Prolonged bleeding. Uterine bleeding: symptoms, treatment

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

Types of dysfunction

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

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

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

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

Abnormal conditions and reasons why there is bleeding from the vagina:

Dysfunctional disorder is pathological bleeding due to hormonal disorders.
An organic disorder is pathological bleeding that develops with pathology of the genital organs.
An iatrogenic disorder in which bleeding is a consequence of taking contraceptives, antithrombic drugs, or installing an IUD.
Uterine bleeding during gestation, labor, and the postpartum period.
Juvenile bleeding.
Dysfunction in postmenopause.

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

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

Menorrhagia

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

Endometritis

In the acute stage of infection, a woman develops a fever along with merorrhagia, and the lower third of the abdomen is painful. On examination, the body of the uterus is enlarged and painful. The disease in its chronic form passes without signs of fever, and no pronounced pain syndrome is observed. The development of endometritis is provoked by the post-abortion or postpartum period.

Myoma

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

Endometriosis

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

Regardless of the pathology, menorrhagia is profuse bleeding with clots. The woman complains of weakness, a sharp deterioration in her general condition, dizziness, and fainting.

Prolonged blood loss leads to severe iron deficiency anemia.

Metrorrhagia

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

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

Anovulatory metrorrhagia

Adolescent girls and menopausal women are susceptible to this type of dysfunction.

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

Postmenopausal metrorrhagia

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

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

When to see a doctor?

There are several additional signs and conditions that may indicate the onset of dysfunction:

Clots appeared in menstrual blood.
Sexual intercourse is accompanied by pain and bleeding.
A woman complains of causeless fatigue and weakness, hypotension.
Pain increases from period to period.
Menstruation is accompanied by fever.

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

- This is the 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. Detection of external bleeding is not difficult, since the source is visible to the naked eye. To diagnose internal bleeding, depending on the location, various instrumental techniques can be used: puncture, laparoscopy, X-ray contrast study, endoscopy, etc. Treatment is usually surgical.

ICD-10

R58 Bleeding not elsewhere classified

General information

Bleeding is a pathological condition in which blood flows from vessels into the external environment or into internal organs, tissues and natural cavities of the body. 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 patient's life and can cause death. Treatment of bleeding, depending on the cause of its occurrence, can be carried out by orthopedic traumatologists, abdominal surgeons, thoracic surgeons, neurosurgeons, urologists, hematologists and some other specialists.

Classification

Taking into account the place into which the blood flows, the following types of bleeding are distinguished:

External bleeding - into the external environment. There is a visible source in the form of a wound, open fracture or crushed soft tissue.
Internal bleeding - into one of the natural cavities of the body that communicates with the external environment: bladder, lung, stomach, intestines.
Hidden bleeding– in tissues or body cavities 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 characteristics of pathogenesis, symptoms, diagnosis and treatment, they are separated into a separate subgroup.

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

Arterial bleeding. Occurs when the artery wall is damaged. It has a high rate of blood loss and is life-threatening. The blood is bright scarlet and flows out in a tense, pulsating stream.
Venous bleeding. Develops when the vein wall is damaged. The rate of blood loss is lower than when an artery of similar diameter is damaged. The blood is dark, with a cherry tint, flows in an even stream, and there is usually no pulsation. If large venous trunks are damaged, pulsation in the rhythm of breathing may be observed.
Capillary bleeding. Occurs when capillaries are damaged. Blood is released in separate drops resembling dew or condensation (symptom of “blood dew”).
Parenchymal bleeding. Develops when parenchymal organs (spleen, liver, kidneys, lungs, pancreas), cavernous tissue and cancellous bone are damaged. Due to the structural features 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 when veins and arteries are simultaneously damaged. The cause, as a rule, is injury to parenchymal organs that have a developed arterial-venous network.

Depending on the severity, bleeding can be:

Lungs (loss of no more than 500 ml of blood or 10-15% of blood volume).
Average (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 blood volume).
Absolutely fatal (loss of 3-3.5 liters or more than 60% of the blood volume).

