Uterine bleeding – This is any outflow of blood from the uterine cavity, with the exception of menstrual and patrimonial bleeding. Uterine bleeding as a symptom may accompany many gynecological and extragenital pathologies, or it may be an independent disease.
Anomalous uterine bleeding occurs without age correction during any period of life. Approximately 3% of newborn girls in the first days of extrauterine life often have bloody discharge from the genital tract of a physiological nature, it consists of dark, uncooling blood, mucus and self-terminate after one or two days. Uterine bleeding that occurs in older women almost always indicates a serious pathology.
The largest group is uterine bleeding due to menstrual dysfunction, or dysfunctional uterine bleeding. They are not associated with anatomical abnormalities, they can occur with a certain periodicity (cyclical) or have an acyclic character.
Among dysfunctional uterine bleeding leading juvenile (adolescent). Juvenile uterine bleeding is diagnosed in girls during active puberty, their cause is associated with imperfect work and the immaturity of the endocrine and hypothalamic-pituitary system.
Uterine bleeding in its origin can be attributed to complicated pregnancy, childbirth or the postpartum period. Also, it sometimes provokes ectopic pregnancy, complicated abortion, genital tumors.
Diseases of the circulatory system, pathology of the heart and / or blood vessels and endocrine diseases are often present among the causes of uterine bleeding in women with good gynecological health.
Among the causes of uterine bleeding are less serious factors: stress, overwork, change in the climatic zone of residence, a sharp weight loss (especially by artificial means). Incorrect use of hormonal contraceptive drugs can also provoke uterine bleeding.
The clinical picture of abnormal uterine bleeding is simple and obvious. Characterized by the appearance of bleeding from the genital tract of varying intensity and duration, which is not menstruation and is not associated with physiological birth. Intense abnormal uterine bleeding provokes anemia clinic, and sometimes can lead to serious consequences: distortion of the cardiovascular system and hemorrhagic shock.
A huge variety of causes of uterine bleeding requires a consistent diagnostic search, including a large list of studies. As a rule, the diagnosis is carried out in stages, when gradually, by means of elimination, diagnostic measures are carried out until the minute when there is no reliable reason for the bleeding.
Stop uterine bleeding is made according to its cause, and certainly taking into account the patient’s condition. In emergency situations, when the strongest uterine bleeding is life threatening, therapy is carried out as part of resuscitation, and after the patient recovers due to the patient’s well-being, the search for the cause of the bleeding begins, and further therapeutic tactics are developed.
Causes of uterine bleeding
Uterine bleeding is etiologically closely related to age, the nature of the hormonal function of the ovaries, as well as the somatic health of women.
Uterine bleeding of the neonatal period is associated with a “sex crisis” – the process of adaptation of a born girl to an “independent” life. After giving birth, a significant amount of maternal hormones remains in the girl’s body, which decreases sharply after delivery. The peak of hormonal decline occurs at the end of the first week of life, at the same time, the baby may experience bloody vaginal discharge. They correlate with the norm, they pass independently as much as possible in two days and do not require outside intervention.
Juvenile uterine bleeding more often occurs in the first two years after the onset of the first menstruation. Their appearance is associated with imperfect regulation of menstrual function or with the consequences of the pathological course of pregnancy and childbirth.
In women who have overcome puberty, uterine bleeding can have the following causes:
1. Pathology of pregnancy. Uterine hemorrhage in the early (up to 12 weeks) terms is caused by miscarriage, frozen pregnancy, vesicular skid. In later periods (after 12 weeks), uterine bleeding can provoke the placenta if it is improperly attached (presumptive) to the uterine wall, or if it begins to exfoliate early.
In pregnant women, uterine bleeding is not always associated with the unfavorable state of the fetus or the threat of premature birth. Sometimes they appear due to the presence of erosion on the cervix, a cervical polyp or a banal mucosal injury.
2. Pathological labor. Extensive birth trauma, delayed particles of the placenta in the uterus giving birth, impaired uterine wall tone (atony and hypotension) initiate uterine bleeding in women who have given birth.
3. Complicated abortion. Severe uterine bleeding may occur after a mechanical injury to the uterine wall. Also, post-abortion bleeding is provoked by not removed parts of the fetus and / or fetal membranes.
4. Ovarian dysfunction. Violation of the physiological rhythmic production of sex steroids by the ovaries leads to a change in the nature of the menstrual function when it acquires the features of uterine bleeding.
5. Infectious-inflammatory changes in the genitals, including those triggered by specific infections (usually gonorrhea).
6. Benign growths: fibroids, polyp, ovarian tumors.
7. Extragenital ailments: diabetes mellitus, diseases of the blood and thyroid gland, pathology of the liver and adrenal glands.
