in Children

• Foreign body
• Vulvovaginitis
• Trauma, related or unrelated to sexual violence
• Premature puberty
• Hemorrhagic cystitis
• Hemorrhagic diathesis
• Tumors
• Urethral prolapse
• Exposure to exogenous sex hormones

The reasons for adults and children may be different.

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

• complications of early undiagnosed pregnancy;
• anovulatory bleeding;
• submucosal fibroid;
• mid-cycle bleeding associated with ovulation;
• breakthrough bleeding when taking contraceptives.

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

Poor hygiene often predisposes to recurrent vulvovaginitis. Adequate advice regarding personal hygiene is required.

Most injuries to the genital area occur accidentally (unintentionally). However, if vaginal trauma is suspected, the possibility of sexual assault should be considered. Blunt trauma causes hematoma formation. A small vaginal hematoma can be treated with local pressure. The use of analgesics is recommended.

Penetrating vaginal injury requires a very careful examination and serious consideration of the possibility sexual violence over the child. If you suspect sexual abuse, you must urgently contact the hospital pediatricians. If necessary, other services are involved - the police and social services. If sexual abuse is suspected, the child should be evaluated by a pediatrician who specializes in child sexual abuse to gather information with minimal discomfort to the child.

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

Two common reasons hemorrhagic cystitis - adenovirus infection And toxic effect drugs (cyclophosphamide). Common clinical signs are sterile hematuria, dysuria, imperative urges for urination. Viral infection goes away on its own, drug toxicity disappears after discontinuation of the drug.

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

Blood diseases in children that may cause vaginal bleeding

Urethral prolapse is a known cause of urethral bleeding, although rare. It is characterized by prolapse of the mucous membrane through the urethra in the form of a bleeding formation in the vulva area. With a large “formation”, dysuria occurs. Often helps local application estrogens.

Benign and malignant tumors vulva are manifested by vaginal bleeding. Botryoid sarcoma is a vaginal cancer that occurs primarily in girls under 2 years of age (90% under 5 years of age). Mesonephric cancer usually affects girls over 3 years of age. Clear cell adenocarcinoma is often associated with antenatal exposure to diethylstilbestrol. If any of these diseases are suspected, urgent referral to a pediatric oncologist is necessary to confirm the diagnosis, treatment and counseling.

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

Diagnosis of vaginal bleeding

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

Story. History of present illness should include quantification(number of pads used per day or per hour) and duration of bleeding, as well as the relationship of bleeding with menstruation. Menstrual function needs to be assessed; including last date normal menstruation, age of menarche and menopause, duration and regularity of the cycle, amount and duration of menstrual bleeding, previous episodes abnormal bleeding, including frequency, duration, volume and nature of bleeding.

Review. Symptoms to look for include missed periods, breast swelling, and nausea (pregnancy-related bleeding); abdominal pain, dizziness and fainting (ectopic pregnancy or ruptured ovarian cyst), chronic pain and weight loss (cancer); and easy bruising, bleeding gums when brushing teeth, minor wounds or venipuncture (impaired hemostasis).

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

Physical examination. Consider signs of hypovolemia (eg, tachycardia, tachypnea, hypotension).

During general examination Clinicians should look for signs of anemia (eg, pale conjunctiva) and signs possible reasons bleeding, which include:

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

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

A complete gynecological examination is carried out in all cases except late pregnancy; in the latter case, bimanual examination is contraindicated until the location of the placenta has been established. In all other cases, speculum examination helps in identifying lesions of the urethra, vagina and cervix. A bimanual examination is performed to assess the size of the uterus and ovaries. If there is no blood in the vagina, a rectal examination is necessary to determine whether gastrointestinal problems are causing the bleeding.

Warning signs. The following signs are of particular concern:

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

Interpretation of symptoms. Significant hypovolemia or hemorrhagic shock is unlikely unless there is a disrupted ectopic pregnancy or, less commonly, rupture of an ovarian cyst (especially in the presence of a tender pelvic mass).