Taking into account the origin, traumatic bleeding is distinguished, which develops as a result of injury to unchanged organs and tissues, and pathological bleeding, which 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 injury, early secondary bleeding occurs during or after surgery (for example, as a result of a ligature slipping from the wall of a vessel), and late secondary bleeding occurs after several days or weeks. The cause of late secondary bleeding is suppuration followed by melting of the vessel wall.

Symptoms of bleeding

Common signs of pathology include dizziness, weakness, shortness of breath, extreme thirst, pale skin and mucous membranes, decreased blood pressure, increased heart rate (tachycardia), pre-syncope and fainting. The severity and rate of development of these symptoms is determined by the rate of bleeding. Acute blood loss is more difficult to tolerate than chronic blood loss, 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 of the skin. When bleeding from the stomach occurs, melena (tarry black loose stools) and vomiting of altered dark blood occurs. With esophageal bleeding, bloody vomiting is also possible, but the blood is brighter, red, rather than dark. Bleeding from the intestines is accompanied by melena, but the characteristic dark vomiting is absent. If the lung is damaged, bright scarlet, light foaming blood is coughed up. Bleeding from the renal pelvis or bladder is characterized by hematuria.

Hidden bleeding is the most dangerous and most difficult to diagnose; they can only be identified by indirect signs. At the same time, the blood accumulating in the cavities compresses the internal organs, disrupting their functioning, which in some cases can cause the development of dangerous complications and death of the patient. Hemothorax is accompanied by difficulty breathing, shortness of breath and weakening of percussion sound in the lower parts of the chest (with adhesions in the pleural cavity, dullness in the upper or middle parts is possible). With hemopericardium, due to compression of the myocardium, cardiac activity is disrupted, and cardiac arrest is possible. Bleeding into the abdominal cavity is manifested by bloating of the abdomen and dullness of percussion sound in its sloping sections. When bleeding into the cranial cavity, neurological disorders occur.

The flow of blood beyond the vascular bed has a pronounced negative effect on the entire body. Due to bleeding, the blood volume decreases. As a result, cardiac activity deteriorates, organs and tissues receive less oxygen. With prolonged or extensive blood loss, anemia develops. The loss of a significant volume of bcc over a short period of time causes traumatic and hypovolemic shock. Shock lung develops, the volume of renal filtration decreases, and oliguria or anuria occurs. Foci of necrosis form in the liver, and parenchymal jaundice is possible.

Types of bleeding

Bleeding from wounds

First aid consists of anesthesia and immobilization with a splint. For open fractures, apply a sterile bandage to the wound. The patient is taken to the emergency room or trauma department. To clarify the diagnosis, radiography of the damaged segment is prescribed. For open fractures, PSO is performed; otherwise, treatment tactics depend on the type and location of the injury. For 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 hidden 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 rib fractures, damage to the pleura is sometimes observed, accompanied by internal bleeding and the formation of hemothorax. With blunt trauma to the abdominal cavity, bleeding from the damaged liver, spleen or hollow organs (stomach, intestines) is possible. Bleeding from parenchymal organs is especially dangerous due to the massive blood loss. Such injuries are characterized by the rapid development of shock; without immediate qualified assistance, death usually occurs.

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

First aid for all internal bleeding of a traumatic nature consists of pain relief, ensuring rest and immediate delivery of the patient to a specialized medical facility. institution. The patient is placed in a horizontal position with legs elevated. Apply cold (a bubble or heating pad with ice or cold water) to the area of suspected bleeding. If esophageal or gastric bleeding is suspected, the patient is not allowed to eat or drink.

