Uterine bleeding. One symptom - several reasons - “I’m healthy!”

There is probably no person in the world who has never experienced external bleeding in their life - for example, from careless handling of a knife when cutting food or from an unfortunate fall from a bicycle that ends in broken knees. The rules of first aid in such situations are simple and well known to everyone. You need to disinfect the wound and stop the bleeding with a bandage or plaster. And if a large vessel (artery) is hit and blood spurts out, then it is necessary to clamp the vessel above the wound site to avoid large blood loss.

Obviously, any bleeding occurs due to the fact that the integrity of the blood vessels is disrupted. Blood stops circulating in the closed space of the vessels and flows out of them. If the integrity of the uterine vessels is compromised, blood flows out through the vagina. It is this external sign that is the reason to suspect something is “off” and consult a doctor.

Uterine bleeding is a symptom of many diseases. These may be gynecological or oncological diseases, as well as complications of pregnancy and childbirth.

In case of uterine bleeding, it is very important not so much to stop the blood loss - this, by the way, is not always the first priority measure - but to identify the cause of the bleeding and, if possible, eliminate it. If this is not done, then there is a high probability of relapse and other manifestations of the disease, as well as its complications. Manipulations aimed at stopping bleeding are carried out in cases where the process of blood loss occurs at a high rate - in this case there is a direct threat to life. After the bleeding has been eliminated, in addition to treatment, restorative procedures must be prescribed: regimen, nutrition, maintaining water balance in the body, vitamin therapy.

Dysfunctional uterine bleeding

Dysfunctional uterine bleeding is bleeding associated with dysfunction of organs, in the absence of any organic pathology (uterine fibroids, internal endometriosis, pathology of the cervix, tumors of the uterus and ovaries).

Ovarian dysfunction is caused by a violation of their hormonal function and occurs quite often. Many women take this disease lightly and do not see it as a direct threat to health. In addition, there is a very common opinion that dysfunction is just a minor malfunction of the body, with which you can live safely, but it is useless to treat it. This approach is fundamentally wrong. Firstly, ovarian dysfunction may be a manifestation of some deep hormonal imbalances that require certain correction. Not to mention that it is unlikely that you will be able to “live well,” because dysfunction is almost always accompanied by physical and moral discomfort and pain. A woman is forced to constantly use analgesics, the body gradually gets used to them, the pain intensifies again... It turns out to be a vicious circle.

The main symptom of dysfunctional bleeding is irregular menstrual cycle. The reason to consult a doctor is when the interval between menstruation is less than 21 days and more than 35 days. It is also not considered normal if:

• menstruation lasts more than 7 days;
• menstrual bleeding is very heavy, a woman is forced to change pads or tampons every hour, including at night;
• Menstruation is accompanied by severe nagging pain in the lower abdomen.

If such symptoms recur over three or more menstrual cycles, then you need to visit a doctor as soon as possible.

Endocrine causes are not always the cause of dysfunction. The functioning of the ovaries can also be affected by factors such as:

• overweight or underweight;
• diabetes;
• frequent stress and depression;
• infectious diseases (flu, pneumonia, sore throat);
• strict diet and fasting;
• genital infection;
• sudden climate change.

Therefore, when going to see a doctor, be prepared that he will ask you questions about your diet, nervous stress, previous diseases and changes in the climatic environment.

Diagnosis of ovarian dysfunction includes a gynecological examination, smear analysis, blood test for hormones, ultrasound of the thyroid gland, adrenal glands and pelvic organs. The doctor may also prescribe magnetic resonance imaging of the brain and separate diagnostic curettage of the uterus.

Treatment is selected individually in each case. First of all, it is aimed at normalizing hormonal levels and correcting lifestyle. In any case, the doctor tries to choose the most gentle therapy. In cases where adolescents or premenopausal women suffer from dysfunction, it is often enough to reduce the level of tension, review the diet and allocate time for active rest and good sleep. The body reacts sensitively to changes that are favorable to it and successfully self-regulates without drug treatment.