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

Among women reproductive age Gynecological or other pathological lesions may be detected that indicate the cause of bleeding. If young patients on hormone therapy do not have obvious abnormalities, bleeding is likely due to hormonal therapy. If the problem is only excessive menstrual bleeding, causes such as uterine pathology or bleeding diathesis need to be considered. Hereditary disorders of hemostasis may initially manifest as severe menstrual bleeding at menarche or during adolescence.

In postmenopausal women, cancer should be suspected.

Dysfunctional uterine bleeding, the most common cause in the reproductive years, is a diagnosis of exclusion after other causes have been ruled out; Additional testing is usually required.

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

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

The analysis should include clinical analysis blood if bleeding is more than usual (for example, more than 1 pad or tampon per hour) or lasts for several days, or if anemia or hypovolemia is suspected. If anemia is detected that is not clearly related to iron deficiency (as indicated by microcytic and erythrocyte indices), it is necessary to test the level of iron in the blood.

Thyroid-stimulating hormone and prolactin levels are routinely measured, even if galactorrhea is not present.

If a hemostatic disorder is suspected, von Willebrand factor, platelet count, PT and PTT should be determined.

If you suspect a symptom of polycystic ovaries, you need to establish the level of testosterone and dehydroepiandrosterone sulfate (DHEA).

Imaging includes transvaginal ultrasound if:

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

Local endometrial thickening detected on ultrasound may require hysteroscopy or sonohysterography to identify small intrauterine masses (eg, endometrial polyp, fibroid).

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

Treatment of vaginal bleeding

Hemorrhagic shock is treated. Women with iron deficiency anemia may need additional dose iron preparations.

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

Basics of Geriatrics

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

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

U healthy woman menstruation occurs regularly, is not accompanied by discomfort and unpleasant symptoms. Irregular, heavy, spontaneous bleeding indicates developed dysfunction. For what reasons does it occur, and what symptoms can it be accompanied by?

Types of dysfunction

Sexual bleeding (uterine, vaginal) is accompanied by many gynecological disorders, pathology of pregnancy, labor, early postpartum period. In rare cases, blood loss from the genital tract is a consequence of injury or pathology in the hematopoietic system.

There are many reasons for this condition. They vary in intensity and can lead to different consequences.

Vaginal bleeding is directly related to infection or mechanical injury, and uterine bleeding is directly related to diseases, hormonal dysfunction, and ovulation.

Starting in adolescence with menstruation, regular loss of blood from the vagina begins to accompany every healthy woman, and this is the norm. On average, physiological blood loss ranges from 40 to 80 ml.

Abnormal conditions and reasons why there's blood coming out from the vagina:

• Dysfunctional disorder – abnormal bleeding against the background of hormonal disorders.
• An organic disorder is pathological bleeding that develops with pathology of the genital organs.
• An iatrogenic disorder in which bleeding is a consequence of taking contraceptives, antithrombic drugs, or installing an IUD.
• Uterine bleeding during pregnancy labor activity, V postpartum period.
• Juvenile bleeding.
• Dysfunction in postmenopause.

The nature of vaginal bleeding can be cyclical (menorrhagia) or acyclic (metrorrhagia).

Cyclic ones last more than 6–7 days, with a profuse character, with a volume of about 100 ml. Acyclic dysfunction is not tied to the menstrual cycle and occurs at an unspecified time.

Menorrhagia

Menorrhagia can be caused by endometritis, fibroids, or endometriosis. With the development of these pathologies, the uterine wall loses its normal contractility, and this intensifies and prolongs vaginal bleeding.

Endometritis

In the acute stage of infection, a woman develops a fever along with merorrhagia, and the lower third of the abdomen is painful. On examination, the body of the uterus is enlarged and painful. Disease in chronic form passes without signs of fever, pronounced pain syndrome not visible. The development of endometritis is provoked by the post-abortion or postpartum period.

Myoma

With neoplasms, in addition to menorrhagic dysfunction, the woman is bothered by pain, discomfort of urination and defecation. During the examination, the doctor discovers an increase in the size of the uterus. The uterus has an uneven, bumpy surface, compacted, palpation does not cause pain. With pathology, alternation of menorrhagia with metrorrhagia is possible.