At the prehospital stage, if possible, anti-shock measures are carried out and blood volume is replenished. Upon admission to medical school. the institution continues infusion therapy. The list of diagnostic measures depends on the nature of the injury. In case of TBI, a consultation with a neurosurgeon, skull X-ray and EchoEG are prescribed, in case of hemothorax - chest X-ray, in case of

Uterine bleeding should not be confused with natural monthly blood loss associated with rejection of the functional layer of the endometrium. When people talk abstractly about uterine bleeding (there is also a term - profuse bleeding), they mean pathological bleeding in women caused by gynecological problems.

Unexpected (or without obvious reasons) bleeding from the uterus poses a great danger to a woman (no matter what age she is). In this regard, gynecologists exclude the so-called symptomatic treatment, since eliminating the bleeding itself (that is, the consequence of some process) is a temporary measure that only aggravates the further growth of the cause of bleeding.

The causes of bleeding in women can be very different and often the symptoms are very vague. In a good way, before “believing” in the established diagnosis, it would be necessary to undergo 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 this phenomenon may occur may vary - from the neonatal period to postmenopause.

Structure of the uterus

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

The fundus is the upper part of the uterus.
The body is cone-shaped, ends with an isthmus at the bottom, leading to the cervix.
Cervix - 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 perimeter is the outer layer of the uterus, which passes into the wall of the abdominal cavity.
The myometrium is the middle, densest layer, which consists of muscles and a large number of vessels.
The endometrium is the inner lining of the uterine cavity to which the fertilized egg is attached. The endometrium, in turn, is divided into two layers:
- Basal (main).
- The functional layer is the one that undergoes monthly rejection in the absence of a fertilized egg.

For reference! The 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 also the entire organism as a whole is necessary.
This process is characterized by stages, where a change in one link leads to disruption of the activity of the entire 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 higher structures of the body.
Functioning of the ovaries - this 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 - progesterone. But despite the importance of organs such as the ovaries, they are also regulated by other organs and systems.
Control by the pituitary gland - this 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 involves the release of an egg.
- Follicle-stimulating hormone (FSH) – during the maturation of the leading, dominant follicle, controls its maturation in full.
The influence of the hypothalamus - the coordinated activity of the hypothalamus takes control of the clear cyclical flow of hormones into the blood. Substances that control this process are “statins”, which reduce the formation of hormonal substances and “liberins”, the main function of which is to stimulate the pituitary gland. In this way, normal production and levels of hormones important for women are constantly maintained.
The influence of the cerebral hemispheres - it is from here that the necessary impulses are distributed 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 disrupted.

It is known that the intensity and duration of menstruation is individual for each woman. There are often cases when a woman or girl mistakes 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 abundant blood clots.
The volume of blood lost is no 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 adolescent girls, which begins from the first menstruation until the age of 18.
Reproductive – characteristic of women from 18 years of age to menopause.
Menopausal – 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 birth.

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. Most often develop after menstruation.
Organic.
Iatrogenic.

Uterine bleeding. Causes

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

Bleeding caused by 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 reasons will be as follows:

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

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

Those related to pregnancy:
- Disturbed pregnancy.
- Bubble drift.
- Chorionepithelioma.
- Placet presentation.
- Premature placental abruption.
- Scars on the uterus.
- Destruction of cervical tissue.
- Low location of the placenta.
- Uterine rupture.
- Injuries.
- Endometritis.
- Retention of parts of the placenta.
- Uterine fibroids.
Reasons not related to pregnancy:
- Neoplasms.
- Ovarian cysts.
- Ovarian ruptures.
- Infections and inflammations 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 volume more than 80 ml with preserved regularity.
Metrorrhagia is bloody, light discharge that is irregular. More typical for the middle of the cycle.
Menometrorrhagia is irregular but prolonged bleeding.
Polymenorrhea - such menstruation appears more often than after 21 days.

Important! A frequent concomitant symptom 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 bloody vaginal discharge, which most often occurs in the first week of life in newborn girls. The reason for this condition is a sharp and rapid change in hormonal levels.

Such conditions do not require treatment and go away on their own, so drug intervention to stop bleeding is not necessary.

