Blood loss and spotting: causes, dangers and remedies

What you need to know about spotting

The content of the article

Any blood loss that occurs outside of the normal menstrual cycle should be assessed by a gynecologist, whether it is mild (spotting) or heavy bleeding.

However, note that, according to numerous scientific sources, one of the most common causes of intermenstrual bleeding is stress, so this symptom should not lead to premature alarms and concerns about malignancy.

Bleeding often occurs as a single symptom, but it can also be accompanied by other symptoms associated with the underlying pathology:

• pain in the abdomen or pelvis;
• vaginal discharge;
• asthenia and general malaise;
• nausea and vomiting;
• fatigue and feeling tired;
• pallor and tachycardia.

Tachycardia
Diagnosis of such conditions is based on recognition of the symptom and associated signs. It is also important to immediately perform instrumental tests, for example, transvaginal ultrasound, which is necessary to identify organic pathologies.

Therapy depends on the cause of the bleeding, as well as on the woman’s age and her desire to have offspring; the choice of method lies with the gynecologist.

Possible causes of bleeding

You already know that spotting is scanty bleeding from the genital tract between menstruation. They can appear differently in different women or in the same woman at different times. Their color may also differ: fresh blood is bright red, older blood is brown or even black.

Let's find out what are the most common causes of spotting between periods.

• Hormonal contraceptives. If you start using hormonal contraceptives (pills, patches, injections, etc.), you may experience some spotting in the first 3 months. Doctors call this breakthrough bleeding. It is associated with changes in the lining of the uterus that occur under the influence of the hormones you take. Barrier methods of contraception (condoms, etc.) do not provoke such discharge.
• Sexually transmitted infections (STIs), such as chlamydia. The prevalence of STIs is increasing worldwide, in part because many of these infections are asymptomatic. In addition to spotting, STIs can cause abnormal vaginal discharge, abdominal pain accompanied by fever, and pain during urination or sex. If you suspect you have an STI, you and your partner should get tested immediately.
• Fibroids or uterine polyps. These are benign tumors that form in the lining or muscles of the uterus. Polyps are manifested by heavy, irregular menstruation (varying in time and intensity), which can lead to difficulties with conception. Uterine fibroids can make themselves felt by pain, constipation, and difficulty urinating.
• Polycystic ovary syndrome (PCOS). Women with PCOS have elevated levels of male sex hormones (androgens), which leads to irregular periods and spotting between periods.
• Oncological diseases of the reproductive system. This includes uterine cancer. These tumors are more common after menopause, although they can also be diagnosed in younger women. If you are over 40 years old and experience spotting between periods, you should consult a doctor for advice.
• Perimenopause. As menopause approaches, hormone levels in the body change, sometimes causing the lining of the uterus to become thicker. This can lead to irregular periods, spotting and other symptoms.

In most cases, spotting is not a cause for concern and medical intervention is not required. But in rare cases, they may indicate a disease and require additional examination.

If you are concerned about any of the above, or are worried about spotting for any other reason, be sure to consult your doctor.

The main causes of vaginal pathological bleeding

There are many causes of vaginal bleeding, but they can generally be grouped into 5 broad categories:

Complications during pregnancy (sometimes undiagnosed, that is, which the woman does not yet know about) include:

• abortion (miscarriage);
• ectopic pregnancy;
• gestational trophoblastic disease.

Dysfunctional reasons:

• anovulatory cycles;
• polycystic ovary syndrome;
• less often metrorrhagia.

Benign organic pathologies:

• uterine fibroids;
• uterine polyps;
• adenomyosis;
• endometriosis;
• genital infections.

Malignant organic pathologies:

• endometrial cancer;
• cervical cancer;
• vaginal cancer;
• sarcomas.

Common systemic causes:

• blood clotting pathologies;
• leukemia;
• hypothyroidism;
• liver and kidney failure.

Spotting may occur during the first cycles of taking hormonal contraceptives (birth control pills) and after using the hormonal IUD.

