Uterine bleeding causes. Uterine bleeding causes and treatment

- this is an outpouring of blood into the external environment, natural body cavities, organs and tissues. The clinical significance of the pathology depends on the magnitude and rate of blood loss. Symptoms - weakness, dizziness, pallor, tachycardia, decreased blood pressure, fainting. Identification of external bleeding is not difficult, since the source is visible to the naked eye. For the diagnosis of internal bleeding, depending on the localization, various methods can be used. instrumental techniques: puncture, laparoscopy, radiopaque examination, endoscopy, etc. Treatment is usually surgical.

ICD-10

R58 Bleeding, not elsewhere classified

General information

Bleeding is a pathological condition in which blood from the vessels is poured into the external environment or into internal organs, tissues and natural cavities of the body. It is a condition that requires emergency medical attention. The loss of a significant volume of blood, especially within a short time, poses an immediate threat to the life of the patient and can cause death. Orthopedic traumatologists, abdominal surgeons, thoracic surgeons, neurosurgeons, urologists, hematologists and some other specialists can treat bleeding, depending on the cause of their occurrence.

Classification

Taking into account the place in which the blood is poured, the following types of bleeding are distinguished:

• External bleeding - into the external environment. There is a visible source in the form of a wound, an open fracture or crushed soft tissues.
• Internal bleeding - into one of the natural cavities of the body, communicating with external environment: bladder, lung, stomach, intestines.
• Hidden bleeding- in tissues or cavities of the body that do not communicate with the external environment: in the interfascial space, ventricles of the brain, joint cavity, abdominal, pericardial or pleural cavities.

As a rule, in clinical practice hidden bleeding is also called internal, however, taking into account the peculiarities of pathogenesis, symptoms, diagnosis and treatment, they are distinguished into a separate subgroup.

Depending on the type of damaged vessel, the following types of bleeding are distinguished:

• arterial bleeding. Occurs when the wall of an artery is damaged. It is characterized by a high rate of blood loss, is a danger to life. The blood is bright scarlet, pouring out in a tense pulsating stream.
• Venous bleeding. It develops when the wall of the vein is damaged. The rate of blood loss is lower than when an artery of the same diameter is damaged. The blood is dark, with a cherry hue, flows in an even stream, and there is usually no pulsation. If large venous trunks are damaged, pulsation in the rhythm of breathing can be observed.
• capillary bleeding. Occurs when capillaries are damaged. Blood is released in separate drops, resembling dew or condensate (a symptom of "bloody dew").
• Parenchymal bleeding. It develops with damage to parenchymal organs (spleen, liver, kidneys, lungs, pancreas), cavernous tissue and cancellous bone. Due to the peculiarities of the structure of these organs and tissues, damaged vessels are not compressed by the surrounding tissue and do not contract, which causes significant difficulties in stopping bleeding.
• mixed bleeding. Occurs with simultaneous damage to the veins and arteries. The cause, as a rule, is the injury of parenchymal organs with a developed arterial-venous network.

Depending on the severity of bleeding can be:

• Lungs (loss of no more than 500 ml of blood or 10-15% of BCC).
• Medium (loss of 500-1000 ml or 16-20% of BCC).
• Severe (loss of 1-1.5 liters or 21-30% of BCC).
• Massive (loss of more than 1.5 liters or more than 30% of the BCC).
• Fatal (loss of 2.5-3 liters or 50-60% of BCC).
• Absolutely fatal (loss of 3-3.5 liters or more than 60% of BCC).

Taking into account the origin, traumatic bleeding is distinguished, which develops as a result of trauma to unchanged organs and tissues, and pathological bleeding that occurs as a result of a pathological process in any organ or is a consequence of increased permeability of the vascular wall.

Depending on the time of occurrence, specialists in the field of traumatology and orthopedics distinguish between primary, early secondary and late secondary bleeding. Primary bleeding develops immediately after the injury, early secondary - during or after surgery (for example, as a result of slipping of the ligature from the vessel wall), late secondary - after a few days or weeks. The cause of late secondary bleeding is suppuration with subsequent melting of the vessel wall.

bleeding symptoms

To the number common features pathologies include dizziness, weakness, shortness of breath, intense thirst, pallor of the skin and mucous membranes, decreased pressure, increased heart rate (tachycardia), pre-syncope and fainting. The severity and rate of development of these symptoms is determined by the rate of blood flow. Acute blood loss is more difficult to tolerate than chronic, since in the latter case the body has time to partially "adapt" to the changes taking place.

Local changes depend on the characteristics of the injury or pathological process and the type of bleeding. With external bleeding, there is a violation of the integrity skin. When bleeding from the stomach occurs melena (tarry black liquid stool) and vomiting of altered dark blood. With esophageal bleeding, hematemesis is also possible, but the blood is brighter, red, rather than dark. Bleeding from the intestine is accompanied by chalky, but there is no characteristic dark vomiting. If the lung is damaged, bright scarlet, light foaming blood is expectorated. For bleeding from the renal pelvis or Bladder characteristic hematuria.

Occult bleeding is the most dangerous and most difficult in terms of diagnosis, they can only be detected by indirect evidence. At the same time, the blood accumulating in the cavities compresses the internal organs, disrupting their work, which in some cases can cause the development dangerous complications and death of the patient. Hemothorax is accompanied by shortness of breath, shortness of breath and weakening of percussion sound in lower sections chest(with spikes in pleural cavity dullness in the upper or middle sections is possible). With hemopericardium, due to compression of the myocardium, cardiac activity is disturbed, cardiac arrest is possible. Bleeding into the abdominal cavity is manifested by bloating and dullness of percussion sound in its sloping sections. With bleeding into the cranial cavity, neurological disorders occur.

