Bleeding from the female genital organs. Bleeding from the female genital organs - Causes, Diagnosis, Emergency care

Uterine bleeding is the release of blood from uterus. Unlike menstruation, with uterine bleeding, either the duration of discharge and the volume of blood released changes, or their regularity is disrupted.

Causes of uterine bleeding

Causes of uterine bleeding may be different. They are often caused by diseases of the uterus and appendages, such as fibroids, endometriosis, adenomyosis), benign and malignant tumors. Bleeding can also occur as a complication of pregnancy and childbirth. In addition, there are dysfunctional uterine bleeding - when, without visible pathology of the genital organs, their function is disrupted. They are associated with a violation of the production of hormones that affect the genital organs (disorders in the hypothalamus-pituitary-ovarian system).

Much less often, the cause of this pathology can be so-called extragenital diseases (not related to the genital organs). Uterine bleeding can occur with liver damage, with diseases associated with blood clotting disorders (for example, von Willebrand's disease). In this case, in addition to the uterine, patients are also worried about nosebleeds, bleeding gums, bruising from minor bruises, prolonged bleeding from cuts, and others symptoms.

Symptoms of uterine bleeding

The main symptom of this pathology is bleeding from the vagina.

Unlike normal menstruation, uterine bleeding is characterized by the following features:
1. Increased blood volume. Normally, during menstruation, 40 to 80 ml of blood is released. With uterine bleeding, the volume of blood lost increases, amounting to more than 80 ml. This can be determined if there is a need to change hygiene products too often (every 0.5 - 2 hours).
2. Increased duration of bleeding. Normally, during menstruation, discharge lasts from 3 to 7 days. In case of uterine bleeding, the duration of bleeding exceeds 7 days.
3. Irregularity of discharge - on average, the menstrual cycle is 21-35 days. An increase or decrease in this interval indicates bleeding.
4. Bleeding after sexual intercourse.
5. Bleeding in postmenopause - at an age when menstruation has already stopped.

Thus, the following symptoms of uterine bleeding can be distinguished:

• Menorrhagia (hypermenorrhea)- excessive (more than 80 ml) and prolonged menstruation (more than 7 days), their regularity is maintained (occurs after 21-35 days).
• Metrorrhagia– irregular bleeding. They occur more often in the middle of the cycle, and are not very intense.
• Menometrorrhagia– prolonged and irregular bleeding.
• Polymenorrhea– menstruation occurring more frequently than every 21 days.

In addition, due to the loss of fairly large volumes of blood, a very common symptom of this pathology is iron deficiency anemia (decreased amount of hemoglobin in the blood). It is often accompanied by weakness, shortness of breath, dizziness, and pale skin.

Types of uterine bleeding

Depending on the time of occurrence, uterine bleeding can be divided into the following types:
1. Uterine bleeding during the newborn period is scanty bloody discharge from the vagina, occurring most often in the first week of life. They are connected with the fact that during this period there is a sharp change in hormonal levels. They go away on their own and do not require treatment.
2. Uterine bleeding in the first decade (before the onset of puberty) is rare and is associated with ovarian tumors that can secrete increased amounts of sex hormones (hormone-active tumors). Thus, so-called false puberty occurs.
3. Juvenile uterine bleeding - occurs at the age of 12-18 years (puberty).
4. Bleeding during the reproductive period (ages 18 to 45) can be dysfunctional, organic, or associated with pregnancy and childbirth.
5. Uterine bleeding during menopause is caused by impaired hormone production or diseases of the genital organs.

Depending on the cause of occurrence, uterine bleeding is divided into:

• Dysfunctional bleeding(can be ovulatory or anovulatory).
• Organic bleeding- associated with pathology of the genital organs or systemic diseases (for example, diseases of the blood, liver, etc.).
• Iatrogenic bleeding– arise as a result of taking non-hormonal and hormonal contraceptives, blood thinning drugs, due to the installation of intrauterine devices.

Juvenile uterine bleeding

Juvenile uterine bleeding develops during puberty (age 12 to 18 years). Most often, the cause of bleeding in this period is ovarian dysfunction - the proper production of hormones is adversely affected by chronic infections, frequent acute respiratory viral infections, psychological trauma, physical activity, and poor nutrition. Their occurrence is characterized by seasonality - winter and spring months. Bleeding in most cases is anovulatory – i.e. due to disruption of hormone production, ovulation does not occur. Sometimes the cause of bleeding can be bleeding disorders, tumors of the ovaries, body and cervix, tuberculosis of the genital organs.
The duration and intensity of juvenile bleeding may vary. Heavy and prolonged bleeding leads to anemia, which is manifested by weakness, shortness of breath, pallor and other symptoms. In any case of bleeding in adolescence, treatment and observation should take place in a hospital setting. If bleeding occurs at home, you can ensure rest and bed rest, give 1-2 tablets of Vikasol, put a cold heating pad on the lower abdomen and call an ambulance.

Treatment, depending on the condition, can be symptomatic - the following remedies are used:

• hemostatic drugs: dicinone, vikasol, aminocaproic acid;
• uterine contractants (oxytocin);
• iron supplements;
• physiotherapeutic procedures.

If symptomatic treatment is insufficient, bleeding is stopped with the help of hormonal drugs. Curettage is performed only in cases of severe and life-threatening bleeding.

To prevent recurrent bleeding, courses of vitamins, physiotherapy, and acupuncture are prescribed. After bleeding has stopped, estrogen-progestin agents are prescribed to restore the normal menstrual cycle. Hardening and physical exercise, good nutrition, and treatment of chronic infections are of great importance in the recovery period.

Uterine bleeding during the reproductive period

During the reproductive period, there are quite a few reasons that cause uterine bleeding. These are mainly dysfunctional factors - when a violation of the correct production of hormones occurs after abortion, against the background of endocrine, infectious diseases, stress, intoxication, and taking certain medications.