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Any vaginal discharge is associated with the functioning of the secretory organs of the reproductive system in a woman. They have a protective and moisturizing function, protecting against infection and creating a normal environment for the healthy functioning of organs.

When does discharge occur?

Discharge appears in growing girls several months before the onset of menstruation. Secretion may vary in properties and quantity, since there is a dependence on the general hormonal background, the onset of sexual activity, and the stage of the cycle. In the middle of the menstrual cycle, when ovulation occurs, the amount of secretion can increase significantly. The same thing happens just before menstruation.

One of the main symptoms indicating the presence of a gynecological disease is pathological discharge. However, it is impossible to characterize the discharge and establish a diagnosis on this basis.

How to distinguish normal discharge from pathological ones

Characteristic differences of pathological discharge:

• Discomfortable sensations accompanying discharge of different shades during any cyclic period. Itching, unpleasant odor, mild pain in the pelvic organs appear;
• Leucorrhoea appears - a cheesy discharge of predominantly white, yellowish or pinkish tints. They are stronger and thicker in comparison with the usual properties of the secretion;
• Bloody discharge of different shades that occurs during any period except the current menstruation;
• Excessive bleeding during menstruation.

The listed types of discharge are symptoms of diseases of various origins, acute and chronic inflammation, and developing formations. Diseases can be related to gynecology, or they can be of a completely different nature, unrelated to the reproductive system.

The difference between normal discharge is the absence of discomfort, no burning sensation, no negative reaction from the genital organs. In the study of smears for flora, lactobacilli predominate, leukocytes are normal. The secretion of a healthy woman resembles mucus of normal nature and transparency, without an unpleasant odor or inclusions. The second half of the cycle may be characterized by stronger discharge, pain both in the pelvic area and in the external organs of the reproductive system.

Types of discharge

They are divided according to location.

• Vaginal. The most common type. Should be present in small amounts in a healthy vagina. A large volume can be caused by pathology, for example, colpitis. The cause is determined through examination.
• Uterine. They indicate the course of pathology in the area of ​​the uterine mucosa (fibroids, endometrial diseases, neoplasms).
• Pipe. They are rare. Indicate inflammation in the fallopian tube.
• Vestibular. They have the appearance of leucorrhoea, localized in the outer part of the genital organs, involving the vagina.

The purpose of diagnosis in the presence of secretions is to determine the source of the secretion and analyze its nature. Preliminary analysis is carried out by abundance, consistency, color. Full analysis - based on laboratory research.

The most common types of discharge:

• Normal transparent mucous membranes, observed outside of menstruation;
• Curdled white or purulent greenish - evidence of inflammation, infectious disease;
• Bloody spotting of different shades in the middle of the cycle indicates a hormonal imbalance and the presence of erosion.

An alarming symptom should be the appearance of bloody discharge in the middle of the cycle, accompanied by severe pain, dizziness, decreased blood pressure, palpitations, and increased sweating. This is the basis for calling an ambulance.

If there are sharp pains with contractions in the lower abdomen, dizziness, severe weakness, this may indicate internal bleeding. Urgent assistance required.

It happens that vaginal discharge is the only sign of an ongoing disease. They are irregular and appear periodically. Laboratory testing is required to make a correct diagnosis. Regular preventive examinations with a gynecologist with tests according to the main list (general urine and blood, smear) help to identify hidden diseases that are asymptomatic.

Discharge in gynecological diseases. Causes and treatment

In women with constant hormonal imbalance, as well as those suffering from infertility, continuous discharge that is not inflammatory in nature is observed.