The outflow of blood outside the vascular bed has a pronounced Negative influence for the whole body. BCC decreases due to bleeding. As a result, cardiac activity worsens, organs and tissues receive less oxygen. With prolonged or extensive blood loss, anemia develops. The loss of a significant volume of BCC within a short period of time causes traumatic and hypovolemic shock. A shock lung develops, the volume of renal filtration decreases, oliguria or anuria occurs. Foci of necrosis are formed in the liver, parenchymal jaundice is possible.

Types of bleeding

Bleeding from wounds

First aid consists of anesthesia and immobilization with a splint. For open fractures, a sterile bandage is applied to the wound. The patient is taken to the emergency room or trauma department. To clarify the diagnosis, an x-ray of the damaged segment is prescribed. With open fractures, PXO is performed; otherwise, the treatment tactics depend on the type and location of the injury. In case of intra-articular fractures accompanied by hemarthrosis, a joint puncture is performed. In case of traumatic shock, appropriate anti-shock measures are taken.

Bleeding from other injuries

TBI can be complicated by occult bleeding and hematoma formation in the cranial cavity. At the same time, a fracture of the skull bones is not always observed, and patients in the first hours after the injury may feel satisfactory, which complicates the diagnosis. With closed fractures of the ribs, damage to the pleura is sometimes observed, accompanied by internal bleeding and the formation of a hemothorax. For blunt trauma abdominal cavity possible bleeding from a damaged liver, spleen or hollow organs (stomach, intestines). Bleeding from parenchymal organs is especially dangerous due to massive blood loss. Such injuries are characterized by the rapid development of shock, without immediate qualified assistance, a fatal outcome usually occurs.

For injuries lumbar region injury or rupture of the kidney is possible. In the first case, the blood loss is insignificant, evidence of bleeding is the appearance of blood in the urine, in the second, there is a picture of rapidly increasing blood loss, accompanied by pain in the lumbar region. With bruises in the lower abdomen, a rupture of the urethra and bladder may occur.

First aid for everyone internal bleeding traumatic nature is to anesthetize, ensure peace and immediate delivery of the patient to a specialized honey. institution. The patient is placed in horizontal position with raised legs. Cold is applied to the area of ​​suspected bleeding (blister or heating pad with ice or cold water). If esophageal or gastric bleeding is suspected, the patient is not allowed to eat or drink.

On the prehospital stage if possible, carry out anti-shock measures, replenish the bcc. Upon admission to medical institution continue infusion therapy. The list of diagnostic measures depends on the nature of the injury. For TBI, a consultation with a neurosurgeon, skull x-ray and EchoEG are prescribed, with hemothorax - chest x-ray, with blunt abdominal trauma - a surgeon's consultation and diagnostic laparoscopy, etc.

Treatment in most cases is surgical - opening the corresponding cavity, followed by ligation of the vessel, suturing, removal of the entire damaged organ or part of it. With minor bleeding, expectant management can be used, combined with conservative measures. With hemothorax, treatment is usually conservative - pleural puncture or drainage of the pleural cavity. In all cases, the patient's condition is monitored, and if necessary, blood loss is compensated.

Uterine bleeding in the intermenstrual period is a dangerous phenomenon. Many women face it, considering this serious deviation as a violation of the menstrual cycle. Acyclic bleeding has no connection with reproductive function, but they are caused by general disorders of the female organ. They most often occur at the age of 35 - 50 due to malfunctions in the ovaries, which are responsible for the maturation of germ cells and the production of hormones.

What can threaten bleeding, what do they indicate? First of all, they are a symptom of the most dangerous diseases from the point of view. Bleeding can be signaled by the following:
chronic course of the inflammatory process in the pelvic organs or appendages;
blood problems;
dysfunction of the endocrine glands.

However, you should not be scared prematurely and self-diagnose.

Symptoms of uterine bleeding

How to distinguish ordinary bloody menstrual flow? First you need to understand that the normal cycle length is 21 - 35 days. The very same menstrual bleeding occurs monthly for 3 to 7 days, and the amount of blood released should not exceed 80 ml. If these data do not correspond to a specific situation, uterine bleeding can be judged.

The classification of deviation is represented by such varieties as:
menorrhagia - prolonged, profuse and persistent bleeding;
metrorrhagia - slight spotting in the intermenstrual period;
polymenorrhea - frequent, the interval between which does not reach 21 days;
menometrorrhagia - irregular but prolonged bleeding from the uterus.

What is dangerous uterine bleeding

Despite the painlessness of uterine bleeding, it causes general weakness and lethargy. Women experience dizziness and complain of constant headaches. In the absence of timely adequate treatment, blood lost in large quantities becomes the cause of anemia.

If the bleeding from the uterus was not caused by an illness, the gynecologist will recommend avoiding stress and reviewing your work and rest schedule.

In a decrease in the amount of iron and red blood cells is found, which can threaten a woman's health with big problems. Bleeding that occurs during menopause deserves special attention. So the body can signal the development various pathologies up to malignancy.

Related article

Sources:

• Uterine bleeding
• Types of bleeding from the uterus

Uterine is a formidable symptom gynecological diseases. Delayed medical care or its absence can lead to tragic consequences. There can be several reasons for the development of uterine bleeding.