Danger

Dysfunctional uterine bleeding is not a harmless disease. During the juvenile period it can lead to:

• anemia;
• hormonal disorders;
• infertility;
• endometriosis.

In women of reproductive age, the disease can be caused by:

• infertility;
• anemia;
• endometrial cancer, breast cancer;
• fibrocystic mastopathy;
• uterine fibroids.

In premenopausal and menopausal patients, dysfunctional uterine bleeding can cause anemia, cancer, and also cause the growth of existing tumors into neighboring organs. from a gynecology clinic at the first symptoms of the disease.

.

Bleeding due to uterine fibroids, adenomyosis, endometrial and cervical canal polyps

Uterine fibroids, endometriosis and polyps and endometrial hyperplasia are diseases associated with benign growth of uterine tissue. They appear most often during reproductive age.

All this pathology is easily diagnosed using ultrasound. As a rule, no additional examination methods are required. You can read about possible treatment options for uterine fibroids in the corresponding section of the website www. ya-zdorova.ru. In the presence of pathology of the uterine cavity, hysteroscopy with the appropriate amount of surgical intervention is indicated to eliminate the cause of bleeding.

Diagnosis of the causes of menorrhagia and metrorrhagia

The gynecologist determines the cause of bleeding based on test results and ultrasound.

• A gynecological examination in a chair will show whether there is prolapse of the genital organs, neoplasms or erosion on the cervix. During pregnancy, cervical insufficiency is clearly visible. Also, already at this stage, injuries from the spiral, after sexual intercourse, etc. are visible;
• Colposcopy. A gynecologist conducts an examination with a device equipped with magnifying glasses. Using a colposcope, internal pathologies of the cervix are identified, and the nature and stage of erosion is determined.
• An ultrasound of the uterus will determine whether there are injuries, neoplasms, or inflammation of the female internal organs.
• Smears for microflora and cytology show STI infections (STDs), precancerous conditions, and cancer.
• A blood test for hormones will determine whether there is a hormonal imbalance.

If this is not enough, you will have to undergo an MRI (tomography) to obtain images of the organs in 3D format at high magnification.

Bleeding in cancer

One of the first manifestations of uterine and cervical cancer is uterine bleeding, although, as a rule, the process may not be at such early stages. It may not cause the woman any painful sensations, be scanty and short-lived. If such bleeding occurs during a regular menstrual cycle, you should immediately consult a doctor.

A timely visit to a gynecologist allows you to detect a tumor at an early stage and significantly increases the chances of a successful cure. The diagnosis can be made based on a gynecological examination, ultrasound and a number of tests.

Types of metrorrhagia

The diagnosis of metrorrhagia is divided into several types:

• Juvenile uterine bleeding is metrorrhagia that occurs in adolescents against the background of disorders of the hypothalamic-pituitary regulation of the ovarian-menstrual cycle.
• Reproductive metrorrhagia is bleeding that occurs during the reproductive period in women, not associated with menstruation. Such bleeding can be divided into several types: anovulatory metrorrhagia - not associated with ovulation, acyclic bleeding.
• ovulatory bleeding that occurs in the middle of the cycle associated with ovulation.

Obstetric hemorrhage

This term refers to intense bleeding that occurs immediately after childbirth. Their cause is a violation of the contractility of the uterus (atony or hypotension of the uterus), or a pathology associated with the blood coagulation system. Hypotony is a decrease in the tone of the uterus, which leads to its inability to actively contract. Atony is a complete loss of the ability to contract and respond adequately to medications and other types of stimulation. Obstetric hemorrhage is very dangerous because it leads to a large loss of blood in a short time. Very often the question is literally about saving a woman’s life - and then doctors decide on a hysterectomy, that is, removal of the uterus.