Bleeding from the uterus before puberty

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

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

Juvenile uterine bleeding

The most common cause of uterine bleeding in the juvenile period is a malfunction of the ovaries, which manifests itself
changes in hormonal levels:

The synthesis of progesterone by the ovaries is disrupted.
Excessive levels of progesterone appear in the body.
The level of FSH increases and the level of LH decreases, which leads to the fact that the process of ovulation does not occur (such bleeding is called anovulatronic).
Due to pathology of the thyroid gland and adrenal glands, impaired hormone production also develops.

In addition, long-term chronic infections, frequent hypothermia, stress, psychological trauma, excessive physical activity, and poor nutrition can lead to the development of juvenile bleeding.

Less commonly, conditions such as tuberculosis, tumors and developmental abnormalities of the cervix, uterine body and ovaries, impaired blood clotting, leukemia, and pituitary tumors can cause such blood loss.

Juvenile uterine bleeding is characterized by seasonality, since the disease most often occurs or worsens in autumn and spring.

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

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

If these therapeutic measures do not have the desired effect, they resort to hormonal therapy. In life-threatening situations, diagnostic curettage is performed.

Bleeding during 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 during reproductive age are as follows:

Changes in hormone concentrations.
Endometriosis.
Adenomyosis.
Pathology of the blood coagulation system.
Endometrial hyperplasia (this pathology is indicated in the case of endometrial thickening of 14 mm or more).
Polyps in the uterine cavity.
Submucosal myomatous nodes.
Intrauterine devices.
Complete/incomplete spontaneous abortion.
Ectopic pregnancy.

Regardless of the cause, one of the leading symptoms is uterine bleeding. If there is a hormonal imbalance, correction is necessary using progesterone-based drugs (Duphaston). If hormonal imbalance is not diagnosed, then it is necessary to use hemostatic drugs to stop uterine bleeding.

In addition, for example, if endometrial hyperplasia is detected, surgical intervention is required using diagnostic curettage from the uterine cavity. The same applies to uterine fibroids, ectopic pregnancy and spontaneous abortion, where surgery cannot be avoided.

Important! Treatment of uterine bleeding in women of reproductive age has the main goal of preserving her reproductive function.

Uterine bleeding during menopause

In women who are in such a period with the development of uterine bleeding of even the most minimal severity, first
First of all, it is necessary to exclude oncological diseases, since this is a very dangerous clinical symptom.

The reason for this is:

Changes in hormonal levels.
Endometrial hyperplasia.
Uterine fibroids of submucosal localization.
Precancerous degeneration and endometrial cancer.
The “forgotten” intrauterine device.

Important! According to clinical studies, in approximately 70% of cases, malignant neoplasms of the endometrium in women during menopause are manifested by uterine bleeding.

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

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

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

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

Important! Even if the old IUD is successfully removed, it is necessary to ensure the integrity of the uterine walls.

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 be caused by the following pathological processes:

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

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

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

Uterine bleeding not associated with pathology of the reproductive system

Such bleeding is also called extragenital, the causes of which are diseases of organs and systems not related to the woman’s genital area.

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

In such cases, the underlying disease is treated first.

Iatrogenic bleeding

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

Bleeding during pregnancy

Chorionic detachment, placenta.
Pathology of the blood coagulation system.
HELLP syndrome.
Threatened abortions.
Uterine rupture.

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

The most important principles of treatment of this pathology are:

Placental abruption requires the prescription of Duphaston, a hemostatic drug. In case of severe bleeding, urgent surgery is necessary.
Blood clotting disorders are eliminated by the administration of drugs that affect the hemostasis system, red blood cells, platelets, and fresh frozen plasma.
Uterine rupture is the most severe and dangerous cause of bleeding, often leading to death. In this case, only emergency surgery can save the woman’s life.