The following types of discharge are characterized as pathological and require treatment:

• In the form of a curdled mass, or in the form of a film or plaque: thrush (candidiasis);
• Transparent mucus with white inclusions, appears at the end of the cycle: erosion, inflammatory process in the cervix;
• Dirty white, in the form of layered films, having a strong unpleasant odor: vaginal dysbiosis;
• In the form of a bubbling yellowish substance: trichomoniasis (infectious disease);
• Abundant green and yellow, uniform consistency: inflammation of the ovaries (exacerbation), inflammation of the fallopian tubes;
• Purulent, thick, worsening after any effort: purulent cervicitis;
• Weak yellowish and greenish, homogeneous: infection with bacterial flora, chronic disease;
• Weak bloody dark colors: endometriosis, polyps;
• Pink with blood inclusions, with a strong odor: chronic pathology in the uterus;
• Dark liquid discharge immediately after menstruation: chronic endometrial disease;
• Large clots during the current menstruation: pathology of blood clotting, polyps, cervical inflexion. The reason may be an intrauterine device;
• Mild bloody, suddenly appearing during pregnancy: placental abruption;
• Immediately after artificial termination of pregnancy, the nature of the discharge varies. Ultrasound guidance is required.
• If, after the abortion procedure, purulent discharge joins the bloody discharge, we can talk about the onset of an infection. The danger is the accompanying pain and high temperature. You should not hesitate to visit a doctor. However, prolonged scanty discharge (sometimes more than a month) can be considered normal.

Based on an examination of the discharge and the diagnosis, the gynecologist prescribes adequate treatment.

Prevention of pathological discharge as a consequence of acute and chronic diseases of a gynecological and other nature is personal hygiene, regular medical examinations, protected sexual intercourse, and timely response to secondary symptoms of the disease.

It should also be taken into account that taking certain medications affects the course of the cycle and may cause minor discharge. Hormonal contraceptives have the same property.

Bloody discharge during pregnancy

Light spotting is common in the early weeks of pregnancy, but heavy bleeding can occur in the third trimester of pregnancy and poses a serious risk to both mother and fetus.

The severity of bleeding is assessed by:

• volume - small drops or real bleeding;
• duration;
• blood characteristics;
• accompanying symptoms.

There are many reasons for bleeding during pregnancy, including:

• urinary tract infections or hemorrhoidal disease (bleeding in which is misunderstood as blood loss of genital origin);
• polyps in the cervix;
• cervical carcinoma;
• placenta previa (abnormality of the placenta);
• placental abruption before childbirth;
• abortion (miscarriage);
• ectopic pregnancy (the embryo, instead of implanting in the uterus, implants in other areas, especially often in the fallopian tubes);
• gestational trophoblastic disease.

Polyps in the cervix
Both in the presence of bloody discharge and in case of more significant blood loss, the patient is always recommended to consult a doctor. If spotting in the first trimester is physiological in nature, when the bleeding was especially heavy, hospitalization would become mandatory.

Almost always in the third trimester of pregnancy, therapeutic treatment includes:

• If the presentation is mild, close monitoring of symptoms is necessary until vaginal delivery eventually occurs;
• If the clinical picture is severe, emergency treatment with continuous cardiotocography (for fetal monitoring) and immediate cesarean section should be performed.

Intense bleeding in the first weeks after childbirth or after an abortion can occur when the uterus has not yet restored its physiological size, or in case of imperfect (insufficient) cleaning of the internal walls.

Bloody discharge is normal

Bloody discharge before menstruation can be a sign of a shift in the menstrual cycle towards shortening due to various reasons. This is a completely acceptable phenomenon, as is spotting after menstruation, especially against the background of stress or a radical change in environment.

Also, occasionally, discharge may occur during ovulation, bloody, spotting or brownish. If they are short-term and painless, they are not dangerous. Sometimes, in the presence of cervical erosion, there may be discharge after sex due to contact bleeding from injured vessels.

Dysfunctional reasons

Anovulatory cycles are those cycles during which normal ovulation does not occur. The basis may be hormonal changes in FSH and LH, estrogen and progesterone. The imbalance causes excessive growth of the endometrium, which sloughs off irregularly at the end of the cycle, causing bleeding even outside the normal menstrual cycle, often long and heavy.