During pregnancy, in the early stages, uterine bleeding can be a manifestation of miscarriage or ectopic pregnancy. In the later stages, bleeding is caused by placenta previa and hydatidiform mole. During childbirth, uterine bleeding is especially dangerous; the amount of blood loss can be large. A common cause of bleeding during childbirth is placental abruption, atony or hypotension of the uterus. In the postpartum period, bleeding occurs due to parts of the membranes remaining in the uterus, uterine hypotension or bleeding disorders.

Often, various diseases of the uterus can be the causes of uterine bleeding during the childbearing period:

• myoma;
• endometriosis of the uterine body;
• benign and malignant tumors of the body and cervix;
• chronic endometritis (inflammation of the uterus);
• hormonally active ovarian tumors.

Bleeding associated with pregnancy and childbirth

In the first half of pregnancy, uterine bleeding occurs when there is a threat of interruption of a normal or ectopic pregnancy. These conditions are characterized by pain in the lower abdomen, delayed menstruation, as well as subjective signs of pregnancy. In any case, if there is bleeding after pregnancy is established, you should urgently seek medical help. In the initial stages of spontaneous miscarriage, with prompt and active treatment, pregnancy can be maintained. In the later stages, the need for curettage arises.

An ectopic pregnancy can develop in the fallopian tubes and cervix. At the first signs of bleeding, accompanied by subjective symptoms of pregnancy against the background of even a slight delay in menstruation, it is necessary to urgently seek medical help.

In the second half of pregnancy, bleeding poses a great danger to the life of the mother and fetus, so it requires urgent medical attention. Bleeding occurs when placenta previa (when the placenta does not form along the back wall of the uterus, but partially or completely blocks the entrance to the uterus), abruption of a normally located placenta, or uterine rupture. In such cases, the bleeding may be internal or external, and requires an emergency caesarean section. Women at risk of such conditions should be under close medical supervision.

During childbirth, bleeding is also associated with placental previa or placental abruption. In the postpartum period, common causes of bleeding are:

• decreased uterine tone and ability to contract;
• parts of the placenta remaining in the uterus;
• bleeding disorders.

In cases where bleeding occurs after discharge from the maternity hospital, it is necessary to call an ambulance for urgent hospitalization.

Uterine bleeding during menopause

During menopause, hormonal changes in the body occur, and uterine bleeding occurs quite often. Despite this, they can become a manifestation of more serious diseases, such as benign (fibroids, polyps) or malignant neoplasms. You should be especially wary of the appearance of bleeding in postmenopause, when menstruation has already completely stopped. It is extremely important to see a doctor at the first sign of bleeding because... In the early stages, tumor processes are more treatable. For diagnostic purposes, separate diagnostic curettage of the cervical canal and the uterine body is performed. Then a histological examination of the scraping is carried out to determine the cause of the bleeding. In case of dysfunctional uterine bleeding, it is necessary to select the optimal hormonal therapy.

Dysfunctional uterine bleeding

Dysfunctional bleeding is one of the most common types of uterine bleeding. They can occur at any age - from puberty to menopause. The reason for their occurrence is a disruption in the production of hormones by the endocrine system - a malfunction of the hypothalamus, pituitary gland, ovaries or adrenal glands. This complex system regulates the production of hormones that determine the regularity and duration of menstrual bleeding. Dysfunction of this system can be caused by the following pathologies:

• acute and chronic inflammation of the genital organs (ovaries, appendages, uterus);
• endocrine diseases (thyroid dysfunction, diabetes, obesity);
• stress;
• physical and mental fatigue;
• climate change.

Very often, dysfunctional bleeding is a consequence of artificial or spontaneous abortion.

Dysfunctional uterine bleeding can be:
1. Ovulatory – associated with menstruation.
2. Anovulatory – occurs between menstruation.

With ovulatory bleeding, deviations occur in the duration and volume of blood released during menstruation. Anovulatory bleeding is not associated with the menstrual cycle and most often occurs after a missed period, or less than 21 days after the last menstrual period.

Ovarian dysfunction can cause infertility and miscarriage, so it is extremely important to consult a doctor promptly if any menstrual irregularities occur.

Breakthrough uterine bleeding

Uterine bleeding that occurs while taking hormonal contraceptives is called breakthrough bleeding. Such bleeding may be minor, which is a sign of a period of adaptation to the drug.

In such cases, you should consult a doctor to review the dose of the drug used. Most often, if breakthrough bleeding occurs, it is recommended to temporarily increase the dose of the drug taken. If the bleeding does not stop or becomes more profuse, additional examination should be carried out, since the cause may be various diseases of the reproductive system. Bleeding can also occur if the walls of the uterus are damaged by the intrauterine device. In this case, it is necessary to remove the spiral as soon as possible.

Which doctor should I contact if I have uterine bleeding?

If uterine bleeding occurs, regardless of the age of the woman or girl, you should contact gynecologist (make an appointment). If uterine bleeding begins in a girl or young girl, it is advisable to contact a pediatric gynecologist. But if for some reason it is impossible to get to one, then you should contact a regular gynecologist at a antenatal clinic or a private clinic.

Unfortunately, uterine bleeding can be a sign not only of a long-term chronic disease of a woman’s internal genital organs, which requires routine examination and treatment, but also symptoms of an emergency condition. Emergency conditions mean acute diseases in which a woman needs urgent qualified medical care to save her life. And if such assistance in case of emergency bleeding is not provided, the woman will die.

Accordingly, you need to contact a gynecologist at the clinic for uterine bleeding when there are no signs of an emergency. If uterine bleeding is combined with signs of an emergency condition, then you should immediately call an ambulance or use your own transport as soon as possible to get to the nearest hospital with a gynecological department. Let's consider in what cases uterine bleeding should be considered as an emergency.