Instruction

Uterine bleeding is divided into 2 broad categories: bleeding as a result of disorders in internal organs and systems and bleeding caused by disorders in the genital area. Non-genital causes include infectious diseases(measles, influenza, typhoid, sepsis), blood diseases (hemophilia, hemorrhagic vasculitis), liver diseases (cirrhosis), diseases of cardio-vascular system(atherosclerosis, hypertension), thyroid dysfunction. Genital uterine bleeding associated with pregnancy early dates, may be as follows: disturbed pregnancy (ectopic or uterine), diseases of the fetal egg (chorioepithelioma, hydatidiform mole).

Genital causes of bleeding associated with pregnancy later dates: premature detachment of the placenta, scar on the uterus, placenta previa, the process of tissue destruction on the cervix, uterus, injuries of the vagina and vulva, low-lying placenta, rupture, violation of the attachment of the afterbirth, delayed discharge of the separated afterbirth, infringement of the afterbirth. Bleeding after childbirth can develop due to a decrease in the tone of the uterus, delayed parts of the placenta, injuries of the soft genital tract, endometritis, chorionepithelioma, uterine fibroids.

There is a large group of genital causes of uterine bleeding not associated with pregnancy: dyscirculatory uterine bleeding (juvenile, reproductive, menopausal), tumors of the ovaries, uterus, ovarian ruptures, ovarian cyst ruptures, uterine trauma, vaginitis, endometritis, cervicitis, cervical erosion, infectious - inflammatory processes. Dysfunctional uterine bleeding can also be caused by rejection of the endometrial layer as a result of a decrease in the concentration of female sex hormones (gestagens, estrogens), disruption of the ovulation process. Similar phenomena are often observed among women aged 30-40 years.

There are heavy and prolonged bleeding, which coincide with menstruation in time. They're called . Bleeding that appears in the interval between is irregular and has a different intensity. As a result of a malfunction in the hormonal system of a woman, ovulation becomes impossible, while the mucous membrane of the uterus (endometrium) grows with insufficient development blood vessels. Blood circulation is disturbed, blood stagnates, the permeability of blood vessels changes. In addition, the function of platelets (the main cells of the coagulation system) decreases, and the processes of blood thinning increase. All this creates favorable conditions for the development of bleeding.

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Uterine bleeding is the discharge of blood from the uterus, which can be caused by various reasons. Similar condition requires mandatory treatment. There are obstetric and dysfunctional uterine bleeding.

Types of uterine bleeding

Obstetric uterine bleeding can occur during pregnancy, during the birth process and in the postpartum period. They begin suddenly, and are dangerous in that a large blood loss develops very quickly, leading to a violation of vital functions. Treatment of such bleeding is carried out in a hospital.

Dysfunctional uterine bleeding develops due to disruption of the organs that regulate the menstrual cycle. Distinguish between ovulatory and anovulatory dysfunctional bleeding. Ovulatory appear in women of reproductive age, anovulatory occur at puberty or menopause s.

Treatment of uterine bleeding

At the first stage of treatment of dysfunctional uterine bleeding, preparations of tranexamic or aminocaproic acid are used. "Tranexamic acid" is used orally in the amount of 4-5 g for 1 hour, and then - 1 g every hour until the bleeding stops. Sometimes prescribed intravenous administration drug in the amount of 4-5 g for 1 hour. Then droppers are made, while 1 g is administered every hour for 8 hours. The total daily amount of the drug should not exceed 30 g.

A significant reduction in blood loss occurs with the use of combined monophasic oral contraceptives, NSAIDs (Nimesulide, Ibuprofen) and Danazol. "Ibuprofen" take 400 mg every 4-6 hours. The daily amount is 1200-3200 mg. "Nimesulide" is prescribed 50 mg three times a day.

In order to treat dysfunctional uterine bleeding, combined low-dose oral contraceptives (COCs) containing 3rd generation progestogens (Desogestrel or Gestodene) are often used. The following is popular: within 4 days, take 1 tab. 4 times, then within 3 days drink 1 tab. 3 times a day, then take 1 tab. twice a day, then 1 tab. per day until the second pack of the drug is finished. Outside of bleeding, to regulate the cycle of menstruation, COCs are taken for 3 cycles, 1 tab. per day (21 days - admission, 7 days - break).

In order to stop bleeding, only monophasic drugs are used. Studies have proven the high efficiency of using monophasic low-dose COCs (Regulon, Marvelon, Rigevidon, Zhanin), ½ tab. every 4 hours until bleeding stops. AT next days the dose is reduced to 1/2 tab. in a day. The duration of hormone intake depends on the severity of iron deficiency anemia and the process of restoring hemoglobin levels.

Uterine bleeding should not be confused with natural monthly blood loss associated with rejection of the functional layer of the endometrium. When they talk abstractly about uterine bleeding (there is another term - profuse bleeding), they mean abnormal bleeding in women due to gynecological problems.

Unexpected (or without obvious reasons) bleeding from the uterus represents for a woman (whatever age she is) great danger. In this regard, gynecologists exclude the so-called symptomatic treatment, since the elimination of the bleeding itself (that is, the consequences of some process) is a temporary measure that only aggravates the further growth of the cause of the bleeding.

The causes of bleeding in women can be very different and often the symptoms are very blurred. In a good way, before “believing” in the established diagnosis, it would be necessary to undergo an examination in two or three independent laboratories.

Uterine bleeding is a manifestation of gynecological diseases, extragenital pathology, and can also be an independent disease.

The age at which such a phenomenon may occur can be different - from the neonatal period to postmenopausal.

The structure of the uterus

The uterus is hollow smooth muscle organ the female reproductive system, which consists of three parts:

• Bottom - top part uterus.
• Body - has a cone-shaped shape, ends with an isthmus at the bottom, leads to the cervix.
• Neck - includes the isthmus, cervical canal and vaginal part.