Bleeding during menopause

Menopause is a natural physiological process. You shouldn’t be overly emotional or wary about him. But at the same time, a woman during menopause needs to listen to her condition so as not to miss truly significant and alarming symptoms. One of them is bleeding.

Uterine bleeding during menopause may indicate disturbances in the functioning of the hormonal system, the occurrence of tumors in the body of the uterus or in the ovaries. Only a doctor can correctly diagnose the disease using ultrasound and tests.

I would like to say a few words about bleeding during sexual intercourse. If this symptom appears, you should definitely consult a doctor. They may indicate cervical disease, be a manifestation of endometriosis, as well as vaginal pathology. In some cases, spotting during sexual intercourse may be associated with dryness of the vaginal mucosa, for example, during the postmenopausal period. In any case, to clarify the diagnosis, you must consult a doctor.

Uterine bleeding is the discharge of blood from the uterine cavity.

The inside of the uterus has two layers. The thin inner layer is called the endometrium. The thick outer muscle wall is the myometrium. In women with regular periods, the endometrium thickens throughout the cycle in preparation for pregnancy. If a woman does not become pregnant, the endometrium is shed during menstruation. Menstruation occurs 10–14 days after ovulation. During menopause, ovulation stops, the endometrium stops growing and becomes thinner.

Normally, a woman loses a limited amount of blood during each menstrual period (less than five tablespoons, or 80 ml). Bleeding that occurs randomly or excessively heavy regular menstrual bleeding is considered abnormal uterine bleeding. Once a woman who is not taking hormone therapy enters menopause and her menstrual cycles end, any uterine bleeding is considered abnormal.

Causes of abnormal bleeding.

Abnormal uterine bleeding can be caused by a variety of conditions. Some conditions are more typical for certain periods of a woman’s life.

Abnormal uterine bleeding in young girls. Bleeding before menarche (the first period in a girl's life) is always abnormal. It can be caused by injury, a foreign body (such as toys, coins, or hygiene products), irritation of the genital area (due to soaps, lotions, or infection), or problems with the urinary tract. Bleeding can also occur as a result of sexual abuse.

Abnormal uterine bleeding in adolescents. Many girls have episodes of irregular bleeding during the first few months after their first menstrual cycle. This usually resolves without treatment once the hormonal cycle and ovulation return to normal. If irregular bleeding persists or if bleeding is heavy, evaluation is necessary.

Abnormal bleeding during adolescence can also be caused by any of the factors that cause bleeding in premenopausal women, such as pregnancy, infection and certain diseases.

Abnormal uterine bleeding in women of reproductive age. Many conditions can cause abnormal bleeding in women between adolescence and menopause. For example, a sharp change in hormone levels during ovulation.

Some women with regular periods experience excessive blood loss during their periods (extremely heavy periods) or bleeding between periods. The most common causes of such bleeding are uterine fibroids (a benign growth in the muscular layer of the uterus), adenomyosis (a condition in which the endometrium grows into the thickness of the muscular layer of the uterus) or endometrial polyps (usually a benign focal growth of the uterine mucosa with the formation of a node on a broad base or on leg). These conditions are particular causes of abnormal uterine bleeding. Fibroids, adenomyosis and polyps can also occur in women with irregular periods.

Other causes of abnormal uterine bleeding in women of reproductive age include:

• pregnancy;
• cancer or precancer (dysplasia) of the cervix or endometrium;
• infection or inflammation of the cervix or endometrium;
• blood clotting disorders such as von Willebrand disease, platelet abnormalities, etc.;
• comorbidities such as hypothyroidism, liver disease or chronic kidney disease.

Hormonal contraception. Girls and women who use hormonal contraceptives (eg, pills, rings, patches) may have breakthrough bleeding between periods. If this occurs within the first few months of starting contraceptive use, it may be due to changes in the endometrium of the uterus. If bleeding continues for more than several months, evaluation may be required and/or a change in contraceptives may be recommended. Women who use injectable contraception often experience irregular bleeding at first, but the bleeding stops over time. Irregular bleeding is common in women using a contraceptive implant. In women using an IUD, bleeding is often irregular at first. Over time, the bleeding becomes lighter, and these women then often experience scanty periods to the point of no periods at all (amenorrhea).