Polycystic ovary syndrome is a disease that affects young women between the ages of 20 and 40. It is characterized by anovulation (in the absence of a normal menstrual cycle and infertility), hirsutism, acne, insulin resistance with an increased risk of developing type 2 diabetes.

By menorrhagia we mean a pathological increase in the amount and duration of menstrual flow, which, however, in this case usually occurs at the end of the cycle.

Stress and eating disorders (anorexia nervosa, bulimia, etc.) can lead to intermenstrual losses and abnormal cycles, as well as metabolic diseases (metabolic syndrome) and hormonal dysfunctions, such as thyroid disease.

By metrorrhagia we mean heavy vaginal bleeding that occurs outside of the normal menstrual cycle.

Benign organic pathologies

Uterine fibroids and endometrial polyps are among the most common causes of vaginal bleeding during the fertile phase. The former are nothing more than abnormal growths of muscle tissue, and the latter - the endometrial mucosa. They can increase in size and often, in combination with hormonal changes, cause bleeding in the form of menorrhagia and metrorrhagia. In this category, it is also important for us to consider ovarian cysts.

Endometriosis means the abnormal presence of endometrium in organs other than the uterus, such as the ovary, fallopian tube, peritoneum, vagina, intestines, lungs. These ectopic lesions may also bleed during the normal menstrual cycle.

Occasional light-colored spotting, possibly worsening with sexual intercourse, may be caused by the presence of an ectropion (an "ulcer" on the cervix).

Genital infections can cause various types of vaginal discharge, but only rarely do they cause bleeding. The most common are those that are sexually transmitted - chlamydia and gonorrhea.

1.Vaginal discharge

​Vaginal discharge performs an important function in cleansing the female reproductive system. The fluid is produced by glands inside the vagina and cervix, and helps remove dead cells and bacteria from the body. This helps keep the vagina clean and prevent infection.

In most cases, vaginal discharge is completely normal

. The amount, as well as the color (from clear to milky white) and odor of vaginal discharge may vary depending on the day of the menstrual cycle. During ovulation, as well as breastfeeding or sexual arousal, the amount of discharge increases. The smell may change during pregnancy or due to poor personal hygiene.

All these changes are not a cause for alarm. But if the color, smell, or consistency of the vaginal discharge seems unusual, or if the vaginal discharge is accompanied by vaginal itching or burning, there is a possibility of infection. And this already requires a thorough examination and, most likely, treatment.

A must read! Help with treatment and hospitalization!

Malignant organic pathologies

They most often occur in the perimenopausal period and consist of malignant tumors of the genital organs. Most common:

• cervical cancer (the most important risk factor is human papillomavirus infection);
• endometrial cancer;
• ovarian cancer;
• cancer of the vagina and vulva.

Ovarian cancer
These are pathologies with a very poor prognosis if they are not recognized in time and treated.