Endometriosis

With endometriosis, menorrhagia is accompanied by pain (algomenorrhea), which progresses over time. During the examination, the doctor notes an enlarged uterus. The smoothness of the surface is preserved in case of endometriosis.

Regardless of the pathology, menorrhagia is abundant bloody issues with clots. A woman complains of weakness sharp deterioration general condition, dizziness, fainting.

Prolonged blood loss leads to severe iron deficiency anemia.

Metrorrhagia

If a woman does not have her period, but is bleeding, then this is metrorrhagia. This condition develops against the background of physical and psychological fatigue, work in hazardous industries, illnesses inflammatory in nature, neoplasms and endocrine disorders.

Metrorrhagia occurs at any time, and if a woman bleeds spontaneously, “out of the blue,” the process is at an acute stage. Chronic metrorrhagia is defined by prolonged intermenstrual bleeding with disrupted cyclicity.

Anovulatory metrorrhagia

Girls are susceptible to this type of dysfunction. adolescence and women in menopause.

With anovulatory metrorrhagia of ovulation and formation corpus luteum does not occur, menstruation is delayed, and bleeding continues for more than 7 days.

Postmenopausal metrorrhagia

Dysfunction develops against the background of fading ovarian function. Menstruation is irregular at first, but eventually stops completely. With the onset of postmenopause, metrorrhagia is a symptom of the formation of benign and malignant tumors.

If a woman has not had her period for more than a year, the onset of metrorrhagia is an undesirable and dangerous symptom. You should contact a specialist as soon as possible.

When to see a doctor?

There are several additional signs and conditions by which one can suspect the onset of dysfunction:

1. IN menstrual blood clots appeared.
2. Sexual intercourse is accompanied by pain and bleeding.
3. A woman complains of causeless fatigue and weakness, hypotension.
4. Pain increases from period to period.
5. Menstruation is accompanied by fever.

If menstruation lasts more than a week, the cycle is shortened to 21 days, there is more discharge than usual or there is bleeding between periods, a woman should not postpone it. You should contact a gynecologist as soon as possible.

Bleeding from the genitals can occur in both men and women, but the causes of these processes are different. Minor bleeding does not threaten the life and health of the patient, but should be the reason for a visit to the doctor. If the blood loss is significant, then emergency assistance is needed to stabilize the situation, replace blood loss, eliminate the cause of bleeding and further treatment.

Normal vaginal and uterine bleeding

In some cases, bleeding from the genitals is considered normal, physiological, and is not a cause for concern. Such bleeding includes:

Pathological bleeding from the genitals

Pathological uterine bleeding occurs as a result malfunction body. In this case, bleeding from the genital organs is caused not only by malfunctions of the reproductive system, but also by other organs. For example, uterine bleeding can be triggered by infectious diseases, blood diseases, disorders of the liver, with increased blood pressure.

Other bleeding is caused by reasons directly related to disturbances in the functioning of the genital organs. Such bleeding can primarily be caused by diseases of the uterus - endometritis, fibroids, endometriosis, benign and non-benign tumors, cervicitis, adenomyosis.

Bleeding with endometritis. Endometritis is called inflammation of the inner layer of the uterus, which occurs due to infection. Streptococci, staphylococci, gonococci, coli and other bacteria. They can enter as a result of abortions, gynecological manipulations, non-compliance with personal hygiene rules, promiscuity. The main symptom of endometritis is bleeding between menstrual cycles. In this case, along with the blood, mucopurulent discharge characteristic of endometritis may come out. With the acute onset of the disease, the patient may feel pain in the lower abdomen and fever, but chronic, sluggish endometritis does not produce such symptoms.

The disease is diagnosed based on the patient’s complaints and a previous history of the disease. During a gynecological examination, the uterus is swollen and painful. To identify the cause of endometritis, diagnostic curettage and sent for histological analysis. Additionally carry out ultrasound diagnostics and hysteroscopy.