First of all, all women should know that uterine bleeding at any stage of pregnancy (even if the pregnancy is not confirmed, but there is a delay of at least a week) should be considered an emergency condition, since the release of blood, as a rule, is provoked by threats to the life of the fetus and future mothers with conditions such as placental abruption, miscarriage, etc. And in such conditions, a woman should be provided with qualified assistance to save her life and, if possible, preserve the life of the gestating fetus.

Secondly, uterine bleeding that begins during or some time after sexual intercourse should be considered a sign of an emergency. Such bleeding may be due to pregnancy pathology or severe trauma to the genital organs during previous intercourse. In such a situation, help for a woman is vital, since in her absence the bleeding will not stop, and the woman will die from blood loss incompatible with life. To stop bleeding in such a situation, it is necessary to sutured all ruptures and injuries to the internal genital organs or terminate the pregnancy.

Thirdly, an emergency condition should be considered uterine bleeding, which turns out to be profuse, does not decrease over time, is combined with severe pain in the lower abdomen or lower back, causes a sharp deterioration in health, paleness, decreased blood pressure, palpitations, increased sweating, and possibly fainting. A general characteristic of an emergency condition with uterine bleeding is the fact of a sharp deterioration in a woman’s well-being, when she cannot perform simple household and everyday activities (she cannot stand up, turn her head, it is difficult for her to speak, if she tries to sit up in bed, she immediately falls, etc.) , but literally lies flat or even unconscious.

What tests and examinations can a doctor prescribe for uterine bleeding?

Despite the fact that uterine bleeding can be provoked by various diseases, when they occur, the same examination methods (tests and instrumental diagnostics) are used. This is due to the fact that the pathological process during uterine bleeding is localized in the same organs - the uterus or ovaries.

Moreover, at the first stage, various examinations are carried out to assess the condition of the uterus, since most often uterine bleeding is caused by the pathology of this particular organ. And only if, after the examination, the pathology of the uterus was not detected, methods of examining the functioning of the ovaries are used, since in such a situation the bleeding is caused by a disorder of the regulatory function of the ovaries. That is, the ovaries do not produce the required amount of hormones at different periods of the menstrual cycle, and therefore bleeding occurs as a response to hormonal imbalance.

So, in case of uterine bleeding, first of all, the doctor prescribes the following tests and examinations:

• General blood analysis ;
• Coagulogram (indicators of the blood coagulation system) (sign up);
• Gynecological examination (make an appointment) and inspection in mirrors;
• Ultrasound of the pelvic organs (sign up).

A complete blood count is needed to assess the extent of blood loss and whether the woman has developed anemia. Also, a general blood test can reveal whether there are inflammatory processes in the body that can cause dysfunctional uterine bleeding.

A coagulogram allows you to evaluate the functioning of the blood coagulation system. And if the coagulogram parameters are not normal, then the woman should consult and undergo the necessary treatment with hematologist (make an appointment).

A gynecological examination allows the doctor to feel with his hands various neoplasms in the uterus and ovaries, and determine the presence of an inflammatory process by changes in the consistency of the organs. And examination in the mirrors allows you to see the cervix and vagina, identify neoplasms in the cervical canal or suspect cervical cancer.

Ultrasound is a highly informative method that allows you to identify inflammatory processes, tumors, cysts, polyps in the uterus and ovaries, endometrial hyperplasia, as well as endometriosis. That is, in fact, ultrasound allows you to identify almost all diseases that can cause uterine bleeding. But, unfortunately, the information content of ultrasound is not sufficient for a final diagnosis, since this method only provides guidance in the diagnosis - for example, ultrasound can detect uterine fibroids or endometriosis, but it is possible to establish the exact location of the tumor or ectopic foci, determine their type and assess the condition of the organ and surrounding tissues - it is impossible. Thus, ultrasound makes it possible to determine the type of existing pathology, but to clarify its various parameters and determine the causes of this disease, it is necessary to use other examination methods.

When a gynecological examination, speculum examination, ultrasound, and a general blood test and coagulogram will be performed, it depends on what pathological process was identified in the genital organs. Based on these examinations, the doctor may prescribe the following diagnostic procedures:

• Separate diagnostic curettage (sign up);
• Hysteroscopy (sign up);
• Magnetic resonance imaging (sign up).

So, if endometrial hyperplasia, polyps of the cervical canal or endometrium, or endometritis are detected, the doctor usually prescribes separate diagnostic curettage followed by histological examination of the material. Histology allows us to understand whether there is a malignant tumor or malignancy of normal tissue in the uterus. In addition to curettage, the doctor may prescribe hysteroscopy, during which the uterus and cervical canal are examined from the inside with a special device - a hysteroscope. In this case, hysteroscopy is usually performed first, and then curettage.

If fibroids or other uterine tumors are detected, the doctor prescribes hysteroscopy in order to examine the organ cavity and see the tumor with the eye.

If endometriosis has been identified, the doctor may prescribe magnetic resonance imaging in order to clarify the location of ectopic foci. In addition, if endometriosis is detected, the doctor may prescribe a blood test for the content of follicle-stimulating, luteinizing hormones, and testosterone in order to clarify the causes of the disease.

If cysts, tumors or inflammation have been identified in the ovaries, additional examinations are not carried out, as they are not needed. The only thing the doctor can prescribe in this case is laparoscopic surgery (make an appointment) for removal of tumors and conservative treatment for the inflammatory process.