Breakthrough bleeding can also occur if the contraceptive regimen is not followed (a pill is missed or a pill is taken too late). In this situation, there is a risk of becoming pregnant.

Abnormal uterine bleeding in women during the menopausal transition. Before the end of the menstrual cycle, a woman goes through a period called the menopausal transition, or perimenopause. During perimenopause, the menstrual cycle begins to change when periods become less regular. While the ovaries of perimenopausal women continue to produce the hormone estrogen, the secretion of the hormone progesterone decreases. These hormonal changes can cause the endometrium to grow and produce excess tissue. This increases the likelihood of developing polyps or endometrial hyperplasia (thickening of the endometrium, which can develop into endometrial cancer). These conditions can cause abnormal bleeding. The menopausal transition is a time when women are most likely to experience abnormal uterine bleeding.

Women during the menopausal transition are also at risk for other conditions that cause abnormal bleeding, such as cancer, infections, and common illnesses.

Perimenopausal women still ovulate for some time and may become pregnant. Pregnancy itself can cause abnormal bleeding. Additionally, perimenopausal women may use hormonal contraceptives, which may cause breakthrough bleeding.

Abnormal uterine bleeding in menopausal women. Women taking hormone replacement therapy may experience cyclic bleeding. In any other case, bleeding during menopause is abnormal and should be investigated. Causes of abnormal bleeding during menopause include:

• Atrophy or excessive thinning of the tissue lining the vagina and uterus caused by low hormone levels.
• Cancer or precancerous changes (hyperplasia) of the endometrium.
• Polyps or fibroids.
• Uterine infection.
• Use of blood thinners (antiplatelet agents or anticoagulants).
• Side effects of radiation therapy.

Diagnosis of abnormal uterine bleeding.

1. Initial assessment. By examining the woman's medical history (anamnesis), the doctor checks the duration and amount of bleeding; factors that lead to bleeding; symptoms that occur along with bleeding, such as pain, fever, or vaginal discharge odor. The doctor will find out whether bleeding occurs after sexual intercourse and whether there is a personal or family history of bleeding disorders. He finds out the woman's medical history and checks the medications she is taking. Also important to the physician are recent weight changes, stress, a new fitness program, or underlying medical conditions. The doctor does a physical examination to evaluate the woman's general health and a vaginal examination to confirm that the bleeding is coming from the uterus and not from another location (such as the vulva or rectum).
2. Laboratory tests. For women of reproductive age, a pregnancy test is performed. If there is any abnormal vaginal discharge, a cervical examination may be performed. Blood tests may be done to look for anemia (low hemoglobin in the blood), blood clotting problems, and other general conditions such as thyroid disease, liver disease, or kidney disease.
3. Endometrial assessment. To rule out endometrial cancer and structural abnormalities (uterine fibroids or polyps), tests that evaluate the endometrium may be performed. Such tests include:

• Endometrial biopsy. An endometrial biopsy is often performed in women aged 45 years and older to rule out endometrial cancer. A biopsy may also be performed in women under 45 years of age if they have risk factors for endometrial cancer. Risks for endometrial cancer include obesity, chronic anovulation, use of tamoxifen (a drug used to treat breast cancer), or a family history of breast or colon cancer. During a biopsy, a thin instrument is inserted through the vagina and cervix to obtain a small sample of endometrial tissue. The biopsy can be performed in an outpatient setting without anesthesia.
• Transvaginal ultrasound. Ultrasound uses sound waves to measure the shape and structure of an organ. An ultrasound probe is inserted into the vagina and provides a clear image of the uterus. Ultrasound may not be able to differentiate between different types of abnormalities (eg, polyp from cancer), and further testing may be required.
• Hysteroscopy. A method of examining the inner surface of the uterus using an endoscopic device inserted into it - a hysteroscope.
• Scraping. The surgical method of removing the contents of the uterine cavity is used, for example, if malignant tissue degeneration is suspected.