Uterine bleeding and spotting as a prerequisite for precancerous diseases

The purpose of this study was to determine the morphological substrate of uterine bleeding and spotting from the genital tract in menopausal patients. Material and methods of research A histological and histochemical study of biopsies of the endometrium and endocervix, surgical material (panhysterectomy with appendages) was carried out in 271 menopausal patients suffering from uterine bleeding and bloody discharge from the genital tract for the period from 1994 to 2003. The average age of the patients was 58. 8±0.4 years. The duration of menopause is from 1 to 10 or more years. The material for the study was fixed with 10% buffered formalin and embedded in paraffin. Paraffin sections 4 µm thick were stained with hematoxylin and eosin according to Jenner-Giemsa, alcian blue, a PIR reaction was performed, and also stained with methyl green - pyronin G. Research results and discussion Based on the results of a histological examination of biopsy and surgical material, we identified nosological units that were the cause uterine bleeding in postmenopause (Table 1). As follows from the data given in the table, the most common cause of uterine bleeding was uterine leiomyoma, the histological structure of which varied: leiomyoma with fibrosis and hyalinosis prevailed, in some cases with petrification and even ossification; Cellular leiomyoma was found less frequently and, in one case, epithelioid cell leiomyoma. The next most common cause of uterine bleeding and spotting from the genital tract is chronic inflammatory diseases of the reproductive tract (endocervicitis and/or endometritis). This is followed by hyperplastic processes of the endometrium, including polyps. Hyperplastic processes were represented predominantly by focal glandular hyperplasia, and retrogressive polyps predominated among polyps. In our observations, uterine cancer (6.3±1.5%) and cervical cancer (2.6±0.1%) caused uterine bleeding and bloody discharge from the genital tract in only 8.9% of cases (total) . Polyps of the cervical canal among our cohort of patients were 2 times more common than cervical cancer and were represented predominantly by epidermal glandular fibrous polyps. In the case of a granulosa cell tumor of the ovary, after 10 years of menopause, acyclic uterine bleeding began with typical secretory transformations of the endometrium. Chronic endocervicitis and endometritis were found not only in isolation, but also associated with non-inflammatory diseases of the body and cervix (fibroids, hyperplastic processes of the endometrium, polyps of the cervical canal). This association was observed in 52.0±3.0% of the total number of patients studied. A characteristic feature of chronic endometritis in menopausal patients was the constant development of squamous metaplasia of the integumentary, and in some cases, glandular epithelium of the endometrium (Fig. 1, 2). Mucinous (endocervical) metaplasia was less frequently detected. In connection with metaplastic processes, developing changes in the epithelium were predominantly of the superficial syncytial and eosinophilic cell types (Fig. 3, 4); clear cell, ciliated cell (tubal) and “clove” types were less common. In isolated cases, morulation was observed. All types of metaplastic changes in the uterine epithelium could simulate endometrial cancer. In the associated form of chronic endometritis, metaplasia and associated changes in the epithelium of the above types were much more common and more widespread. Dysplastic changes in the epithelium of the uterine type and metaplastic epithelium in the isolated form of chronic endometritis were detected relatively often, but they were limited to dysplasia I, less often - II degree. In endometritis associated with non-inflammatory diseases of the body and cervix, grade II dysplasia predominated. The inflammatory infiltrate was represented by small focal accumulations of lymphocytes with a scant admixture of plasma cells and neutrophilic granulocytes with an almost complete absence of macrophages. A characteristic feature of the inflammatory infiltrate was an abundant amount of weakly degranulating tissue basophils. We observed a similar picture with moderately differentiated endometrial adenocarcinoma in a menopausal patient (Fig. 5). The inflammatory process was often accompanied by pronounced fibrosis and even hyalinosis of the stroma, in which the cystically dilated glands were “embedded.” Thus, the most common cause of uterine bleeding and bloody discharge from the genital tract in postmenopausal patients is non-inflammatory benign diseases of the body and cervix. Chronic inflammatory processes themselves cause uterine bleeding, and when associated with non-inflammatory diseases, they contribute to their occurrence or intensification. Dysplastic changes in the integumentary and glandular epithelium of the endocervix and endometrium during chronic inflammation can serve as the basis for malignant degeneration.

References 1. De Cherney A., Nathan L. Current Obstetric and Gynecologic. Diagnosis and Treatment. Ninth Edition, 2003. 2. Paavonen J. Pelvic inflammatory disease // Medicin. – 2001. – Vol. 29 (8).– P. 48–51. 3. Kolonina V.F., Ionova E.V. and others. X-ray craniography in the diagnosis of juvenile uterine bleeding // Ros. Bulletin of Akush. and gynek. – 2005. –T. 5. – pp. 39–43. 4. Wilder R. Hormones, pregnancy and autoimmune diseases // Ann. NY acad. Sci. – 1998. – Vol. 60 (EM). – P. 45–50. 5. Smetnik V.P., Tumilovich L.G. Non-operative gynecology. – St. Petersburg, 1995, books 1 and 2.

Common systemic causes

These are systemic pathologies that can affect several systems, which among the symptoms can also produce vaginal bleeding.