In the case when, according to the results Ultrasound (sign up), gynecological examination and speculum examination did not reveal any pathology of the uterus or ovaries; dysfunctional bleeding is assumed due to a hormonal imbalance in the body. In such a situation, the doctor prescribes the following tests to determine the concentration of hormones that can affect the menstrual cycle and the appearance of uterine bleeding:

• Blood test for cortisol (hydrocortisone) levels;
• Blood test for the level of thyroid-stimulating hormone (TSH, thyrotropin);
• Blood test for triiodothyronine (T3) level;
• Blood test for thyroxine (T4) level;
• Blood test for the presence of antibodies to thyroid peroxidase (AT-TPO);
• Blood test for the presence of antibodies to thyroglobulin (AT-TG);
• Blood test for follicle-stimulating hormone (FSH) levels;
• Blood test for luteinizing hormone (LH) levels;
• Blood test for prolactin level (sign up);
• Blood test for estradiol levels;
• Blood test for dehydroepiandrosterone sulfate (DEA-S04);
• Blood test for testosterone levels;
• Blood test for sex hormone binding globulin (SHBG) levels;
• Blood test for the level of 17-OH progesterone (17-OP) (sign up).

Treatment of uterine bleeding

Treatment of uterine bleeding is aimed primarily at stopping bleeding, replenishing blood loss, as well as eliminating the cause and preventing it. All bleeding is treated in a hospital setting, because First of all, it is necessary to carry out diagnostic measures to determine their cause.

Methods to stop bleeding depend on age, its cause, and the severity of the condition. One of the main methods of surgically stopping bleeding is separate diagnostic curettage - it also helps to identify the cause of this symptom. To do this, a scraping of the endometrium (mucous membrane) is sent for histological examination. Curettage is not performed for juvenile bleeding (only if severe bleeding does not stop under the influence of hormones and is life threatening). Another way to stop bleeding is hormonal hemostasis (use of large doses of hormones - estrogen or combined oral contraceptives Mirena). If intrauterine pathology is detected, chronic endometritis, endometrial polyps, uterine fibroids, adenomyosis, and endometrial hyperplasia are treated.

Hemostatic agents used for uterine
bleeding

Hemostatic agents are used for uterine bleeding as part of symptomatic treatment. Most often prescribed:

• dicinone;
• ethamsylate;
• vikasol;
• calcium preparations;
• aminocaproic acid.

In addition, drugs that contract the uterus - oxytocin, pituitrin, hyfotocin - have a hemostatic effect during uterine bleeding. All of these drugs are most often prescribed in addition to surgical or hormonal methods of stopping bleeding.

Dicinone for uterine bleeding

Dicynone (etamsylate) is one of the most common drugs used for uterine bleeding. Belongs to the group of hemostatic (hemostatic) drugs. Dicynone acts directly on the walls of capillaries (the smallest vessels), reduces their permeability and fragility, improves microcirculation (blood flow in the capillaries), and also improves blood clotting in places where small vessels are damaged. However, it does not cause hypercoagulation (increased blood clot formation) and does not constrict blood vessels.

The drug begins to act within 5-15 minutes after intravenous administration. Its effect lasts 4-6 hours.

Dicinone is contraindicated in the following cases:

• thrombosis and thromboembolism;
• malignant blood diseases;
• hypersensitivity to the drug.

The method of administration and dose is determined by the doctor in each specific case of bleeding. For menorrhagia, it is recommended to take dicinone tablets, starting on the 5th day of the expected menstruation and ending on the fifth day of the next cycle.

What to do with prolonged uterine bleeding?

With prolonged uterine bleeding, it is important to seek medical help as soon as possible. If signs of severe anemia appear, it is necessary to call an ambulance to stop the bleeding and further observation in the hospital.

Main signs of anemia:

• severe weakness;
• dizziness;
• decreased blood pressure;
• increased heart rate;
• pale skin;

Folk remedies

As folk remedies for the treatment of uterine bleeding, decoctions and extracts of yarrow, water pepper, shepherd's purse, nettle, raspberry leaves, burnet and other medicinal plants are used. Here are some simple recipes:
1. Infusion of yarrow herb: 2 teaspoons of dry herb are poured with a glass of boiling water, left for 1 hour and filtered. Take 4 times a day, 1/4 cup of infusion before meals.
2. Infusion of shepherd's purse herb: 1 tablespoon of dry herb is poured with a glass of boiling water, left for 1 hour, pre-wrapped, then filtered. Take 1 tablespoon, 3-4 times a day before meals.
3.

The term “uterine gynecological bleeding” (as opposed to “obstetric”) should be understood as bleeding when, instead of normal menstrual flow, there is too much blood (hypermenorrhea), too frequent menstruation (polymenorrhea) or bleeding appears with a rhythm disturbance - metrorrhagia, or acyclic bleeding. Previously, all these types of gynecological bleeding were divided into menorrhagia and metrorrhagia. Recently, these terms have been replaced by the terms “cyclic” and “acyclic” bleeding. The problem of gynecological bleeding has a long history. It can be divided into three periods. The first is the false anatomical doctrine of Ruge, according to which the cause of gynecological bleeding is explained by various histological changes in the endometrium; upon further study, these changes turned out to be separate phases of the menstrual cycle. The second period can be called the period of false functional theory, according to which heavy uterine bleeding was explained by the abundance of ovarian hormones, and meager bleeding was explained by a decrease in the production of sex hormones.

The third period is the period of studying the functions of the genital organs in the light of the teachings of I.P. Pavlov. In turn, the functions of the latter are considered in interaction with the functions of the entire organism, which is under the general regulatory influence of the central nervous system.

Uterine bleeding is highly variable depending on the etiology and pathogenesis, the age of the patient, environmental conditions, etc. The classification of gynecological bleeding has not yet been fully developed also because the etiology and pathogenesis of uterine bleeding cannot always be accurately clarified.

One of the best modern classifications uterine bleeding, we consider the classification of M.D. Gutner, based on pathogenetic and clinical-morphological characteristics.