Postpartum uterine bleeding

Various reasons can lead to such conditions:

Ruptures of the cervix during childbirth.
Placenta accretion to the inner wall of the uterus or retention of its parts.
Postpartum uterine hypotension.
Blood clotting disorder.
Premature suture dehiscence after cesarean section.

There is not much time left to treat heavy bleeding after childbirth, since large blood loss can quickly lead to the death of the woman.

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

In some cases, manual inspection of the uterine cavity is used to identify the presence of remnants of 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 over a short period of time.
Increasing weakness.
Dizziness.
Pronounced pallor.
Fall in blood pressure.
Tachycardia.
Drowsiness, lethargy.

Even if at least one of the above symptoms is detected, emergency medical attention is necessary.

Important! Profuse uterine bleeding is an extremely dangerous condition for a woman. If assistance is not provided in a timely manner in difficult situations, a woman can very quickly (within a few minutes) develop hemorrhagic shock and death.

If uterine bleeding occurs at home, you must first call emergency specialized care.

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

Place the woman in a horizontal position with her legs raised up (place them on a high pillow).
Constantly apply cold to the lower abdomen.
Monitor blood pressure and heart rate.
Transport by ambulance to any nearest medical facility.

In intensive care conditions, 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, ensure powerful vasoconstriction of the uterine vessels and contraction of the uterus.

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

Attention! In case of profuse uterine bleeding, it is strictly forbidden to do the following:

Apply heat to the lower abdominal area.
Take a warm bath or shower.
Use medications at your own discretion.
Carry out douching and rinsing.
Take warm baths.

Diagnostics

For juvenile uterine bleeding, the following measures must be taken:

Determine the start and end date of the last initial menstruation and the date of the initial menstruation that progressed to bleeding.
Do .
Donate blood for estrogen, prolactin, cortisol, progesterone.
Donate blood for thyroid hormones - T3, T4, TSH.
Determine your basal temperature between periods.
Do an ultrasound of the pelvic organs, adrenal glands, and thyroid gland.
Conduct ultrasound monitoring of the 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 and abdominal organs.

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

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

Attention. To diagnose polyps of the uterine cavity and its walls, fibroids, curettage is required.

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

Uterine bleeding. Treatment

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

Diagnostic curettage in many cases is an effective treatment method, 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 an effective way to stop bleeding is hormonal hemostasis, in which large dosages of hormones are prescribed.

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

During reproductive age, all women experience menstruation once a month, characterized by bleeding that lasts several days. For some, they may be scanty and painless, while others experience severe blood loss and pain during this period. And here it is very important to understand when spotting is normal and when it indicates the opening of uterine bleeding in order to stop it in a timely manner. After all, if it is not stopped, the woman may lose too much blood, which will result in sad consequences for her. Now you will find out how to stop bleeding during menstruation and why it can occur.

Main features

Before we talk about how to stop bleeding during heavy periods, you must first figure out whether they are bleeding. After all, for some women such menstruation is considered the absolute norm and it depends, first of all, on the individual characteristics of the body, as well as on heredity. If heavy periods are not accompanied by weakness and dizziness and are observed in a woman constantly, then there is no need to make any attempts to reduce blood flow, since this can only cause harm.

It is necessary to carry out any actions only if the copious discharge of blood is actually bleeding. It can be determined by the following characteristics:

Menstruation lasts more than 7 days (not spotting, but blood!).
A sanitary pad fills up in less than 1.5-2 hours, making it necessary to change it frequently.
The woman experiences severe weakness, dizziness, pale skin, drop in blood pressure, nausea, and fainting.

In all these cases, it is undoubtedly necessary to act as quickly as possible. Since excessive blood loss can cause a sharp drop in hemoglobin levels, followed by the onset of anemia, characterized by a lack of oxygen in the body. When it is deficient, cells begin to starve and die very quickly. Moreover, first of all, brain cells suffer from a lack of oxygen, which can lead to serious health problems.

In addition, if severe bleeding is not prevented in a timely manner, it can be fatal. Therefore, if a woman has all the signs described above, she should under no circumstances hesitate.