Bleeding due to uterine fibroids arise due to a decrease in uterine tone, a violation of its contractile abilities and the appearance of additional venous plexuses. They can appear both in the middle of the cycle and during menstruation, lengthening it by a couple of days. The blood released due to fibroids is dark in color, thick, and does not contain any impurities of pus. When myomatous nodes grow under the mucous membrane of the uterus, mucous with an unpleasant odor is added to the bloody discharge.

The diagnosis is established on the basis of concomitant factors (lack of childbirth, long-term contraception, irregular sex life, previous inflammatory diseases of the uterus, etc.) and gynecological examination. During the examination, doctors note that the uterus has a lumpy structure, is denser to the touch, and is slightly increased in size. Upon palpation, myomatous nodes can be seen. Additionally, an ultrasound examination is performed to determine the type of fibroid, the degree of its growth into the uterine layers, and the presence of associated complications, both for the uterus and for other organs.

Bleeding with endometriosis. Research in different countries show that about eighty percent of patients suffer from bleeding with endometriosis. Endometriosis of the uterus occurs due to improper hormonal regulation of the natural process of endometrial shedding when pregnancy does not occur. An increase in estrogen levels and prolonged ovulation contribute to the proliferation of the endometrium, and sometimes hematogenous migration of endometrial cells into the fallopian tubes, muscle layer uterus

The classic symptom of endometriosis is prolonged menstruation and bleeding in the middle of the cycle. The severity of bleeding is individual in each case, but all cases are characterized by the duration of this process. As a rule, there is no pain during bleeding.

If bleeding due to endometriosis is too long, this can cause iron deficiency anemia, which causes signs of weakness, drowsiness, general malaise, and decreased performance.

Bleeding from uterine tumors are not specific sign this disease, therefore diagnosing tumors only on the basis of this sign is not correct. However, with cancerous formations in the uterus, symptoms of tumor germination and its disintegration appear later. Bleeding is accompanied by pain in the lower abdomen, pain after sexual intercourse, weight loss, and various types of vaginal discharge.

The bleeding itself from tumors varies in severity and of different durations. Blood can be present as streaks in mucous secretions, or it can be released for a long time and in large volumes. Diagnosis of the disease is carried out by a thorough examination of the genital organs and taking a biopsy.

Bleeding with cervicitis occurs due to both injury to the inflamed cervix during sexual intercourse and spontaneously during exacerbation inflammatory process. Most often, women notice such bleeding after intercourse; they are small in volume, contain mucus, or themselves appear as bloody streaks in the mucus. The discharge also contains pus coming out of cervical canal. The disease is diagnosed based on the patient’s complaints and a gynecological examination, which clearly shows the inflammatory process in the cervix. Additionally, a colposcopy is performed and a smear from the cervical canal is taken.

Bleeding with adenomyosis caused by a disruption of the normal formation of tissues in the body. In particular, with adenomyosis, the endometrium begins to grow into the myometrium, which causes bleeding. Typically, bleeding occurs in the middle of the cycle, the volume of blood released is insignificant. Patients complain about painful sensations lower abdomen, pelvic pain, feeling of internal pressure. The diagnosis is made based on ultrasound examination and a thorough history taking.

The nature of bloody discharge as a sign of disease

Despite the fact that spotting is already a clear symptom of dysfunction of the genital organs in a woman, they can be different in nature. Depending on the nature of the discharge, we can assume what disease caused the bleeding.

1. Abundant bright red discharge without any admixture of pus indicates high blood pressure, endometriosis;
2. Thick, dark-colored bloody discharge indicates uterine fibroids, polyps, and neoplasms in the uterine cavity;
3. Minor bleeding mixed with pus suggests cervicitis, endometritis;
4. Minor discharge without any admixture of pus may indicate adenomyosis, initial stage tumor germination.

It is important to remember that the above is a pure clinic of diseases, which is quite rare. Most often, other symptoms may be added to the discharge, confusing the doctor, so when assessing the discharge in a patient, you should not rely on classic manifestations, but always take into account what complications and accompanying illnesses can blur the clinic of true pathology. Sometimes this is difficult to do even for doctors, not to mention patients, so women do not need to become hysterical and suspect that they have late-stage cancer with dark discharge. Perhaps in this case there was a rupture of the venous vessels during the growth of fibroids, which is not a malignant neoplasm and can be successfully treated hormonal drugs may not require surgical intervention provided that tumor growth is stopped.