The weight of such an organ in girls and nulliparous women is about 50 g.

The structure of the uterus is such that it includes three layers:

• The perimetrium is the outer layer of the uterus that extends into the wall of the abdominal cavity.
• Myometrium is the middle, densest layer, which consists of muscles and a large number of blood vessels.
• Endometrium - inner shell uterine cavity, to which the fetal egg is attached. The endometrium, in turn, is divided into two layers:
  • Basal (basic).
  • Functional - this is the layer that undergoes monthly rejection in the absence of a fertilized egg.

For reference! Rejection of the functional layer of the endometrium, accompanied by bleeding from the uterus, is called menstruation.

Menstrual cycle

For the normal functioning of the female reproductive system, the participation of not only the genital organs, but the whole organism as a whole is necessary.
Such a process is characterized by stages, where a change in one link leads to a disruption in the activity of the whole organism.

Normally, the regulation of the menstrual cycle is due to the following processes:

• The activity of the uterus is the main organ of the female reproductive system, which is controlled by the higher structures of the body.
• The functioning of the ovaries is paired organ is an endocrine gland that produces progesterone, estrogens and androgens. The most significant role in the first phase of the cycle is occupied by estrogen hormones, and in the second - by progesterones. But, despite the importance of organs such as the ovaries, they are also regulated by other organs and systems.
• Control by the pituitary gland - such a part of the brain controls the production of hormones, without which a woman, in principle, cannot be a woman in the full sense of the word:
  • Luteinizing hormone (LH) - it is the peak levels of this hormone that ensure the full process of ovulation in the ovaries, which consists in the release of the egg.
  • Follicle-stimulating hormone (FSH) - when the leader matures, dominant follicle controls its maturation in full.
• Influence of the hypothalamus - the coordinated activity of the hypothalamus takes control of a clear cyclical flow of hormones into the blood. The substances that control this process are "statins", which reduce the formation of hormonal substances and "liberins", whose main function is to stimulate the pituitary gland. Thus, there is a constant maintenance of normal production and levels of hormones important for a woman.
• Impact hemispheres the brain - it is from here that the necessary impulses spread to all the controlling structures of the female reproductive system. Even the slightest stress, for example, can lead to a failure of menstruation, because the entire regulation of the menstrual cycle is completely lost.

It is known that the intensity and duration of menstruation for each woman is individual. It is not uncommon for a woman or girl to take heavy periods for bleeding. To avoid this, you need to know the criteria for normal, healthy menstruation:

• The duration of menstruation should not be more than 7 days.
• Menstrual blood should not contain large and profuse blood clots.
• The volume of lost blood is not more than 80 ml.
• Preservation of the cyclicity of menstruation (from 21 to 35 days is normal).

Attention. Despite these criteria, it is necessary to pay attention first of all to the amount of blood released, since about 20% of cases turn out to be bleeding, leading to chronic anemia.

Classification

• Bleeding in newborns.
• Uterine bleeding before puberty.
• Juvenile - typical for adolescents - girls who start from the first menstruation and up to 18 years.
• Reproductive - inherent in women from 18 years old to the menopause period.
• Climacteric - can occur in women during menopause.

• Bleeding from the uterus during pregnancy:
  • First trimester - up to 12 weeks.
  • Second trimester - from 13 to 26 weeks.
  • Third trimester - from 27 to 40 weeks.
• Postpartum uterine bleeding:
  • In the early postpartum period - up to 2 hours after birth.
  • In the late postpartum period - within 42 days after childbirth.

Depending on the cause of uterine bleeding, there are:

• Dysfunctional:
  • Ovulatory - associated with menstruation. They are characterized by an increase in the volume and duration of bleeding.
  • Anovulatory - occurs between menstrual bleeding. More often develop after menstruation.
• Organic.
• Iatrogenic.

Uterine bleeding. The reasons

The causes of uterine bleeding in women are very diverse. In order to make it easier to understand this issue, they are divided into two large groups:

• Bleeding due to dysfunction of the female reproductive system (genital).
• Bleeding caused by diseases of other organs and systems (nongenital, extragenital).

In the development of such a process as extragenital uterine bleeding, the causes will be as follows:

• Diseases of the blood and the hematopoietic system - hemophilia, hemorrhagic vasculitis, deficiency of vitamins involved in blood coagulation).
• Infectious diseases (flu, sepsis, etc.).
• Cirrhosis of the liver.
• Atherosclerosis.
• Arterial hypertension.
• Hypothyroidism.

The causes of bleeding of genital origin may be associated with pregnancy or develop outside of pregnancy:

• Those related to pregnancy:
  • Disrupted pregnancy.
  • Bubble drift.
  • chorionepithelioma.
  • Placenta previa.
  • Premature detachment of the placenta.
  • Scars on the uterus.
  • Destruction of cervical tissue.
  • Low location of the placenta.
  • Rupture of the uterus.
  • Injuries.
  • Endometritis.
  • Delay parts of placenta.
  • Myoma of the uterus.
• Reasons not related to pregnancy:
  • Neoplasms.
  • Ovarian cysts.
  • Ovarian ruptures.
  • Infections and inflammation of the female genital organs.
  • Cervical erosion.
  • Cervicitis and endocervicosis.
  • Vaginitis.
  • Endometritis.

Uterine bleeding. Symptoms and types

• Menorrhagia (hypermenorrhea) - menstruation lasting more than 7 days and with a volume of more than 80 ml with preserved regularity.
• Metrorrhagia - bloody, not copious discharge, which are irregular. More inherent in the middle of the cycle.
• Menometrorrhagia - irregular but prolonged bleeding.
• Polymenorrhea - such menstruation occurs more often than after 21 days.