An addition to this classification is A. E. Mandelstam’s classification of bleeding in the postmenopausal period.

1. Bleeding due to damage to the uterus (cervix or body):
a) ulcerative processes of various nature;
b) polyps (mucous or fibromatous);
c) malignant neoplasms (cancer, sarcoma), less often benign adenomas).

2. Bleeding due to ovarian damage:
a) development of hormone-producing tumors;
b) development of a cancerous tumor (sarcoma).

3. Bleeding from the uterus due to extragenital processes;
a) vascular atheromatosis;
b) hypertension;
c) decompensated heart disease.

4. Bleeding from the vagina, vulva, urethra (ulcers of various origins, cancer, trauma, etc.).

Based on the classification of A. S. Gologorsky, we have compiled a classification of gynecological (uterine) bleeding, reflecting the causes of a particular group, their. In the classification, all bleeding is divided into two groups: 1) bleeding accompanied by morphological and anatomical changes in the genital organs and 2) bleeding without these changes, i.e. functional or, rather, dysfunctional. The first group of bleeding, in turn, is divided into three subgroups: 1) cyclic, 2) acyclic and 3) cyclic untimely (transitional).

Let's move on to consider the causes and nature of bleeding in diseases accompanied by cyclic, acyclic and transitional bleeding.

A. Cyclic bleeding
1. Intramural fibroids. Previously, some authors, like Galban, explained the mechanism of cyclic bleeding in intramural uterine fibroids as follows. The muscular wall of the uterus, which contains fibroid nodes in its thickness, is not capable of prolonged and strong contractions, as a result of which the vessels of the basal layer during menstruation are not completely compressed and are not thrombosed, which leads to heavy and prolonged bleeding. The closer the myomatous nodes are located to the basal layer of the endometrium, the more profuse the bleeding; the size of the nodes does not matter much. In modern times, many authors believe that fibromatous nodes in the myometrium create only a predisposition to uterine bleeding, while hormonal influences are considered the real cause. Thus, Beckler believes that the cause of cyclic bleeding in fibroids is the increased production of estrogen hormones, which leads to endometrial hyperplasia.

2. Internal adenomyosis of the uterus. The appearance of uterine bleeding in the past was explained by a decrease in the contractility of the uterine muscles. Supporters of the hyperhormonal influence of the ovaries see the cause of bleeding in cyclical and pathological changes in the endometrium. Uterine bleeding with internal adenomyosis is found in 3/4 of patients.

3. Cause of bleeding in inflammatory diseases of the uterine appendages, including chronic adhesive ones, consists of active and passive hyperemia, the development of endometritis of a specific order, gonorrheal and tuberculous, and also depends on perio-oophoritis of various etiologies, disrupting the normal maturation and function of follicles and corpus luteum.

4. Retrodeviations of the uterus, especially fixed and subfixed ones, accompanied by phenomena of pelvic stagnation, often cause significant cyclic bleeding. They are eliminated by curing these abnormal positions of the uterus.

5. Hypoplasia and infantilism of the uterus cause cyclic menstrual bleeding quite rarely; in these cases, amenorrhea or short, light menstrual bleeding is more often observed.

6. Pathological menopause can cause cyclic, but more often acyclic bleeding, which is characterized by an erratic course with periodic returns to cyclic bleeding or temporary amenorrhea.

The examination reveals a slight increase and density of the uterus; Menstruation is often anovulatory (single-phase).

7. General diseases, including nervous and mental shocks, can cause constant changes in menstruation, approaching the type of cyclic bleeding; this is consistent with the opinions of modern authors about the decisive role of the central nervous system in the pathogenesis of menstrual cycle abnormalities.

Acute and chronic infections - typhoid, influenza and malaria - often cause heavy menstruation. Vitamin deficiency developing in these diseases plays an important role. Diseases of the cardiovascular system, chronic nephritis, and cirrhosis of the liver also play an important role. Finally, diseases of the endocrine organs that cause various abnormalities of the menstrual cycles often contribute to the appearance of cyclic bleeding. This can be observed with hypo- and hyperthyroidism, pituitary insufficiency, and diseases of the pancreas. Physical fatigue, vitamin deficiencies, metabolic diseases, etc. also have an impact.

B. Acyclic bleeding
1. Submucosal fibroids of the uterus. With submucosal fibroids, which occupy a significant part of the uterine cavity or even all of it, the tumor mucosa is constantly injured due to friction against the walls of the uterus; It is the friction caused by every physical exertion of the patient that leads to bleeding. The second cause of bleeding in submucosal fibroids is overstretching of the myometrium and pathological growth and thickening of the endometrium in this disease. But the most profuse bleeding, often leading patients to anemia, is caused by necrosis of the submucosal fibromatous node.

2. Mucous and fibrous polyps of the body and cervix at first they usually cause moderate bleeding, while the endometrial cycle proceeds normally. Often this recurring small spotting is associated with menstruation. With increased bleeding from polyps, menstrual bleeding becomes acyclic.

3. Internal adenomyosis of the uterus, which is characterized by cyclic bleeding and dysmenorrhea, gives a picture of acyclic bleeding in menopausal age or in combination; with submucosal fibroids and polyps or with chronic inflammatory disease of the appendages and pelvic peritoneum.

4. Cervical and uterine cancer. In the early stages of cervical cancer, bleeding is of a contact nature, in the form of small bloody spots, while maintaining a more or less normal type of menstruation. As the cancerous tumor grows and the vascular branches are destroyed, bleeding becomes more frequent and profuse and overlaps cyclic menstrual bleeding. In case of uterine cancer, the cause of bleeding is the disintegration of the tumor. Since uterine cancer develops most often during menopause, bleeding is acyclic in nature. More profuse bleeding is observed when the tumor spreads deep into the myometrium.