Causes of bleeding during pregnancy

The onset of pregnancy significantly changes the functioning of a woman’s body. Now it has new functions, but also new threats - sudden bleeding. Discharge of blood from the genital organs during pregnancy most often occurs in the first or third trimester, which is associated with the greatest changes in a woman’s body - preparation for bearing a child and preparation for childbirth. Bleeding at any of these stages can pose a threat to pregnancy.

In the first trimester of pregnancy bleeding can be caused by:

• threat of miscarriage if before pregnancy the woman had genital tract infections, chronic and acute inflammatory diseases uterus Such bleeding can also occur due to taking certain medications, too much physical activity, or injury to the lower abdomen;
• complete miscarriage, when the embryo is no longer capable of further development and separated from the uterine cavity;
• incomplete miscarriage, when the embryo has died, but, nevertheless, is still in the uterine cavity. Its further expulsion is inevitable, therefore such a pregnancy is not preserved, but the uterine cavity is curetted;
• a frozen pregnancy, as a result of which the fetus does not develop, but the mother’s body is still able to provide for its vital functions. After the fetus freezes, the female body receives a signal about it as foreign body, and after some time it is spontaneously expelled from the uterine cavity. In some cases, doctors may insist on using abortion medications or curettage of the uterine cavity;
• ectopic pregnancy - the attachment of the fetus not in the uterine cavity leads to further problems, for example, rupture of the fallopian tubes may occur and severe bleeding from the genitals may occur. In this case, both the fallopian tube and the fertilized egg are removed; given that healthy second tubes, pregnancy is possible in the future;
• hydatidiform mole. Hydatidiform mole is the fertilization of a defective egg, as a result of which an embryo as such is not formed. However, chorionic villi grow in the form of bubbles, and the woman’s body reacts to this with symptoms of pregnancy - vomiting, nausea, and malaise. With a hydatidiform mole, heavy bleeding can occur at any time.

If bleeding in the early stages is more dangerous for the fetus than for the woman, then later periods endanger both the life of the fetus and the life of the mother. They may occur in the following cases:

• Placenta previa causes painless bleeding in seventy percent of women with this diagnosis, and twenty percent of expectant mothers feel cramping pain in the lower abdomen. In another ten percent, the blood does not come out freely, but pours into the uterine cavity between its wall and the placenta;
• placental abruption is a very rare occurrence, but the most severe for the fetus and mother. In this case, dark red blood comes out with clots, the uterus is in good shape, and the lower abdomen hurts as if it were contractions. In this case, the question of emergency surgery caesarean section;
• an even rarer situation is bleeding from the umbilical cord or vessels located in membrane. A clear indicator of this pathology is an increase and then a slowdown in the fetal heartbeat, which indicates blood loss. In each case, the doctor makes an individual decision to continue the pregnancy.

Bleeding after childbirth

During the postpartum period, bleeding from the genitals is normal. They continue abundantly for another two hours after the baby is born, and then gradually decrease and take the form of menstruation. The duration of such bleeding varies, but no more than a month after the birth of the child. The discharge at first is bright red in color, and after ten days the blood is only mixed with the mucous discharge. After some time, clear mucus will be released from the vagina, and then the discharge will stop.

Pathological bleeding may occur if:

• after childbirth, there are remains of the placenta in the uterine cavity (division anomalies, additional lobule);
• there are disturbances in uterine contraction as a result of the birth of a large fetus, polyhydramnios, overweight women in labor, long labor;
• injuries were diagnosed during the passage of the child through the birth canal (uterine ruptures, vaginal ruptures);
• the blood clotting process is disrupted.

After giving birth, for two hours, the woman is in the postpartum ward, where doctors monitor her. When the bleeding stops, the young mother and baby are transferred to a regular ward until discharge from the hospital. However, in difficult cases, bleeding can occur even with an apparently favorable end of labor. The reasons for such late bleeding are as follows:

• placental polyp (remnants of the placenta that have not been removed);
• development of endometritis;
• pathologies in the blood clotting chain;
• disturbances in uterine contractions.