Important! A frequent concomitant sign of prolonged uterine bleeding is Iron-deficiency anemia, which occurs due to a decrease in the level of hemoglobin in the blood.

Uterine bleeding in newborns

They are scanty spotting from the vagina, which most often occurs in the first week of life of newborn girls. The reason for this condition is a sharp and rapid change in hormonal levels.

Such conditions do not require treatment and pass on their own, so medical intervention to stop bleeding is not necessary.

Bleeding from the uterus before puberty

Rarely registered. The main cause of this pathology are hormone-positive ovarian tumors, which constantly produce a large amount of hormones.

For reference. This condition is regarded as false positive puberty.

Juvenile uterine bleeding

most common cause uterine bleeding of the juvenile period is a failure in the activity of the ovaries, which is manifested
hormonal changes:

• The synthesis of progesterone by the ovaries is impaired.
• An excess of progesterone appears in the body.
• The level of FSH rises and the level of LH decreases, which leads to the fact that the process of ovulation does not occur (such bleeding is called anovulatron).
• Due to the pathology of the thyroid gland and adrenal glands, impaired hormone production also develops.

In addition to the development of juvenile bleeding, prolonged chronic infections, frequent hypothermia, stress, psychological trauma, excessive physical exercise, malnutrition.

Less commonly, such blood loss can be caused by conditions such as tuberculosis, tumors and anomalies in the development of the cervix, uterine body and ovaries, impaired blood coagulation, leukemia, and pituitary tumors.

For juvenile uterine bleeding, seasonality is characteristic, since more often the disease occurs or worsens in autumn and spring.

Treatment in such cases is necessary in a hospital with the appointment bed rest, use to stop bleeding - vikasol, dicinone, aminocaproic acid, applications of a cold heating pad. Vitamins, iron-based preparations to eliminate anemia, uterine contractions (oxytocin), ascorutin and physiotherapy are also shown.

Important! Treatment is individual in each case. With correctly prescribed therapy, almost 90% of cases recover within 12 months. normal cycle and uterine bleeding stops.

If the indicated remedial measures do not have the desired effect, resort to hormone therapy. AT life threatening situations, diagnostic curettage is performed.

Bleeding in the reproductive period

Important! According to statistics, every third woman of reproductive age has experienced uterine bleeding at least once in her life.

The causes of uterine bleeding of reproductive age are as follows:

• Changes in the concentration of hormones.
• Endometriosis.
• Adenomyosis.
• Pathology of the blood coagulation system.
• Hyperplasia of the endometrium (such a pathology is spoken of in the case of thickening of the endometrium from 14 mm or more).
• Polyps in the uterine cavity.
• Submucous myomatous nodes.
• Intrauterine spirals.
• Complete/incomplete spontaneous abortion.
• Ectopic pregnancy.

Regardless of the cause, one of the leading symptoms is uterine bleeding. In the event of a hormonal failure, a correction is necessary with the use of progesterone-based drugs (Dufaston). If a hormonal imbalance is not diagnosed, then it is necessary to use hemostatic medications to stop uterine bleeding.

In addition, for example, when endometrial hyperplasia is detected, surgery using diagnostic curettage from the uterine cavity. The same applies to uterine fibroids, ectopic pregnancy and spontaneous abortion, where without surgical intervention not enough.

Important! Treatment of uterine bleeding in women of reproductive age has the main goal - to preserve her childbearing function.

Uterine bleeding with menopause

In women who are in such a period with the development of uterine bleeding, even the most minimal degree of severity, in the first
queue must be excluded. oncological diseases, as this is a very dangerous clinical symptom.

The reason for this is:

• Change in hormonal background.
• hyperplasia of the endometrium.
• Uterine fibroids of submucosal localization.
• Precancerous degeneration and endometrial cancer.
• "Forgotten" intrauterine device.

Important! According to the data clinical research, about 70% of the time malignant neoplasms endometrium in women during menopause are manifested by uterine bleeding.

The most important thing in determining further treatment tactics is diagnostic curettage with biopsy extraction and its diagnosis.

Detection of submucosal fibroids involves hysteroresectoscopy with removal of the node / nodes. If the size of the nodes is large, then the removal of the uterus and appendages is indicated.

If the cervix bleeds, the reasons for this, according to studies, often lie in its precancerous degeneration, which requires a biopsy and determination of further patient management tactics.

The presence of a coil installed more than 5 years ago is an indication for its removal, followed by anti-inflammatory therapy.

Important! Even with the successful extraction of the old spiral, it is necessary to make sure that the walls of the uterus are intact.

If uterine bleeding leads to the development of anemia, which happens quite often, it is necessary to prescribe iron supplements.

Dysfunctional bleeding

Failure of the control system can cause the following pathological processes:

• Sharp and chronic diseases genital organs.
• Pathology of the endocrine system.
• Stress.
• Mental and physical fatigue.
• Climate change.
• Abortions (including spontaneous).

Important! Dysfunctional uterine bleeding with ovarian dysfunction is one of the most common causes of infertility.

The most optimal method of treatment in such cases is hormonal therapy.

Uterine bleeding not associated with the pathology of the reproductive system

Also, such bleeding is called extragenital, the causes of which are diseases of organs and systems that are not related to the female genital area.

A distinctive feature in this case is the combination of uterine bleeding with nosebleeds, increased bleeding of the gums, lengthening of the bleeding time from cuts and scratches, and the appearance of bruises with minor bruises.

In such cases, the underlying disease is treated first.