Various factors can trigger bleeding during menstruation. For example:

Severe stress.
Emotional fatigue associated with active work activity and lack of sleep.
Taking hormonal drugs.
Recently inserted intrauterine device.
Abrupt climate change.
Gynecological diseases.

As for hormonal drugs, women take them for various purposes - to treat infertility, prevent the onset of unwanted pregnancy (among these drugs the most common are Postinor, Jess Plus), for serious hormonal imbalances in the body resulting from pathologies of the thyroid gland, ovaries, pituitary gland or adrenal gland. Such drugs can be taken for a long time and, naturally, they provoke another hormonal imbalance, which can also cause bleeding during the onset of menstruation.

If the blood loss is not severe, there is no need to worry, you can continue to take the drug. But when a woman experiences heavy periods accompanied by the symptoms described above, she should immediately consult a doctor. Perhaps the prescribed drug is not suitable for her body and needs to be replaced.

Bleeding associated with IUD insertion is also not uncommon. As a rule, it opens immediately after the procedure or during the first menstruation. This is due to the fact that when installing the spiral, the mucous membranes of the cervical canal are severely damaged, and they begin to bleed. If after the next menstruation the bleeding does not stop, you should also visit a doctor, since this phenomenon indicates the development of inflammatory processes that require immediate removal of the IUD from the cervix.

If we talk about gynecological diseases, the most common causes of bleeding during menstruation are the following:

Polycystic disease.
Endometriosis or adenometriosis.
Erosion (with this pathology, spotting may occur in the middle of the cycle).
Uterine fibroids.
Fibrosis.
Ectopic pregnancy.
Miscarriage (in this case, along with bloody discharge, a mucous clot may come out of the vagina).

To understand the true cause of the bleeding, you need to undergo a full examination. This is the only way to make an accurate diagnosis and prescribe appropriate treatment, which will avoid the development of serious complications.

What to do if bleeding occurs?

When a woman experiences heavy bleeding during her period and experiences fainting, under no circumstances should attempts be made to stop it at home. You need to call an ambulance immediately. The woman needs to be hospitalized!

While the doctors are traveling, the patient needs to be given first aid. It is as follows:

The woman must be laid on the bed so that her legs are higher than the level of her body, that is, raised up.
Apply a cold heating pad to the abdominal area (when exposed to low temperatures, the blood vessels narrow and bleeding decreases), but for no more than 15 minutes.
Provide her with frequent drinks, since with heavy periods there is a strong loss of fluid in the body, which can lead to dehydration (you can give water and sweet, weak tea, but not hot).

As soon as the doctors arrive, they will take the woman to the hospital. Here she will receive all the necessary treatment that will quickly stop the bleeding. If the blood loss is insignificant, the doctor may prescribe the woman medication treatment, which is carried out at home. As a rule, the following medications are recommended for heavy periods:

Dicynone. It has two forms of release - tablets and injections. After taking Dicynone tablets, a decrease in blood loss is observed only after 2 - 3 hours. If you inject this drug, relief occurs within 15 to 20 minutes. Therefore, it is natural that in case of severe bleeding, it is recommended to inject Dicinon. And in tablets it is prescribed only for preventive purposes.
Vikasol. Available in tablet form and has a hemostatic effect. It is recommended to take it 1 tablet. no more than 2 times a day.
Tranexam. A new generation hemostatic agent, which also has two forms - tablets and injections. Tranexam injections are considered more effective because they act much faster.
Hyfotocin. This drug is not a hemostatic agent, but it has a beneficial effect on the contractile functions of the uterus.

As an additional therapy and prevention of complications, the doctor can also prescribe calcium gluconate, which is taken 3-4 times a day, ascorbic acid 1 g once a day and aminocaproic acid (the dosage is determined individually).