If there is a sudden onset of bleeding and a rapid increase in the volume of blood released, it is necessary to urgently call ambulance and deliver the woman to medical institution. Further actions determined depending on the cause of the bleeding. If it can be stopped, the patient is left under supervision for some time, and sometimes it becomes necessary to remove the uterus.

Bleeding after menopause

Menopause occurs in women at at different ages, most often menopausal manifestations make themselves felt after forty-five years. Normally, if there are no diseases of the genital organs, then menstruation stops by itself, becoming less and less in duration and less in volume. By some time they disappear completely.

However, during this period, a woman should be attentive to her health, since there is a certain risk of bleeding. Reasons why bleeding occurs after menopause:

• atrophic vaginitis associated with estrogen deficiency. When the level of this hormone in the blood decreases, changes in the vaginal mucosa occur, making it more susceptible to infections and erosions. Discharge with atrophic vaginitis is scanty, brownish, as if at the end of the cycle;
• Tumors (benign and malignant) can also cause bleeding. Average age patients with this diagnosis are over 60 years old, and half of them with malignant neoplasms bleeding from the genitals was observed;
• changes in the endometrium, the appearance of vascular fragility, blood stagnation in the pelvic organs.

Menstrual bleeding

Menstrual bleeding accompanies every representative of the fair sex during childbearing age. Thus, the female body prepares to receive a fertilized egg. During the first two weeks of the cycle, a woman’s body actively produces estrogen, which is responsible for the growth of the endometrium and the growth of follicles. At the moment of ovulation, the egg leaves the follicles and moves along fallopian tubes, descending into the uterine cavity. It is here that she most often encounters sperm.

The fertilized egg tries to sink into the enlarged endometrium. If fertilization does not occur and the egg does not attach to the walls of the uterus, then it is excreted from the body in the blood. During menstruation, bleeding reaches approximately 80 ml, but this figure is individual and may vary. Along with the blood, the slightly overgrown inner layer of the uterus, which was preparing to receive the embryo, is also excreted. Endometrial detachment and spotting may be accompanied by pain, especially in the first days of menstruation.

This process is designed by nature in such a way that every month the uterus is renewed as much as possible to ensure the vital activity and safety of the new embryo.

What to do if there is heavy bleeding

If there is no uterine bleeding visible reasons, is not associated with menstruation, then if the amount of hemorrhage is insignificant, you can try to stop it yourself. To do this, you need to lie down in bed, put a pillow or cushion under your feet, and cold on your lower abdomen. After stopping the bleeding, a visit to the doctor is required to find out the cause of the hemorrhage. The doctor may prescribe vitamins, iron supplements, and hormonal contraceptives.

The appearance of blood from the vagina outside of menstruation is not considered normal and can greatly frighten a woman. At home, it is impossible to determine the cause of this pathology and you cannot do without a doctor’s examination. Bleeding from the vagina occurs due to natural reasons, for example, during menstruation, in all other cases it can mean a different threat to women's health.

Many factors influence the condition women's health, and each woman depends on different problems of the reproductive system.

During sexual intercourse

Very often the cause of bleeding is damage to the walls of the vagina or cervix during intense sexual contact. If blood appears suddenly and in large quantities, it is better to immediately contact a specialist. Rupture of the walls due to deep penetration of the penis, erosion, and sometimes infectious process provoke the release of blood during sexual intercourse.

A sexual partner can infect a woman, and gynecological diseases can call, and after it.

Inflammatory process

Cervicitis, or inflammation of the cervix, as well as inflammation of the vagina most often leads to bleeding during sexual relations and between menstruation. An infection that enters a woman's reproductive system during sexual intercourse or poor personal hygiene can cause cervical disease. To prevent the process from going into chronic stage, you need to visit a gynecologist on time, and if there is heavy bleeding, call for medical help.