Iatrogenic bleeding

This type of blood loss occurs due to the use of contraceptives, wearing spirals and taking drugs that cause blood thinning.

Bleeding during pregnancy

• Detachment of the chorion, placenta.
• Pathology of the blood coagulation system.
• HELLP - Syndrome.
• Threatened abortion.
• Rupture of the uterus.

Important! Bleeding during pregnancy is the most common cause of death in obstetric practice.

The most important principles of treatment of such pathology are:

• Placental abruption requires the appointment of Dufaston, hemostatic drugs. In case of severe bleeding, urgent surgery is necessary.
• Violation of blood clotting is eliminated by the introduction of drugs that affect the hemostasis system, erythrocyte, platelet mass, fresh frozen plasma.
• Uterine rupture is the most severe and dangerous reason bleeding, often leading to lethal outcome. In this case, only emergency surgery can save a woman's life.

Postpartum uterine bleeding

Various reasons can lead to such conditions:

• Rupture of the cervix during childbirth.
• placenta accreta to inner wall uterus or delay of its parts.
• Postpartum hypotension of the uterus.
• Blood clotting disorder.
• Premature rupture of sutures after caesarean section.

For treatment heavy bleeding after childbirth, there is not much time left, since a large blood loss can quickly lead to the death of a woman.

Important. To stop bleeding, intravenous administration of oxytocin, hemostatic drugs, saline solutions, colloidal agents, .

In some cases, a manual revision of the uterine cavity is used for the presence of remnants of the membranes and parts of the placenta.

In severe cases, surgery is necessary.

First aid

In order to provide first aid to a woman in a timely manner, it is necessary to know the main signs of uterine bleeding, which
called profuse bleeding.

• Strong, copious discharge of blood for a short period of time.
• Growing weakness.
• Dizziness.
• Marked pallor.
• The fall blood pressure.
• Tachycardia.
• Drowsiness, lethargy.

Even if at least one of the above symptoms is determined, emergency medical attention is needed.

Important! Profuse uterine bleeding is an extremely dangerous condition for a woman. With untimely assistance in difficult situations a woman can develop hemorrhagic shock and death very quickly (within a few minutes).

If uterine bleeding happened at home, first of all, you need to call an ambulance specialized help.

Before her arrival, it is necessary to carry out the following manipulations to stop uterine bleeding:

• Give the woman a horizontal position with her legs raised up (lay them on a high pillow).
• Apply cold to the lower abdomen.
• Control blood pressure and heart rate.
• Transport by ambulance to any nearest medical facility.

In intensive care, infusion therapy is carried out in accordance with the woman's vital signs.

Important! One of the most effective measures aimed at saving the life of a woman with profuse uterine bleeding is curettage, which allows you to remove bleeding areas of the endometrium, provide powerful vasoconstriction of the uterine vessels and contraction of the uterus.

Profuse bleeding is a very dangerous condition. Life can depend on the correctness and timeliness of actions.

Attention! With profuse uterine bleeding, it is strictly forbidden to do the following:

• Apply heat to the lower abdomen.
• Take a warm bath or shower.
• Use medicines at your own discretion.
• Douching, washing.
• Do warm baths.

Diagnostics

With juvenile uterine bleeding, the following measures should be taken:

• Determine the date of the beginning and end of the last initial menstruation and the date of the initial menstruation, which developed into bleeding.
• Do .
• Donate blood for estrogen, prolactin, cortisol, progesterone.
• Donate blood for thyroid hormones - T3, T4, TSH.
• Determine the basal temperature between periods.
• Make an ultrasound of the pelvic organs, adrenal glands, thyroid gland.
• Spend ultrasonic control ovulation process.
• Take an x-ray of the skull.
• CT, MRI of the brain.

Uterine bleeding in women of reproductive age requires:

• Gynecological examination.
• Exceptions for ectopic pregnancy.
• Hysteroscopy.
• Ultrasound of the pelvic organs and abdominal cavity.

About 30% of all uterine bleeding occurs during menopause. In such cases, first of all, it is necessary to exclude ordinary menstruation, since as menopause occurs, the function of the ovaries is depleted, which leads to irregular periods.

In order to exclude the pathological process, hysteroscopy is indicated. Curettage is also recommended to confirm endometriosis.

Attention. For the diagnosis of polyps of the uterine cavity and its walls, fibroids, curettage is required.

If oncological processes are suspected, an MRI, CT scan is necessary.

Uterine bleeding. Treatment

The goal of treatment of uterine bleeding is its elimination, replenishment of blood loss, clarification and treatment of the cause, as well as prevention. Any uterine bleeding requires immediate treatment, as it is dangerous to leave a woman without proper therapy in this condition.

Diagnostic curettage in many cases is effective method treatment, as it allows not only to stop bleeding, but also to identify its cause.

Important! For juvenile bleeding that is not life threatening, curettage is not indicated.

Also effective way stopping bleeding is hormonal hemostasis, in which large doses of hormones are prescribed.

As symptomatic treatment hemostatic drugs (dicinone, vikasol), drugs for uterine contraction (oxytocin), blood components, iron preparations, vasoconstrictors, vitamin therapy are used.

Uterine bleeding is profuse bleeding from the uterine cavity. In most cases, this pathology is caused by a failure of hormonal functions in the female body. Uterine bleeding poses a serious threat to a woman's health, they are fraught with numerous complications, and in some situations can even cause death.