8. Hormonal medications taken for the purpose of therapy or contraception.
In women who have overcome the 45-year-old frontier, uterine bleeding leads in the list of gynecological ailments. Their appearance is often associated with physiological changes in the hormonal function of the ovaries.
Symptoms and signs of uterine bleeding
Uterine bleeding is the appearance of bleeding, treated by a woman as atypical.
First of all, uterine bleeding should be distinguished from physiological bleeding. Bleeding is considered “normal” if it:
– accompanies the process of childbirth or is associated with the postpartum processes of uterine involution;
– associated with mechanical removal of the uterine mucosa (diagnostic curettage or abortion) or with therapeutic and diagnostic procedures (for example, cauterization of erosion, removal of the intrauterine device, hysteroscopy).
Physiological uterine bleeding is distinguished by a tendency to self-extinction and the absence of pathological causes.
According to the etiology of uterine bleeding, they are divided into dysfunctional (associated with menstrual dysfunction), organic (provoked by the pathology of the genital organs or non-gynecological diseases) and iatrogenic. Iatrogenic uterine bleeding more often appears after taking drugs that affect the hormonal system, blood clotting or psycho-emotional sphere.
As a rule, the most popular complaints for uterine bleeding are:
– bleeding from the genital tract in the intermenstrual period or against the background of the delay of the next menstruation;
– a change in the nature of menstrual bleeding: menstruation may last too long or differ unusually large blood loss;
– incessant bleeding after childbirth or abortion, often in combination with high fever, intense pain and poor health;
– bleeding on the background of the extinction of menstrual function during menopause, when the monthly begin to confuse;
– sudden bleeding (often scanty) after menopause;
– general weakness, dizziness, feeling unwell against the background of atypical bloody uterine secretions (indicate anemia).
It should be noted that the term bleeding is not associated with the amount of blood secreted. Uterine bleeding can be both short and scanty, and long and abundant.
To establish the cause of uterine bleeding is possible already at the stage of conversation and gynecological examination. This happens if a cervical polyp is visualized, extensive erosion on the cervix or there is an indication of the uterine myoma present.
Laboratory diagnosis includes testing for the presence of infection (swabs and cultures) and the study of hormonal status.
Ultrasound scanning allows you to determine the size and condition of the uterus and endometrium, see the fibroids or polyps, as well as detect structural changes in the ovaries.
If to determine the cause of uterine bleeding is required to examine the condition of the endometrium, a diagnostic biopsy, curettage or hysteroscopy.
Uterine bleeding after childbirth, abortion and menstruation
Postpartum hemorrhages are more often associated with parts of the placenta (afterbirth) remaining in the uterine cavity, hypo- and atony of the uterus, or with a placental polyp.
Physiological labor implies complete detachment of the placenta from the uterine wall and its rejection after the birth of the fetus. If a part of the afterbirth remains in the uterus after completion of labor, its muscular wall is not capable of completely contracting and constricting the bleeding uterine vessels.
The reason for the delay of parts of the placenta is often its too tight attachment or even the increment of its lobes to the wall of the uterus. After birth, they remain in the uterus and provoke uterine bleeding.
Also, the source of postpartum hemorrhage is sometimes not the afterbirth lobes, but its membranes remaining in the uterus due to improper management of labor or the presence of infection in the uterus.
Foreign elements in the uterus after childbirth provoke not only heavy bleeding, they contribute to infection. In the event of an infection, signs of acute inflammation join the copious uterine bleeding: fever, severe pain, admixture of pus in the uterine discharge.
Sometimes massive uterine bleeding in births appears after discharge from the hospital for 8-21 days.
As a rule, with proper management of labor, the separated placenta is carefully examined for integrity. If there is a defect in the posleda (missing pieces), broken shells are visible (or they are missing), the fact of their delay in the uterine cavity is established. In this case, manual examination and emptying of the uterus is performed.
The process of childbirth is accompanied by an intense load on the muscle wall of the uterus. Sometimes, if there is a multiple pregnancy or high water, the uterine muscles are forced to overload so that after birth, they completely or partially lose the ability to restore the size of the uterus to the prenatal indicators. If the lack of uterine tone decreases, postpartum uterine bleeding provokes, they are called hypo-or atonic.
There is a similar mechanism for the development of uterine bleeding after an abortion. Bleeding after an abortion is often associated with incorrect execution of the procedure of emptying the uterus. If part of the fetus remains in the uterine cavity, it becomes a source of bleeding and infection of the uterus.
Severe uterine bleeding with clots and severe pain after abortion against the background of a sharp deterioration in health may indicate perforation (puncture) of the uterine wall.