Defloration process

Rupture of the hymen is usually accompanied by the release of blood, which should not be a lot. This process is often painful, but the pain goes away over time, as does the bleeding. Some girls do not bleed because the hymen is too thin. Vaginal bleeding should not appear again during sex. If this situation occurs again, you should consult a doctor.

Dysfunctional bleeding

Increased estrogen secretion affects the uterus and disrupts menstrual cycle, the epithelium grows, which then leaves the uterus in the form of unexpected bleeding. Such changes mean a malfunction of the ovaries. Sometimes anemia may develop with periodic discharge large quantity blood from the uterus, because dysfunctional bleeding differs in duration and intensity.

Menstrual cycle

The natural cause of vaginal bleeding will be monthly menstrual flow. One of the few situations where you don't need to worry is your period. Behind medical care You can only contact them if they are too painful.

Then it is worth conducting an examination to find out the cause of the pain. Normally, a woman should not secrete more than 100 ml of blood per menstrual period. The first days are characterized by less vaginal bleeding than the last.

The influence of contraceptives

Many girls and women protect themselves from unwanted pregnancy by using intrauterine device or tablets. Sometimes the causes of vaginal bleeding lie in misuse methods of contraception or abrupt withdrawal of pills.

There is no cause for concern if vaginal bleeding is minor and appears within six months after insertion of the IUD. In case of heavy discharge, it is better to consult a doctor, but if a woman has spotting Brown, which decreases each time, then the situation is connected only with the presence of a spiral in the uterus.

When, medications are prescribed to relieve the inflammatory process so that the foreign object takes root in female body. Also, such women require constant supervision by a gynecologist.

Cancellation of oral contraceptives

Despite the convenience and reliability of the method, it has its drawbacks. If a woman misses a pill, bleeding is likely. Among side effects the drug causes vaginal bleeding. If only a small spot appears from the vagina and it has a blood-colored color, there is no need to worry.

Sometimes a woman will simply need to choose another drug with a lower dose active substance. In case of heavy discharge, it is necessary to consult a doctor. Cancel oral contraceptives also leads to bleeding, because due to sharp decline the amount of hormones may cause bleeding.

Puberty and other reasons

During age-related changes, teenage girls often experience bleeding from the vagina. The main reason for this situation is immaturity reproductive system. The amount of discharge is slightly greater than during normal periods. The reason why there is bleeding from the vagina at this age is juvenile bleeding within two years after menarche.

Reproductive age

In women with disrupted hormone levels, the regular menstrual cycle is disrupted and spotting appears between periods. Malignant tumors, as well as ovarian cysts, also lead to the appearance of blood. Reception medicines, failures in circulatory system have an impact on women's health.

Menopause

When a woman enters the completion phase menstrual flow after 45 years, menstruation becomes irregular, and vaginal bleeding increases and feeling unwell. All these symptoms are characteristic of menopause due to hormonal changes, so a slight spot is not a pathology. If the discharge has bad smell, abundant and do not stop for a long time, you should make an appointment with a doctor.

Pregnancy and bleeding

During pregnancy, the woman should not have any bleeding. Their presence threatens miscarriage and termination of pregnancy. Even a small amount of blood will be a signal for an urgent visit to the gynecologist, because a woman may have placental abruption and the baby cannot be saved.

If the placenta comes out ahead of schedule, it is very difficult to preserve the baby and the health of his mother. Seeing a doctor earlier at the first symptoms in the form of spotting will save both lives.

An ectopic pregnancy is life-threatening not only for the child, but also for the mother. The development of the fetus outside the uterus leads to rupture of the walls of the tubes due to an increase in fetal weight. It is possible to stop the bleeding through surgery.

Gynecological diseases

If perhaps the woman has serious gynecological diseases. When the discharge does not stop for more than a week, it means that an infection has entered the genitals. Among the most common diseases are:

• endometriosis;
• uterine fibroids;
• adenomyosis;
• polyps;
• endometrial hyperplasia;
• polycystic ovary syndrome.

With endometriosis, in 80% of patients, the first symptom of the disease is bleeding. Blood clots can come out of the vagina, so you need to stop the development of the disease so that the process does not become chronic.