If a woman has hormonal disorders, then the main treatment may include taking hormonal medications. They are selected individually and only after taking a blood test for hormones, which allows us to identify which hormone the body lacks.

If a woman has been diagnosed with serious pathologies that caused bleeding during menstruation, then various types of surgical interventions can be used as therapeutic therapy. Among them, the most common are:

Scraping or abrasion.
Cryodisruption.
Endometrial ablation.

Most often, such operations are performed when:

Frozen pregnancy in the early stages.
Ectopic pregnancy (in this case, removal of the fallopian tube may be necessary).
Hyperplasia of the endometrium of the uterus.
Endometriosis.
Myoma, fibrosis, polyposis, etc.

Alternative medicine

It is possible to stop uterine bleeding during menstruation using traditional methods, but only if the blood loss is insignificant and the woman’s general condition is satisfactory. In order to stop heavy periods at home, you can use various medicinal plants that have a hemostatic effect.

Nettle. This herb helps maintain uterine tone and vitamin C, which helps strengthen vascular walls and stop blood loss. A herbal decoction is made from the plant, which is then taken ½ cup 3 to 4 times a day. It is prepared like this: take 2 tbsp. l. nettle, add 0.5 liters of water and simmer over low heat for about 10 minutes. Next, the decoction must be left for half an hour and strained, after which it can be drunk.

Chamomile also has a beneficial effect on the female body and helps fight heavy periods. An infusion is prepared from the herb, which is also taken 3-4 times a day, 70-100 ml. And they do it as follows: take 1 tbsp. l. herbs, pour 0.4 liters of boiling water over it and leave for an hour, then filter.

To stop heavy blood loss, you can use a plant such as shepherd's purse. Tea is made from it. To do this, take 20 g of water, pour in 0.4 liters of boiling water and leave for about 30-40 minutes. Then filter and take 100 ml orally 3 times a day before meals.

Recovery after bleeding

When bleeding, the female body loses a lot of blood. Naturally, it will take him some time to recover. But in order for recovery to occur faster and the menstrual cycle to normalize, he needs help. To do this, a woman should:

Eat as many fresh vegetables and fruits as possible.
Drink a lot (herbal decoctions and infusions, teas, dried fruit compotes).
Avoid sexual intercourse for a while.
Take medications prescribed by your doctor.

If, 3 to 7 days after the bleeding has stopped, a woman continues to smear, she should definitely visit a doctor. Perhaps she has hidden diseases that require adjustment of the prescribed therapy. If this is not done, bleeding may occur again and not only during menstruation, but also in the intermenstrual period.

Uterine bleeding (vaginal bleeding)

Uterine bleeding can occur in physiological and a number of pathological conditions. Since the woman herself cannot determine the source of bleeding, a manifestation of uterine bleeding is vaginal bleeding. Uterine bleeding can be an absolutely physiological phenomenon in two cases: during menstruation, if its duration is no more than 7 days and the frequency of occurrence is not less than once every 25 days. Also, uterine bleeding in the form of short-term spotting may be normal during ovulation.

What uterine bleeding is considered pathological?

Uterine bleeding can occur in women of different ages. Pathological vaginal bleeding occur in the following cases:

Increased length of periods (menorrhagia), increased bleeding (menorrhagia and hypermenorrhea) and too frequent periods (polymenorrhea)
Bleeding not associated with menstruation, occurring irregularly - metrorrhagia
Bleeding in the postmenopausal period (if more than 6 months have passed since the last normal menstruation

Also, uterine bleeding can occur in pregnant women in the early and late stages.

Why does uterine bleeding occur?