Uterine bleeding after the end of regular menstruation can have many causes, which may have innocuous causes or be caused by serious pathology. Those are more often:
– side effects from the beginning (the first three months) of taking hormonal contraceptives or their incorrect use (for example, abrupt cancellation);
– uterine fibroids or cervical polyp;
– Oncological gynecological pathology.
Dysfunctional uterine bleeding
Uterine bleeding associated with impaired regulatory function of the pituitary and hypothalamus, when in the absence of diseases of the uterus and appendages, hormonal dysfunction that changes the menstrual cycle appears to be dysfunctional. Since the greatest number of hormonal fluctuations falls on young (14–18 years) and premenopausal (18–45 years) age, the greatest number of dysfunctional uterine bleeding is recorded among patients of these age groups.
Dysfunctional uterine bleeding is not uncommon and is diagnosed in almost every fifth patient who has contacted the gynecologist.
Normally, the menstrual cycle consists of two equivalent phases, separated by an ovulation period – the release of a ripe egg cell beyond the limits of the ovary. Ovulation occurs in the middle of the cycle. After the egg leaves the ovary, in the place where it matured, a yellow body forms.
In the first menstrual phase, estrogens dominate, in the second place they are occupied by progestin (progesterone).
Dysfunctional bleeding caused by a rhythm disturbance of hormonal secretion, as well as a change in the number of sex steroids.
The clinic of dysfunctional bleeding is closely related to the presence or absence of ovulation, so they are divided into:
– ovulatory (ovulation is), characteristic of the reproductive age;
– anovulatory (without ovulation), often found in young girls and menopausal women.
At the heart of all dysfunctional bleeding is a violation of the menstrual cycle. It may have the following forms:
– “abnormal” copious menstruation (regular or irregular), lasting longer than a week;
– menstruation with a small (less than 20 days) or large (more than 35 days) interval;
– absence of menstruation for more than six months, provided that there is no pregnancy, lactation and menopause.
In the absence of ovulation, menstruation becomes irregular, with long delays. Usually after a delay of one month and a half or two months, there is profuse bleeding that lasts longer than a week. Uterine bleeding with clots may occur. A large amount of blood that accumulates in the uterine cavity does not have time to evacuate in time and forms clots – fragments of coagulated blood. The presence of blood clots may also indicate a violation of the coagulation system or a decrease in uterine wall tone (for example, after childbirth or abortion).
Regularly recurring significant blood loss often leads to concomitant anemia.
Therapy for dysfunctional uterine bleeding involves a detailed diagnosis of their cause. It is necessary to determine in which of the links of the hormonal regulation violations occurred in order to properly compensate for them.
Treatment of uterine bleeding
The choice of treatment for uterine bleeding always implies a detailed study of their cause.
Postpartum uterine bleeding due to a delay in parts of the placenta or fetal membranes cannot be stopped without a revision of the uterine cavity. After giving birth, the uterus retains its large size, and the cervix has not yet returned to its original size and freely passes the hand. With the observance of all the rules of antiseptics, a manual examination of the uterine cavity is performed in order to find the culprit of bleeding. The detected fragment of the afterbirth or membranes is removed, and then infectious complications are prevented.
Bleeding after abortion, due to the delay of parts of the fetus, is stopped by curettage of the uterine cavity.
Juvenile uterine bleeding is treated in several stages. Initially, the bleeding is stopped. If the bleeding is moderate, and the patient’s condition is not disturbed, symptomatic hemostasis is resorted to. Long-term and heavy juvenile bleeding with the presence of secondary anemia require the use of hormones. Also, hormonal hemostasis is used if bleeding continues after symptomatic treatment. The choice of a hormonal agent is always individual, because it depends on the specific clinical situation. Usually preference is given to gestagens or a combination of estrogen with gestagens.
Even the most effective hemostasis cannot rule out a recurrence of juvenile uterine bleeding, therefore the next therapeutic step is anti-relapse therapy aimed at eliminating the true cause of the bleeding – hormonal dysfunction. With the help of hormonal preparations, the normal menstrual cycle inherent in a particular patient is recreated. As a rule, anti-relapse treatment continues for three months.
Dysfunctional uterine bleeding of the reproductive period is also treated in stages:
Stage I Stopping bleeding.
1. Symptomatic hemostasis. It includes means to reduce the musculature of the uterus, as well as preparations of hemostatic action.
2. Surgical hemostasis. Scraping uterine cavity. The method leads among menopausal women due to the increased risk of endometrial cancer.
3. Hormonal hemostasis. It is justified only for young women who have not realized the reproductive function of women who do not have indications of endometrial pathology in the history.
Stage II. Recreation of the normal menstrual cycle and relapse prevention.