The main cause of bleeding is considered to be a disorder in the production of female sex hormones. In addition, there are many factors that can provoke bleeding from the uterus. These include:

1. Diseases of the hematopoietic system.
2. thrombocytopenia.
3. Pathologies that develop during pregnancy.
4. Traumatic injuries of the genital organs.
5. Pathological processes in the uterus, as well as its appendages.
6. Various gynecological diseases.
7. The presence of tumor neoplasms, both benign and oncological.
8. Complications arising after childbirth.
9. Pathology of the liver.
10. Endocrine diseases.
11. Miscarriage.
12. The use of intrauterine contraceptives
13. Long-term use of hormonal contraceptives.
14. Endometriosis.
15. Changes in climatic conditions.
16. Frequent stressful situations.
17. Tuberculosis of the genital organs.
18. hypovitaminosis,
19. Disorders of the activity of the adrenal cortex
20. Pathology of the thyroid gland.
21. Availability inflammatory processes in the reproductive system.

Symptoms

A characteristic feature of this pathology is considered to be abundant bleeding, lasting more than a week. In addition, uterine bleeding is characterized by the presence of such symptoms:

1. Hypotension.
2. General weakening of the body.
3. Dizziness.
4. The presence of blood clots in the discharge.
5. Sanitary napkins should be changed every hour or more.
6. Pain in the lower abdomen.
7. development of anemia.
8. Paleness of the skin.
9. Tachycardia.
10. Slow pulse.
11. Loss of consciousness.

How to remove bleeding from menstruation?

Uterine bleeding differs from typical menstruation in a number of characteristic ways. These include the following factors:

1. A significant increase in the volume of allocated blood (over eighty milliliters per day).
2. Passion for the duration of the discharge (menorrhagia).
3. Bleeding is observed in the intermenstrual period (polymenorrhea).
4. Bleeding also occurs during menopause, which is not typical for menstruation.
5. Metrorrhagia, characterized by failures in the regularity of the menstrual cycle, is also a pathological manifestation.
6. If there are at least a few of the above signs, we are talking about uterine bleeding.

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Kinds

The presented pathology may differ in a number of signs due to the causes of occurrence, as well as some concomitant factors. The classification distinguishes the following varieties:

1. Dysfunctional bleeding is a pathology that occurs due to a violation of the ovulation process, as well as the activity of the organs responsible for regulating the menstrual cycle. Most often observed in women aged thirty to forty years.
2. Obstetric bleeding usually occurs during pregnancy, during the birth process, as well as the early postpartum period. This type bleeding is considered one of the most dangerous, as it is distinguished by suddenness and intensity. In fifteen percent of cases, in the absence of timely assistance, obstetric bleeding can lead to the death of a woman.
3. Organic bleeding occurs due to various anomalies of the female genital organs, as well as in the presence of systemic types of diseases.
4. Iatrogenic bleeding. Their appearance leads to prolonged and uncontrolled use. hormonal contraceptives, as well as incorrect installation of an ectopic device.
5. Menopausal bleeding - occur during menopause, as a result of hormonal failure in the body.
6. Juvenile bleeding occurs mainly in adolescent girls during puberty.
7. Diffuse bleeding occurs due to nodular adenomyosis of the uterus and associated changes in the myometrium.

Diagnostics

In case of suspicion, it is necessary, without delay, to contact a specialist - gynecologists and go through comprehensive examination. This is necessary in order to accurately establish the causes of this manifestation, as well as eliminate provoking factors. Diagnosis is also necessary because the presence of pathology in the form of spotting from the uterus can be a sign of a fairly serious disease that needs immediate treatment.

For uterine bleeding, the following diagnostic procedures are used:

1. General blood analysis.
2. Studies of smears from the cervix (in case of suspected cancer).
3. Ultrasound procedure.
4. Biopsy - taking suspicious tissue for further examination.
5. Blood chemistry.
6. Analyzes for the content of hormones.
7. Curettage of the cervical canal and the walls of the uterine cavity for histological examination. This procedure, among other things, is characterized by a therapeutic effect, since blood clots are removed during scraping, as well as defective epidermis.

How to stop bleeding?

In case of uterine bleeding, an ambulance should be called immediately. And before the doctors arrive, everything possible should be done to alleviate the condition of the woman. Remember that not only health, but also the life of the patient depends on timely and competently provided first aid. So, in order to stop severe uterine bleeding on your own, you must do the following:

1. Give the victim hemostatic drugs (Etamzilat, Dicyon, etc.).
2. After the medicine is taken, the patient should be laid down, and a pillow should be placed under her legs.
3. It is recommended to apply a heating pad with ice or just something cold to the lower abdomen.
4. At plummet blood pressure, let the patient drink sweet hot tea.

Every woman has a process menstrual bleeding takes place completely individually, depending on the characteristics female body. The average duration of the period of menstruation is determined up to five days. At the same time, if there are any atypical discharges, then it is worth thinking about the pathology. However, bleeding should not be excluded, which can be easily confused with menstruation. Therefore, in order to provide timely assistance, it is necessary to have an understanding of the distinguishing features.

During the period of menstruation per day, a woman begins to release blood in medium quantities (about 50 ml.). The first days of menstruation are characterized by bloody discharge of a bright color, then in the following days the discharge becomes darker and is allocated in portions. The shades of outgoing blood also differ for each woman individually. Subsequent release can occur with a sharp rise or movement, physical activity.

Additionally, mucus or blood clots appear in menstrual flow. At the same time, the smell of secretions is also present. menstrual blood characterized by an odor reminiscent of fresh meat.

Attention! If the discharge during menstruation has an atypical brown color or the discharge is scanty, it is recommended to consult a gynecologist for advice.