For example:

• bleeding disorders such as hemophilia A and B, von Willebrand disease, platelet function disorders;
• leukemia and lymphomas;
• liver failure;
• renal failure;
• severe dysthyroidism.

An important and fundamental classification for tracking the various causes of vaginal bleeding is the classification by age group.

Causes of vaginal bleeding by age group

In girls, bleeding before menarche (the first menstrual cycle) should always be carefully investigated). Possible causes of the pathology:

• vulvovaginitis;
• vaginal neoplasms;
• accidental injury;
• foreign bodies;
• violence;
• premature puberty;
• hormonal tumors;
• accidental use of certain drugs.

Causes of intermenstrual bleeding in adolescence and subsequent years:

• inability to ovulate;
• polycystic ovary syndrome;
• changes in coagulation;
• pregnancy (even unrecognized);
• sexually transmitted diseases;
• violence.

Causes of intermenstrual bleeding during the reproductive period:

The predominant cause is menorrhagia (heavy and prolonged menstrual flow), associated with benign organic pathologies - fibroids, polyps. In this category, bleeding due to problems during pregnancy is also likely.

Causes of intermenstrual bleeding in perimenopause: in this age group there is a very high risk of developing an organic malignant disease (genital cancer).

Causes of intermenstrual bleeding during menopause: during the postmenopausal period, benign causes predominate, such as endometrial and vaginal atrophy, endometrial polyps and, much less frequently, malignant tumors.

Uterine bleeding - symptoms and treatment

Treatment of uterine bleeding is divided into surgical and medical. Drug treatment can be hormonal and non-hormonal [11][20].

In case of acute uterine bleeding and for women over 35 years of age, surgical treatment is preferable:

• Hysteroscopy with biopsy. Insertion of a hysteroscope into the uterine cavity to visualize it, identify and remove a pathological focus in the uterus. At the same time, it is also a diagnostic research method. The operation is effective for polyps, submucosal uterine fibroids and endometrial hyperplasia.

• Separate diagnostic curettage of the uterine cavity and cervical canal. Recommended for premenopausal, postmenopausal women and for acute bleeding. The disadvantage of this method is the formation of adhesions in the pelvic cavity and Asherman's syndrome, which lead to infertility [11][20].
• Endometrial ablation is the complete destruction of the endometrium. Effective in eliminating uterine bleeding, but leads to amenorrhea, scarring in the uterine cavity (which will complicate biopsy taking) and infertility. Therefore, it is performed only in premenopausal and postmenopausal women [15][17].
• Hysterectomy - removal of the uterus via laparotomy (an incision in the lower abdomen along the hairline). It may be recommended for patients who refuse hormonal therapy and for those who experience symptomatic anemia or a significantly reduced quality of life due to bleeding [11][20].
• Emergency measures are required extremely rarely, only in case of heavy bleeding. Hemodynamics (blood movement through the vessels) is stabilized by intravenous administration of crystalloid solutions, blood products and other measures. If the bleeding does not stop, uterine tamponade is performed - a urinary catheter balloon is inserted into the uterine cavity, expanding it with the introduction of 30-60 ml of water. In this way, the vessels in the uterus are mechanically compressed, and bleeding stops [20].

Non-hormonal drug treatment (for young girls under 35 years old) includes:

• Taking NSAIDs (non-steroidal anti-inflammatory drugs) reduces bleeding by 25-35% and eliminates pain due to a decrease in the production of prostaglandins [5][18].
• Antifibrinolytics - tranexamic acid, which inhibits the production of enzymes that dissolve blood clots. Stop bleeding, reducing blood loss by 40–60%. They also have anti-allergic and anti-inflammatory effects. Take no more than five days. Allowed for pregnant women [2].

Hormone therapy suppresses endometrial growth and reduces menstrual bleeding. Treatment usually lasts six months or more [11][12][20]. Hormone therapy treatments include:

• combined oral contraceptives;
• vaginal rings;
• gestagens;
• progestin-releasing intrauterine systems.