Treatment.

Birth control pills are often used to treat uterine bleeding caused by hormonal changes or hormonal imbalances. Hormonal contraceptives can be used in women with irregular periods to establish regular cycles and prevent excessive endometrial growth. In women with regular periods, they may be used to treat excessive menstrual bleeding.

During perimenopause, hormonal birth control may be used to regulate the menstrual cycle and prevent endometrial overgrowth.

Progesterone, a hormone produced by the ovary, is also often used in treatment. It is effective in preventing or treating excessive bleeding in women with irregular periods. A synthetic form of progesterone called progestin may be recommended to treat abnormal bleeding. Progestin can be in the form of pills, injections, implants, or intrauterine devices.

Surgery may be required to remove abnormal uterine structures (eg, fibroids, polyps). Women who are past childbearing and have heavy menstrual bleeding may consider endometrial ablation, a surgical procedure that uses heat, cold, electrical energy or laser to destroy the lining of the uterus (endometrium).

Women with uterine fibroids are treated surgically, either by removing the fibroids (eg, myomectomy) or by reducing the blood supply to the fibroids (eg, uterine artery embolization). The most radical surgical treatment for abnormal uterine bleeding is a hysterectomy, or removal of the entire uterus. Hysterectomy can be performed using conventional laparoscopy, through the vagina, or by open access - laparotomy (dissection of the anterior abdominal wall to gain access to the abdominal and pelvic organs).

How to feel about “grandmothers’ recipes”?

In preparing this article, we conducted a survey and found out that, without exaggeration, a huge number of women are trying to cope with the situation of uterine bleeding on their own - using traditional medicine recipes. Naturally, in this case we are talking about moderate or scanty bleeding. The reasons for this state of affairs most likely lie in the absence of a certain culture of treatment and constant monitoring of one’s health. On the other hand, many books and brochures with various folk recipes can now be bought at any bookstore. It is also not difficult to find such information on the Internet. Recipes based on nettle, yarrow, St. John's wort, and viburnum are presented there as safe, effective, affordable, and, moreover, tested by several generations of women.

Without criticizing traditional medicine and recognizing its merits, we would like to focus your attention, first of all, on the inadmissibility of self-medication in case of uterine bleeding. As noted above, the causes of bleeding can be different. Bleeding is only a consequence, a symptom of the disease. You need to treat what caused it: tumor, dysfunction, uterine fibroids, endometriosis, etc. Therefore, it is extremely important to consult a doctor in a timely manner and correctly diagnose the causes of bleeding. And only then, in the treatment regimen, in some cases folk remedies can be used.

Treatment with folk remedies

To stop and prevent uterine bleeding, you can use decoctions and infusions of medicinal plants. The most popular and effective folk recipes for stopping bleeding are listed below.

• Yarrow infusion - You need to take 2 teaspoons of dried plant material, pour a glass of boiling water. The solution is infused for about an hour, then filtered. The infusion is taken a quarter glass 4 times a day before meals.
• Nettle decoction - Take a tablespoon of dried nettle leaves and pour a glass of boiling water. The solution is simmered over low heat for 10 minutes, then filtered. The prepared decoction is taken one tablespoon 3 times a day before meals.
• Infusion of shepherd's purse - Take a tablespoon of dried plant material and pour a glass of boiling water. The container with the solution is wrapped in a warm towel and left for an hour to infuse. The finished infusion is filtered and taken a tablespoon 3 times a day before meals.

It must be remembered that folk remedies cannot be a complete replacement for medications; they are used only as an addition to the main therapy. Before using herbal remedies, you should definitely consult a medical specialist to exclude intolerance to the medicinal plant and other contraindications.