Uterine bleeding and menstruation: the main differences

In order to identify pathology, a patient should be interviewed, who can easily characterize the typical menstrual flow characteristic of her. Therefore, any changes should alert the woman. The nature of menstruation can change dramatically, therefore, it is necessary to pay attention to such alarming signs:

1. The volume of menstrual flow increases significantly.
2. The release of blood does not occur in portions, but proceeds almost continuously.
3. Outgoing secretions are characterized by a too liquid consistency.
4. There are no blood clots.
5. The color of the discharge becomes rich red.
6. There is no specific odor characteristic of blood.
7. There are signs of anemia.
8. There is marked weakness.
9. Possible pain in the lower abdomen.
10. Before the onset of menstruation, sexual intercourse may cause soreness.

Carefully! If the above symptoms are observed, then you should not hesitate to visit a specialist.

Causes of bleeding

For the body, blood loss is enough dangerous manifestation. Almost a third of all uterine bleeding is due to pathological process that originated in the female reproductive system. Basically, pathologies of this kind do not pose a threat to life, but lead to poor health, anemia, low rates iron in the blood, as well as problems with sexual activity. Therefore, in order to prevent the occurrence of pathology, you need to know the main causes that provoke it.

The root causes of bleeding are as follows:

• termination of pregnancy, which occurred artificially (abortion) or naturally (miscarriage);
• if the delivery was by caesarean section;
• frequent diets, which lead to complete intoxication of the entire female body;
• problems with general hormonal background, sharp failures;
• iron deficiency or beriberi;
• blood ailments;
• blood clotting disorder;
• prolonged depression, stressful situations;
• ailments, infectious nature;
• excessive physical activity and heavy lifting;
• inflammatory process in the reproductive system;
• gynecological pathologies;
• pathological neoplasms.

Classification of secretions

Specialists classify uterine bleeding into three types.

Bleeding	Short description
Normal	Every cycle a woman has menstrual flow, which is considered to be a natural norm for the body.
conditionally normal	There are discharges in the pre-ovulatory or post-ovulatory period. Implantation bleeding is also included in the conditionally normal type of bleeding.
Pathological	These bleedings can occur at any age - with menopause, during the period of reproductive activity, adolescence. They can be divided into subspecies: Functional. Bleeding occurs due to problems with endocrine system or dysfunction of the pituitary gland; organic. If a woman is diagnosed with neoplasms (polyps and others) or ailments (for example, endometriosis), then bleeding often occurs; systemic. Most often provoked by autoimmune diseases or pathologies of a chronic nature

Learn more about types of bleeding

Dysfunctional

The main signs of this type of bleeding are profuse blood loss or a protracted nature. Teenage girls and menopausal women are at risk. The provoking factor of the pathology is an excessive amount of estrogen or progesterone. To eliminate this pathology use hormone therapy.

There are two types of dysfunctional blood loss:

• ovulatory. They are characterized by manifestations of an abnormal cycle, that is, for a month a woman has slight discharge of a meager nature, or, conversely, short menstruation, which have an interval of more than one month;
• anovulatory. Differ in significant blood loss, violation of the cycle, feeling unwell, loss of appetite and constant desire sleep.

It is important! Primary pathology can be determined using a gynecological examination, supplemented by ultrasound.

Juvenile

May appear seasonally. This is due to the fact that the corpus luteum is not formed due to hormonal failure. If a teenage girl is diagnosed with neoplasms in the reproductive system, then juvenile bleeding is not excluded.

Breakthrough

One third of cases of breakthrough bleeding occur due to problems with the uterus, which are provoked by intrauterine device. Also, bleeding can be provoked by the consequences of taking hormonal contraception. To prevent subsequent bleeding, it is recommended to remove the coil and pick up correct dosage contraceptives.

Profuse

Profuse blood loss is difficult to distinguish from monthly discharge, since they are also characterized by menstrual pain. The only symptom- increased blood loss, which is characterized by scarlet discharge. The period of occurrence is difficult to pinpoint because it varies.

This is dangerous! Profuse bleeding is difficult to diagnose and requires urgent hospitalization of a woman. In this case, it is imperative surgical treatment in the form of curettage of the uterus.

Video - How to distinguish menstruation from bleeding?

Bleeding and menopause

In menopause, a woman is not excluded the risk of neoplasms different nature(myomas, polyps). This is explained by a decrease in estrogen levels, which are responsible for the normal menstrual cycle. It is significant that a woman will experience severe soreness during sexual intercourse, as well as the interval between menstrual cycles over three months.

Blood loss during pregnancy

If after conception a woman has any bleeding, then this is a direct threat to her life and to the fetus. Having found a bright spotting of a woman, you should immediately call an ambulance. Allocations are accompanied by the following symptoms:

1. emergence severe pain in the lower abdomen, which resemble contractions.
2. Nausea leading to vomiting.
3. Increased sweating.
4. The appearance of dizziness.

Note! The occurrence of bleeding during pregnancy is considered dangerous sign which is life threatening.

How to help

First of all, it is necessary to minimize all physical activity. Then revise the diet and include beef meat, offal (liver), products with high content gland.

If a woman has started to have heavy blood loss, then she urgently needs to lie down in such a position that the pelvis is slightly raised. To do this, you can put a pillow or raise it a little. lower limbs. Thus, loss of consciousness can be avoided, and symptoms can be reduced.

To reduce bleeding, you need to apply cold compress so that the vessels of the uterus narrowed, and muscle layer uterus has shrunk.

Do not ignore any pathological discharge, because they can be a sign of a serious illness. The specialist will tell about the causes of uterine bleeding in the video commentary.

Video - Why does uterine bleeding occur?