1. Vitamin therapy: folic acid, vitamins E, B, C.
2. Homeopathic medicines that regulate menstrual function: Remens, Mastodinon and the like.
3. Hormone therapy. The medicine is selected according to the patient’s age and the nature of the hormonal dysfunction.
Stage III. Restoration of the ability to reproduce.
Conducted among young women planning pregnancy. Ovulation stimulating agents are used.
During menopause, dysfunctional uterine bleeding also implies a phased therapy. First, at the first stage, surgical hemostasis (curettage) is often performed. Subsequent hormonal treatment is aimed at suppressing ovarian activity and the formation of atrophic changes in the endometrium.
How to stop uterine bleeding
Any abnormal uterine bleeding should be eliminated with a qualified technician. However, women do not always seek help, preferring to cope with non-intensive bleeding on their own.
Indeed, sometimes the bleeding is very successfully stopped by the woman herself. But since hemostasis is only the first stage of therapy, without subsequent adequate treatment, uterine bleeding can not only recur, but also return accompanied by more serious symptoms.
If a woman knows about the cause of uterine bleeding and is sure that there is no serious reason behind him, it is possible to try to stop him yourself.
Infusions and decoctions of herbs cause a good hemostatic effect. They are used not only as monotherapy, but also as part of a comprehensive treatment, enhancing its effect and shortening the treatment time.
Clinically proven pronounced hemostatic effect of nettle, shepherd’s bag, yarrow, burnet.
Women who have already experienced uterine bleeding episodes and know their cause, use well-known and “proven” drugs. Dicine with uterine bleeding is perhaps the most popular hemostatic agent. It affects the vascular wall, reduces its permeability and restores the normal mechanism of blood coagulation. Dicionone is used for uterine bleeding in pill or injectable form.
The drug Tranexam for uterine bleeding is also very effective. It enhances blood clotting processes and thereby stops the bleeding. An additional effect of the drug is its anti-allergic and anti-inflammatory effect. Tranexam is used for uterine bleeding of a dysfunctional nature, with heavy menstruation.
When choosing a drug and a method for its administration, it should be remembered that even the most innocuous medication has adverse side effects and contraindications, therefore, when starting a self-liquidation of uterine bleeding, a woman risks harming her health.
Even if uterine bleeding is stopped, a visit to the doctor is necessary to determine its exact cause and subsequent anti-relapse treatment.
Independent hemostatic measures can also be carried out in the presence of an emergency situation while waiting for an ambulance car, when there is a lot of uterine bleeding, severe pain and feeling unwell. In order to reduce negative symptoms, it is necessary to lie down on a hard surface, slightly raising your legs, put something very cold on the stomach – an ice bubble, any bag of frozen food, a container filled with very cold water (for example, a bottle). You can also attach ice (for example, ice cubes in the package). Pre-cold should be wrapped with a cloth to avoid contact frostbite. It is also necessary to replenish the fluid lost by the body during bleeding. You should drink more water, sweet tea or herbal decoctions.
If uterine bleeding is associated with a hormonal contraceptive, you should inform your doctor and get recommendations about its replacement. It should be remembered that abrupt withdrawal of hormonal contraceptive can cause uterine bleeding or strengthen the existing one.
Preparations for uterine bleeding
To eliminate uterine bleeding, drugs of different pharmaceutical groups are used:
1. Means that enhance the contraction of the uterine muscles (Oxytocin, Methylaergomentrin, Ergotamine and the like). From phytopreparations used tincture of water pepper, shepherd’s bag extract.
Reinforced uterine contractions quickly evacuate the contents of the uterus and spasm bleeding vessels, causing their obstruction.
2. Antihemorrhagic and hemostatic drugs. Accelerate the blood clotting time, restore the normal tone of the wall of small vessels and narrow their lumen. The most popular are Ditsinon, Calcium chloride 10%, Calcium gluconate 10%, Vikasol, Ascorbic acid, Tranexam.
3. Hormonal hemostatic agents. Perhaps the most extensive drug group. A significant list of available hormonal drugs allows you to choose the necessary combination of hormones in the composition of the drug in order to eliminate hormonal disruption and stop uterine bleeding in women belonging to different age categories.
Juvenile uterine bleeding is stopped with the help of gestagens (Duphaston, Norkolut, Utrogestan), combined drugs (Non-ovlon, Microgene).
Dysfunctional uterine bleeding of the reproductive period is eliminated using monophasic hormonal contraceptives (Microgenon, Marvelon, Femoden), gestagens (progesterone derivatives) or estrogens (Estradiol, Sinestrol).
Dysfunctional bleeding of the premenopausal period is stopped with the help of gestagens (Norcolut, Orgametril, Progesterone derivatives) and antigonadotropic drugs (Danazol, Gestrinone).
Postmenopausal uterine bleeding undergoes surgical treatment.