The main mechanisms for the development of uterine bleeding are as follows:

Hormonal dysregulation of the relationship between elements of the hypothalamic-pituitary-ovarian-endometrial axis
Structural, inflammatory and other gynecological disorders (including tumors)
Blood coagulation disorders

The most common mechanism of uterine bleeding is this: during the anovulatory cycle (the follicle does not mature), the corpus luteum does not develop. As a result, progesterone (one of the female sex hormones) is not produced in sufficient quantities during the second phase of the cycle. At the same time, estradiol (another female sex hormone) continues to be produced in excess. Under the influence of estradiol, increased growth of the endometrium (the inner layer of the uterus) occurs, which becomes so thick that the blood vessels cease to adequately supply it with blood. As a result, the endometrium dies and undergoes desquamation. The desquamation process is not complete, is accompanied by uterine bleeding and is delayed for a long time.

The most common causes of uterine bleeding

Bleeding during early pregnancy occurs during spontaneous abortion. In this case, vaginal bleeding begins immediately or some time after the start of the abortion due to the leakage of accumulated blood. Bleeding can also occur during ectopic (ectopic) pregnancy.
Bleeding in late pregnancy can be associated with placental rupture, hydatidiform mole, placental polyps, and placenta previa.
Uterine bleeding can be symptoms of diseases associated with changes in the structure of the reproductive organs, such as adenomyosis (endometriosis of the uterus), cancer of the uterus, cervix or vagina, endometrial hyperplasia, submucosal nodes with uterine fibroids or nascent nodes, cervical and endometrial polyps.
Vaginal bleeding may be a sign of atrophic vaginitis, cervicitis, a foreign body in the vagina, or damage to the cervix, uterus or vagina.
Uterine bleeding due to impaired ovarian function can occur in the following conditions: dysfunctional uterine bleeding, functional ovarian cysts, polycystic ovary syndrome (polycystic).
Endocrine disorders: hypothyroidism or hyperprolactinemia.
Vaginal bleeding due to blood clotting disorders develops with hereditary diseases of the coagulation system, liver diseases, and when taking certain medications.
Uterine bleeding may occur when using contraceptives and hormonal therapy. Most often in cases of prescription of drugs such as Depo Provera, with hormone replacement therapy, in the presence of an intrauterine device, with levonorgestrel implants and in case of long gaps in taking contraceptives.

When should you see a doctor if you have uterine bleeding?

In cases where menstruation lasts more than 7 days, if the amount of discharge during menstruation is greater than usual, if menstruation occurs more often than once every 25 days, if you have bleeding outside of menstruation, you should consult a doctor. When examined in a chair, you can see damage to the vagina and cervix, the onset of vaginitis, and erosion of the cervix. Also, upon examination, you can see a nascent submucosal node with uterine fibroids or a cervical polyp. Uterine bleeding often accompanies infertility, since it is always based on a violation of the structure of the endometrium or a violation of the hormonal regulation of ovulation and the menstrual cycle. In addition to the examination on the chair, it is often necessary to do a transvaginal ultrasound, since with this method it is possible to evaluate changes in the ovaries and in the uterine cavity. Often, a uterine ultrasound is critical to diagnosing the causes of uterine bleeding. If an ultrasound of the uterus reveals structural changes that do not have clear signs, a blood test may be prescribed to measure the content of sex hormones and thyroid hormones. Whenever there is uterine bleeding, a pregnancy test is performed. To assess the degree of acute or chronic blood loss, a general blood test is prescribed, where the indicators of red blood cells, hemoglobin, hematocrit, platelets and ESR are monitored.

Treatment of uterine bleeding

Treatment of uterine bleeding depends on the reason causing it. Most often, treatment is conservative and consists of the use of drugs that increase the ability of blood to clot and drugs that correct hormonal imbalances. The correct choice of these medications takes into account many factors, which are brought together by the doctor. If the bleeding is not eliminated by medication or has an underlying cause that cannot be eliminated conservatively, surgical treatment is performed. Surgical treatment can consist of both therapeutic and diagnostic curettage of the endometrium and hysterectomy (removal of the uterus).

In obstetrics and gynecology we work in the following areas:

Vaginal discharge in women, discharge during pregnancy

Ultrasound diagnosis of Down syndrome and other chromosomal abnormalities

We treat such problems.