Combined oral contraceptives:

• contains at least 30 mcg ethinyl estradiol;
• contain levonorgestrel 150 mcg or gestodene 75 mcg - as an analogue of progesterone, which is produced by the corpus luteum after ovulation.

Take one tablet every 3-4 hours (up to six tablets per day) until bleeding stops completely. Then the intake should be continued, reducing the number of tablets by one per day. When one tablet per day remains, you should take them until 21 days from the start of treatment. Then take a break of 7 days (bloody menstrual-like discharge will appear). Then continue one tablet a day for 21 days, then break again for 7 days. The course is six months or more.

The ethinyl estradiol and etonogestrel vaginal ring can be used instead of the pill after bleeding has stopped if this method is more convenient than taking the pill every day. The vaginal ring is an elastic ring that conforms to the anatomical shape of the vagina, from which ethinyl estradiol is released daily. It is installed deep in the vagina from the first day of menstruation (or immediately, without a break after taking hormonal pills) on the 21st day (similar to taking combined oral contraceptives). Then it is removed for 7 days (similar to a break when using hormonal pills). It is recommended to use for at least six months [12][14][20].

Progestin drugs:

• dydrogesterone - 30 mg per day;
• micronized progesterone - 300 mg per day;
• norethisterone - 5-10 mg per day.

Taking gestagens continues for at least six months. Approved for use during pregnancy [11][20].

Levonorgestrel-releasing intrauterine systems. Under the influence of body temperature, a daily dose of a hormone is released that acts on progesterone and estrogen receptors in the uterus, thereby inhibiting the growth of the endometrium. Intrauterine systems are effective for 97% of patients. They are used for from 6 months to 5 years, providing contraception (hormonal effect on the endometrium and mechanical effect like a spiral) [11][19].

Gonadotropin-releasing hormone agonists (GnRH) - These drugs suppress the production of hormones by the ovaries, leading to amenorrhea. They are used to reduce the size of leiomyomas or before surgical treatment. However, their side effects (eg osteoporosis) limit their use to six months [11][16].

Summarizing:

• for uterine bleeding in juvenile age, hormonal drugs should be used;
• for bleeding in pregnant women, gestagens (dydrogesterone or micronized progesterone) and fibrinolysis inhibitors (tranexamic acid) should be used;
• in perimenopausal and postmenopausal age, surgical methods are used (hysteroscopy and curettage of the uterine cavity).

If, after a histological examination of a biopsy sample from the uterus, malignant changes are detected, then hysterectomy (removal of the uterus) is used with possible removal of the appendages and regional lymph nodes. If there is a question about a woman’s reproductive function, and the ovaries cannot be preserved, cryopreservation of oocytes is recommended.

Symptoms

Along with vaginal bleeding, other symptoms sometimes occur due to the underlying pathology. The most common:

• abdominal or pelvic pain (due to anovulation and other causes);
• vaginal discharge (with genital infection);
• asthenia and general malaise;
• nausea and vomiting;
• feeling tired;
• pallor and tachycardia associated with anemia secondary to bleeding that reduces hemoglobin levels.

Bloody discharge a week before your period: should you worry?

If your period is due in about a week and you've already noticed some spotting, don't worry. It is unlikely that they are talking about any serious problem, so it is better to remain calm and try to objectively assess the situation.

To get started, check out our list of the most common causes of this type of discharge. This will give you an idea of ​​possible diagnoses and whether you need to seek medical help and, if so, how urgently.

However, there are symptoms to watch out for:

• pain in the lower abdomen;
• heat;
• spotting or other vaginal bleeding after menopause;
• spotting that gets worse or appears more frequently over time.

If you are concerned about any of these, seek professional advice as soon as possible.

Diagnostics

The diagnosis is made based on observation of symptoms and the general clinical picture associated with the use of instrumental studies.

Gynecologist assesses bleeding characteristics:

• duration;
• intensity;
• associated symptoms;
• main pathologies.