Adenomyosis causes disruption of cell formation, the endometrium grows, which causes bleeding. Sometimes dense nodules or granulomas appear in the vagina due to the presence of inflammation in the body, after removal of which the vagina bleeds.

Hormonal imbalance

Hormonal changes can occur at any time due to accidental severe stress, exacerbation chronic processes and inflammation in the body. In case of malfunctions endocrine system there may be blood in small quantities. Diseases such as hyperthyroidism often cause pathological disorders.

If production is disrupted female hormones, pathological bleeding appears. Discharges vary in volume and character, but they are caused by disruption of the endocrine glands.

High levels of prolactin, which is responsible for normal lactation, lead to bleeding immediately after childbirth, which is considered natural process and goes away in 3-4 weeks.

How to stop bleeding

First of all, the doctor will definitely examine the woman with bloody discharge and begin to stop it as soon as possible. Treatment depends on many factors, the woman’s age, and can be medicinal or surgical. Assign hormonal pills to balance hormones, antibiotics to remove infection in the body. At heavy discharge Iron supplements are used to prevent anemia.

Only the doctor knows how to stop the bleeding. Folk remedies In such cases, it cannot be used independently, but only under the supervision of a doctor. For recipes traditional medicine They use mint, orange peel, nettle, and yarrow. The effect will be positive if you use herbal decoctions simultaneously with the correct drug treatment and a decrease in physical activity.

Every healthy woman has monthly bleeding from the vagina. They are called menstruation. They should be regular, not very abundant and last no more than 7 days. It happens that a couple of days before and after menstruation, weak spotting appears. This is normal if they are not very abundant and are associated with the cycle.

Sometimes there is also slight vaginal bleeding between periods. They are usually very weak and last 2-3 days. All other cases of bleeding require close attention and examinations by a doctor. After all, they may indicate an incipient disease.

In what cases can blood be released from the vagina?

Here are the common causes of vaginal bleeding:

1. Abnormally long or . If they occur for more than 7 days with the release of a large volume of blood, this can lead to iron deficiency anemia. Therefore, you need to visit a doctor to find out the causes of this condition. These may be inflammatory diseases, infections or hormonal disorders. Sometimes the reasons for heavy periods are not related to the genitals. They can appear due to stress, severe hypothermia or physical overexertion.
2. Vaginal discharge with blood is often associated with hormonal imbalances. They can occur in women of any age who have decreased function of the thyroid gland or pituitary gland.
3. Women during menopause, especially at the beginning, may experience bleeding. The reason for this may be the body becoming accustomed to this condition, or polyps or tumors. In order to exclude serious illness, you should see a doctor.
4. Mucus and blood may be released from the vagina due to inflammation, endometriosis or polyps.
5. The cause of such discharge is often polyps in the uterus, ovarian cysts or malignant tumors. Therefore, it is recommended to immediately consult a doctor in order to start treatment on time. After all, blood clots released from the vagina indicate bleeding in the uterus. It can also be caused, which is very dangerous.
6. Blood from the vagina after sex may appear due to injuries and microcracks in the mucous membrane. The reason for this may be a lack of lubrication or violent sexual intercourse.
7. Bleeding often occurs as a result of taking birth control pills, especially in the first three months. Some other drugs may also cause minor bleeding. They usually go away on their own after stopping these medications, but it is better to be examined by a doctor.
8. Bleeding can also be caused by reasons not related to gynecology. For example, a bleeding disorder or drinking alcohol in large doses.

Blood from the vagina during pregnancy

The first three months, slight bleeding - most often normal phenomenon, almost all women have them. But you still need to see a doctor to rule out complications. Why might there be blood? This may indicate an incipient miscarriage or ectopic pregnancy. Minor bleeding may occur after sex due to microtrauma to the mucous membrane.

Bleeding is very dangerous in later stages. It may indicate placenta previa, placenta rupture or abruption, as well as premature birth. The cause of bleeding may be infectious diseases cervix or inflammation, which are also dangerous for the child.

To determine why there is bleeding from the vagina, you should definitely visit a doctor. Because in most cases, bleeding requires immediate treatment, otherwise it can be life-threatening for the woman.