5. Sources of acyclic bleeding may be located outside the uterus, which is observed with neoplasms, ulcerative processes of the vagina, urethra (polyps, cancer, tuberculosis, gummous and trophic ulcers).

6. Endometritis. Chronic and specific endometritis - tuberculosis and gonorrheal - can also cause prolonged acyclic bleeding. The clinical picture of these endometritis is presented in the chapters on gonorrhea and genital tuberculosis.

7. Erosion of the vaginal part of the cervix, as well as extropion (eversion of the mucous membrane of the cervical canal due to cervical ruptures) can also cause acyclic bleeding, usually small or contact (during coitus). Simultaneously with these acyclic bleeding, normal menstruation occurs, since the endometrial (uterine) and ovarian components of the menstrual cycle are not disturbed.

8. A fairly common cause of acyclic bleeding is disrupted normal and pathological pregnancy: placental remains and polyps, decidual endometritis, hydatidiform mole. These bleedings, with a certain right, belong to obstetrics; they are mentioned here in connection with the hospitalization of such patients in gynecological hospitals.

9. General, infectious, endocrine diseases, as well as blood diseases can cause not only cyclic, but also acyclic bleeding.

IN. Transitional bleeding
These include: 1) additional and 2) intermenstrual bleeding.

A. S. Gologorsky calls these bleeding transitional forms between cyclic and acyclic bleeding.

Additional bleeding can occur before or after menstrual bleeding, directly joining it. The duration of these bleedings exceeds 10-12 days. The endometrial and ovarian cycles proceed normally. Additional bleeding is based on the same diseases as with acyclic bleeding.

Intermenstrual bleeding occurs between two periods, but no later than the 17th-19th day of the cycle.

Extrasexual diseases can also cause pre- and postmenstrual and intermenstrual gynecological bleeding. They are explained by toxic myocardial dystrophy in infectious diseases or stagnation of blood in the pelvis in diseases of the heart, liver, kidneys and lungs.

About therapy in the article

Cyclic uterine bleeding occupies a large share among gynecological diseases, accounting, according to V.F. Snegirev, 18% of the total number of patients with gynecological diseases.

Clinically, they are divided into 2 groups: with a normal (ovulatory) cycle and with an anovulatory one.

Cyclic bleeding during the ovulatory cycle. Depending on the nature, strength and duration, ovulatory bleeding is divided into 3 groups: excessively heavy uterine bleeding (hypermenorrhea), long, protracted menstruation - longer than 7, but not more than 12 days (polymenorrhea), bleeding with rhythm disturbances, which are repeated more often than 3 weeks (after 12-16 days), - proyomenorrhea.

Combined menorrhagia (hyperproyomenorrhea, or hyperpolymenorrhea) is often observed.

Cyclic bleeding is most often combined with hyperpolymenorrhea and is characterized by heavy and prolonged bleeding with a normal menstrual rhythm. In such patients, menstruation is delayed for 7 or more days, bleeding is heavy, with blood clots. If it lasts 12 or more days, it is called metrorrhagia.

Hyperpolymenorrhea occurs as a result of the following reasons. Most often (30-35%) the cause of this condition is inflammatory diseases of the uterus and its appendages. In this case, bleeding occurs as a result of weakening of the uterine muscles due to infection and intoxication, as well as partial or complete fixation of the uterus resulting from the inflammatory process, or a combination of these factors.

Incorrect positions of the uterus in 10-15% of cases cause uterine bleeding due to congestion and the formation of adhesions that fix the uterus. They can be caused by active and passive hyperemia in the pelvic area due to the inflammatory process of the genital organs, stagnation of blood in the systemic circle due to heart valve defects, lung diseases, as a result of interrupted sexual intercourse, masturbation, etc.

A number of common serious diseases can also lead to hyperpolymenorrhea. Among them are hemorrhagic diathesis, thrombopenia, Werlhof's disease, liver and kidney diseases, severe intoxication of the body, and severe metabolic diseases.

In persons with a labile nervous system, due to rapid and sudden redistribution of blood (grief, fear), the vessels of the abdominal cavity dilate, which leads to uterine bleeding. Dysfunction of the thyroid gland, pituitary gland, and adrenal gland may also be accompanied by increased or prolonged uterine bleeding. In these cases, the activity of the hormonal glands affects menstrual function through the ovary. Bleeding such as proyomenorrhea is often observed in combination with hyperpolymenorrhea or hypooligomenorrhea. The main causes of proyomenorrhea are: inflammatory diseases of the uterine appendages (active and passive hyperemia leads to accelerated maturation of ovarian follicles, which contributes to a more frequent onset of menstruation); hypoplasia, leading to the death of an inferior germ cell, causing a reduction in the luteal phase; stagnation in the pelvis (constipation, interrupted sexual intercourse, sexual excesses, masturbation, abnormal positions of the uterus); ovarian dysfunction with uterine fibroids.

Acyclic bleeding in women is called metrorrhagia. They are characterized by a complete lack of periodicity and have no connection with the menstrual cycle. It is impossible to describe the amount of blood lost, since the discharge is profuse, spotting, and sometimes blood clots are present. Bleeding can occur with uterine fibroids, benign tumors, and other diseases of the female reproductive system.

Discharge between periods is a concern for many women. You must first understand what leads to violations of this kind, find out the reason for inconstancy. You should familiarize yourself with the factors that lead to such pathologies:

• hormonal imbalances;
• changes in physiological state;
• endometriosis;
• inflammatory processes;
• tumors of different types;
• cervical erosion;
• gynecological injuries;
• stress;
• hypovitaminosis.

The pituitary gland, uterus and ovaries are responsible for the occurrence of such bleeding, regardless of the named reasons. Disruption of their work affects the course of the menstrual cycle. The main cause of acyclic bleeding is an imbalance of the hormonal balance of progesterone and estrogen. Women in menopause need to be especially careful.