If the bleeding is quite cyclical and regular, it is likely due to benign organic lesions or anovulation. If bleeding is irregular, the possibility of malignancy should also be considered.

Blood tests are performed to assess whether the patient has anemia, which in severe cases requires supportive care, including blood transfusion.

Blood tests

From an instrumental point of view, the gold standard for diagnosing vaginal bleeding is transvaginal ultrasound, which can identify both benign and malignant organic lesions, evaluate the characteristics of the endometrial mucosa and any changes in the ovaries.

The ultrasound results may then require other methods such as

• CT scan of the abdomen and pelvis;
• Nuclear magnetic resonance;
• In case of organic lesions - hysteroscopy and endometrial biopsy.

But first of all, the possibility of pregnancy is always excluded using an hCG test.

Treatment and reasons for choosing a therapy method

Treatment depends only on the underlying cause of the bleeding. Once identified, drug therapy (dysfunctional causes) or surgical intervention (malignant formations) may be required.

A woman should always choose the most appropriate treatment, including taking into account her age or her desire to have children. This allows you to increase patient adherence to therapy, as well as achieve maximum success.

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Pathological causes of pink discharge

Possible causes of slight bleeding may be diseases of the genital organs1,8.

Cervical diseases

Minor bleeding sometimes accompanies cervical erosion16. They can be provoked by sexual intercourse and even a gynecological examination16.

Erosion can occur as a result of various processes. Among other things, its appearance can be caused by16:

• improper use of tampons;
• the use of certain medications in the form of suppositories or vaginal tablets;
• chronic inflammation;
• sexually transmitted infections;
• hormonal problems;
• decrease in the body's defenses.

Inflammatory processes of the genital organs

The reason for the appearance of blood in the discharge may be inflammation of the genital organs8,9, for example, caused by sexually transmitted infections9. During inflammation, blood is released if vascular permeability increases and blood cells leave the vascular bed13.

If your period has ended, but suddenly there is discharge mixed with blood, you need to check with a gynecologist and rule out inflammation of the inner layer of the uterus (endometritis)8. If a burning sensation occurs in the intimate area, spotting may indicate vulvovaginitis - inflammation of the external genitalia and vagina8.

Endometriosis

With endometriosis, tissue similar to the endometrium, that is, the inner layer of the uterus, penetrates beyond the uterine cavity, takes root and grows in the muscle layer or in another organ11. Under the influence of hormones, a “piece” of uterine tissue undergoes the same changes as the endometrium itself during the menstrual cycle. Therefore, pinkish discharge before and after menstruation may be a symptom of endometriosis11.

Changes in the vaginal mucosa

The condition of the vaginal mucosa largely depends on the hormonal status10. At different periods of a woman’s life - after childbirth, during lactation (breastfeeding), during menopause and menopause - there is a deficiency of estrogen, due to which vaginal atrophy10 (the volume of its tissue decreases)14. This is manifested by the fact that its mucous membrane becomes thin, dry, vulnerable and easily injured10. Therefore, sexual intercourse may well cause microtrauma to the vagina and the appearance of pink discharge after sex6,10.

Bleeding, which manifests itself as pink or brown spots on underwear, can be a symptom of serious diseases, including tumors8. Therefore, the first thing you should do when you notice such discharge is to be examined by a gynecologist.

To prevent the unexpected appearance of even scanty bleeding from causing you discomfort and causing unpleasant surprises in the form of soiled underwear and clothes, use panty liners. In the Carefree® line you can choose different types of panty liners, for example:

• The Carefree® Cotton series are breathable pads with the most delicate “cotton” inner coating. CAREFREE® Cotton Feel Flexiform allows the pads to be flexible so they fit any type of laundry.
• Carefree® Super Thin individually packaged products are easy to take with you, they follow the curves of the body, are almost invisible on the skin and are ideal for those who lead an active lifestyle.

CAREFREE® - comfort and protection in unexpected situations, a feeling of cleanliness and freshness throughout the day.

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