If bleeding occurs after constant menstruation, it is very often a sign of a tumor.

When classifying the causes of metrorrhagia, the following main factors are identified: disease of the vagina, uterus, ovaries; changes in the hormonal structure of the ovaries; somatic, iatrogenic disease; discharge during pregnancy.

Diagnosis of acyclic discharge

A symptom of metrorrhagia is acyclic discharge that appears in the middle of the cycle. The factor causing this condition is a disease of the reproductive system in women: fibroids, uterine cancer, ovarian tumors. This often results in abdominal pain and dizziness. Sometimes the condition is acute, but can be virtually asymptomatic. In any case, a thorough examination is necessary.

In order to identify the causes of metrorrhagia and take timely measures, such a diagnosis is recommended.

1. History of the disease.
2. Study of the patient's clinical condition.
3. Determination of hemoglobin levels, hormones, coagulation ability and blood biochemistry.
4. Study of the level of the hormone B-hCG.
5. Ultrasound transvaginal examinations.
6. Endometrial biopsy.
7. Consultations with various specialists.

Diagnosis is always based on general and gynecological examination data. Diagnostic curettage of the genital mucosa followed by histological examination allows for effective treatment. The types of diagnostics and the nature of these procedures should always be determined by the attending physician.

Types of acyclic bleeding

Intermenstrual blood is a sign of infections, cervical injuries, vaginal injuries, fibroids, adenomyosis, ovarian cysts. The discharge has a different character: smearing, abundant, intense, accompanied by cramping pain.

Dysfunctional uterine bleeding is often associated with the ovaries. During menopause and menopause, the body is rebuilt and intermenstrual discharge occurs. If very young girls develop infectious diseases or simply get into a cycle, they may occur.

The result of changes in hormonal levels during menopause and hormonal contraception are iatrogenic hemorrhages. They sometimes appear when taking anticoagulants and regular aspirin.

Blood discharge during pregnancy indicates a threat of miscarriage. Pain in the abdomen, back, low body temperature are additional signs of this condition. It can also be used during ectopic pregnancy, when the decidua of the uterus is detached. In late pregnancy, bleeding occurs due to placental abruption.

Metrorrhagia with hormonal contraception

Iatrogenic bleeding may occur with hormonal contraception. One of these drugs, Escapelle, acts on hormonal levels, causing side effects, including acyclic uterine bleeding. Escapelle is considered an effective emergency contraceptive that is not used regularly. appear frequently. Women think that there is a cycle failure, but this is not so. Your periods will return to normal. If your period is delayed by five or seven days, this is normal.

Postinor is an emergency contraceptive drug, after taking which blood discharge may appear. This is evidence that conception did not occur. Later. Repeated or regular use of the drug is not recommended, since acyclic bleeding may become constant against this background.

Methods for treating uterine acyclic bleeding

Treatment directly depends on the causes of the disease and the woman’s age. Teenagers are prescribed drugs that stop bleeding, strengthen blood vessels, and are recommended to take vitamins. During reproductive age, hormonal drugs are indicated, and surgical operations are performed to eliminate tumors. During menopause, bleeding is evidence of oncological pathologies of the uterus or ovaries. Surgical intervention leading to removal of the uterus and appendages is necessary. If this is a disorder of the hormonal system, hormone replacement therapy is prescribed.

For emergency assistance, when blood loss is small, medications are administered orally, but if the process is very active, parenterally. Oxytocin and methylergometrine are used. After an injection of oxytocin, the uterus relaxes, bleeding resumes, after methylergometrine it contracts more slowly, which is good for hemostasis. For small discharges, experts recommend ergotal, ergometrine, intramuscular vikasol, calcium gluconate, intravenous aminocaproic acid.

Stopping juvenile bleeding begins with hemostasis. In women of childbearing age, this method is used if there is no precancerous condition or endometrial cancer. During menopause, curettage of the uterine lining begins. You can stop the discharge with hormonal agents, but only if there is no endometrial cancer.

Acyclic uterine bleeding should only be stopped by a doctor. Self-medication in this case is unacceptable. Incorrect diagnosis and inappropriate treatment lead to various troubles. Sometimes women stop bleeding using traditional medicine, but do not suspect that the cause of the discharge is a tumor or hormonal pathology.

Conclusion

When treating diseases whose symptoms are, it is very important to make a timely diagnosis. Women should immediately contact a gynecologist for help. The treatment regimen for acyclic bleeding is always individual. First of all, it is necessary to stop bleeding in a timely manner and formulate an optimal course of drug treatment, the duration of which should be at least twenty-one days.

Rental block

JUMK is acyclic uterine bleeding in girls of puberty.

Etiology:

a) predisposing factors: constitutional features (asthenic, intersex, infantile); increased allergization; unfavorable clinical, geographical and material factors; influence of damaging factors in the ante- and intranatal period (prematurity, gestosis, Rhesus conflict); frequent infectious diseases in childhood.

b) permissive factors: mental shocks; physical overload; brain concussion; colds.

Pathogenesis: based on dysfunction of the hypothalamic-pituitary system. The immaturity of the hypophysiotropic structures of the hypothalamus leads to disruption of the cyclic formation and release of gonadotropins, which disrupts the processes of folliculogenesis in the ovaries and leads to anovulation, in which atresia of follicles that have not reached the ovulatory stage of maturity occurs. In this case, ovarian steroidogenesis is disrupted, estrogen production is relatively monotonous, but long-lasting, progesterone is formed in small quantities. Progesterone deficiency affects primarily the endometrium. The stimulating effect of E2 causes endometrial proliferation. With progesterone deficiency, the endometrium does not undergo secretory transformation, but hyperplasias and undergoes glandular-cystic changes. Uterine bleeding occurs due to congestive plethora, expansion of capillaries, development of areas of necrosis and uneven rejection of the endometrium. Prolonged bleeding is facilitated by a decrease in the contractile activity of the uterus during its hypoplasia.

There are two types of UMC:

a) hypoestrogenic type - endometrial hyperplasia develops slowly, subsequent bleeding is not so heavy as long-lasting

b) hyperestrogenic type - endometrial hyperplasia quickly develops, followed by incomplete rejection and bleeding

Clinic: observed most often in the first 2 years after menarche, but sometimes already from menarche; occurs after a delay in menstruation for varying periods, lasts up to 7 days or more, varies in intensity, is always painless, quite quickly leads to anemia even with slight blood loss and secondary disorders of the blood coagulation system (thrombocytopenia, slow coagulation, decreased prothrombin index, slow blood reaction clot). Until the end of puberty, ovulatory bleeding in the form of hyperpolymenorrhea is characteristic due to insufficient production of LH by the pituitary gland and inadequate development of the corpus luteum.

Diagnosis: should be carried out jointly with a pediatrician, hematologist, endocrinologist, neurologist, otorhinolaryngologist.

For hypoestrogenic type:

1. External gynecological examination: correct development of the external genitalia, pale pink color of the mucous membrane and vulva, thin hymen.

2. Vaginoscopy: the mucous membrane is pale pink in color, the folding is weakly expressed, the cervix is ​​subconical or conical in shape, the pupil phenomenon is +/- or +, the discharge is light, bloody, without mucus.

3. Rectoabdominal examination: the uterus is typically located, the angle between the body and the cervix is ​​not pronounced, the size of the uterus corresponds to age, the ovaries are not palpable.

4. Functional diagnostic tests: monophasic basal temperature, CPI 20-40%, cervical mucus tension length 3-4 cm

For the hyperestrogenic type:

1. External examination: correct development of the external genitalia, juiciness of the vulva, fringed juicy hymen

2. Vaginoscopy: mucous membranes are pink, folding is well expressed, the cervix is ​​cylindrical in shape, the pupil phenomenon is ++, +++ or ++++, the discharge is copious, bloody, mixed with mucus.

3. Rectoabdominal examination: a slightly enlarged uterus and ovaries are palpated, the angle between the cervix and the body of the uterus is well defined.

4. Functional diagnostic tests: monophasic basal temperature, CPI 50-80%, cervical mucus tension length 7-8 cm.

All patients with JMC are shown an ultrasound to clarify the condition of the internal genital organs.

Basic principles of therapy:

1. Therapeutic and protective regime a) organization of proper work and rest b) elimination of negative emotions c) creation of physical and mental peace d) balanced nutrition e) rational therapy after concomitant diseases.

2. Non-hormonal hemostatic therapy (with moderate blood loss and menstrual age no more than 2 years, no signs of organic pathology of the uterus and ovaries):

a) fractional uterotonic drugs (oxytocin)

b) hemostatic agents (calcium gluconate, dicinone, ascorbic acid, vikasol)

c) restorative treatment (glucose solution, vitamin B6, B12, folic acid, cocarboxylase or ATP)

d) antianemic therapy (gemostimulin, ferroplex, blood transfusion when hemoglobin levels are below 70 g/l)

3. Herbal medicine (mastodinone, nettle extract, shepherd's purse, water pepper)

4. Physiotherapy: electrical stimulation of the cervix, electrophoresis of novocaine on the area of ​​the cervical sympathetic nodes, endonasal electrophoresis with vitamin B1, acupuncture, local hypothermia - treatment of the cervix with tampons with ether

5. Hormonal therapy - in the absence of effect from symptomatic therapy, heavy bleeding in the absence of anemia, and the presence of contraindications to diagnostic uterine curettage. Use combined estrogen-gestagen drugs containing ethinyl estradiol 50 mg/tab (anteovin, ovulene, lingeol, non-ovlon).

6. Therapeutic and diagnostic curettage of the uterus. Indications: profuse bleeding threatening the life and health of the girl; prolonged moderate bleeding that does not respond to conservative therapy; recurrent bleeding in the absence of effect from symptomatic and hormonal therapy; suspicion of adenomyosis; suspicion of organic pathology of the myometrium.

Further treatment depends on the data of histological examination: for endometrial hyperplasia or adenomyosis, pure gestagens (duphaston, Provera, Primolut-nor) are prescribed.

Prevention of relapses of JMC:

1. All girls undergo hormonal therapy to regulate the menstrual cycle:

a) hypoestrogenic type: combined estrogen-gestagen drugs (Logest, Noviket, Regulon)

b) hyperestrogenic type: gestagen drugs (Provera, Primolut-nor, Duphaston)

During the rehabilitation period after discontinuation of hormonal drugs - mastodinone or vitamin therapy: folic acid, vitamin E, glutamic acid, vitamin C.

2. For the purpose of immunocorrection for recurrent JMC, the prescription of licopid is indicated.

3. Organization of the correct regime of mental, physical labor and active rest, elimination of negative emotions, creation of physical and mental peace, normalization of body weight, balanced nutrition, etc.

4. Physiotherapy

5. Treatment of concomitant diseases.

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This topic belongs to the section:

Gynecology

Answers on gynecology. Department of Obstetrics and Gynecology. Women's consultation LCD. Textbook on obstetrics. Gynecological diseases, treatment and prevention.

This material includes sections:

Gynecological hospital

Organization of gynecological care for girls and adolescents

Clinical examination

Medical examinations

Ethics in medicine

Rehabilitation program

Physiotherapy

Methods for examining gynecological patients

Gynecological examination

The purpose of gynecological examination of girls and adolescents

Functional diagnostic tests

Diathermoexcision (diathermo- or electroconization) of the cervix