uterine bleeding - is any flow of blood from the uterine cavity, with the exception of generic and menstrual bleeding.Uterine bleeding as a symptom can accompany a lot like gynecological and extragenital pathologies or it can be an independent disease.
There abnormal uterine bleeding with no adjustment for age at any time in life.Approximately 3% of newborn girls in the first days of extrauterine life often appears bloody discharge from the genital tract of a physiological nature, it consists of dark incoagulated blood, mucus and independently stops after one or two days.Occurs in older women uterine bleeding almost always indicates a serious pathology.
The largest group consists of uterine bleeding due to menstrual dysfunction or dysfunctional uterine bleeding.They are not associated with anatomical abnormalities can occur with a certain periodicity (cyclical) or have an acyclic character.
Among dysfunctional uterine bleeding leading juvenile (teenage).Juvenile uterine
uterine bleeding in origin can be attributed to complicate pregnancy, childbirth or the postpartum period.Also, it sometimes provokes an ectopic pregnancy, abortion complications, tumors of the sexual sphere.
Diseases of the circulatory system, diseases of the heart and / or vascular and endocrine diseases often present among the causes of uterine bleeding in women with gynecological good health.
Among the causes uterine bleeding and present less serious factors: stress, fatigue, changes in the climate zone of residence, drastic weight loss (especially by artificial means).Incorrect use of hormonal contraception and drugs can provoke uterine bleeding.
simple and obvious clinical picture of abnormal uterine bleeding.Characterized by the appearance of bleeding from the genital tract of varying intensity and duration of the non-menstrual and non-physiological childbirth.Intensive abnormal uterine bleeding provoking anemia clinic, and can sometimes lead to serious consequences: the distortion of the cardiovascular system and hemorrhagic shock.
great variety of reasons uterine bleeding requires consistent diagnostic search, including a large inventory of research.Usually, the diagnosis is done in stages, when gradually, by process of elimination, performed diagnostic activities until the moment when the cause of significant bleeding is not there.
stop uterine bleeding is made according to his reason, and always taking into account the state of the patient.In emergency situations, when strong uterine bleeding endangered the life, the therapy in resuscitation, and after the restoration of the health of patients due to start searching for the causes of bleeding, produced further therapeutic tactics.
Causes uterine bleeding
uterine bleeding etiologically has a close relationship with age, the nature of the hormonal ovarian function, as well as the physical health of women.
uterine bleeding neonatal period is associated with "a crisis of sexual" - the process of adaptation of the girls born to "independent" life.After birth, the girls in the body remains a significant amount of maternal hormones, which decreases sharply after delivery.Peak hormonal decline occurs at the end of the first week of life, at the same time the infant may appear bloody vaginal discharge.They correspond to the norm, are themselves the most in two days and do not require outside intervention.
Juvenile uterine bleeding usually occur in the first two years after the onset of menarche.Their appearance is associated with the regulation of menstrual function imperfections or the effects of pathological course of pregnancy and childbirth.
have overcome puberty women uterine bleeding may have the following causes:
1. Pathology of pregnancy.Uterine bleeding in early (before 12 weeks) is caused by the timing of abortion, "frozen" pregnancy, molar pregnancy.In the later stages (after 12 weeks), uterine bleeding can cause the placenta if it is properly attached (predlezhit) to the uterine wall, or if it begins to flake off prematurely.
Pregnant uterine bleeding is not always linked to the disadvantage status of the fetus, or a threat of premature birth.Sometimes they appear as a result of the presence of erosion of the cervix, cervical polyp or banal mucosal injury.
2. Pathological delivery.Extensive birth injuries, delayed particles of the placenta in the uterus gave birth, a violation of the tone of the uterine wall (atonia and hypotonia) initiate uterine bleeding in women who have given birth.
3. abortion complications.The massive uterine bleeding may occur following mechanical trauma uterine wall.Also, post-procedural bleeding provoke not remote part of the fruit and / or membranes.
4. Ovarian dysfunction.Violation of rhythmic physiological sex steroid production by the ovaries leads to a change in the character of menstrual function, when it acquires the features of uterine bleeding.
5. Infectious and inflammatory changes in the genital organs, including infections provoked specific (usually gonorrhea).
6. benign: fibroids, polyps, ovarian tumors.
7. Extragenital ailments: diabetes, blood diseases and thyroid pathology of the liver and adrenal glands.
8. Hormonal Medications taken to therapy or contraception.
In women who have overcome the 45-year milestone, uterine bleeding in the lead in the list of gynecological ailments.Their occurrence is more often associated with physiological changes in the hormonal ovarian function.
Symptoms and signs of uterine bleeding
uterine bleeding - is the appearance of bleeding, treats women as atypical.
First, uterine bleeding must be distinguished from the physiological bleeding.Bleeding is considered "normal" if it:
- is menstruation;
- accompanies the birth process or processes associated with postpartum uterine involution;
- due to the mechanical removal of the endometrium (diagnostic curettage or abortion) or therapeutic and diagnostic procedures (such as cauterization of erosion, removal of intrauterine device, hysteroscopy).
physiological uterine bleeding distinguishes the trend toward self-extinction and lack of pathological causes.
According to the etiology of uterine bleeding, they are divided into dysfunctional (associated with menstrual dysfunction), organic (provoked by the pathology of genitals or neginekologicheskimi diseases), and iatrogenic.Iatrogenic uterine bleeding often occur after taking medicines that affect the hormonal system, blood clotting, or psycho-emotional sphere.
As a rule, the most popular complaints in the uterine bleeding are:
- bleeding from the genital tract in the intermenstrual period or background to delay the next menstruation;
- changes in menstrual bleeding patterns: menses may last too long or different unusually large blood loss;
- continuing bleeding after childbirth or abortion, often in combination with a high fever, intense pain and poor health;
- bleeding on the background extinction menstrual function during menopause, when periods start, "confused";
- sudden spotting (often meager) after menopause;
- general weakness, dizziness, malaise against the background of atypical uterine bleeding secretions (indicate anemia).
should be noted that the term "bleeding" is not associated with an amount of blood.Uterine bleeding can be both brief and scant, and long and abundant.
The cause of uterine bleeding is possible at the stage of discussions and a pelvic exam.This occurs when the cervical polyp visualized, extensive erosion on the neck or refer to existing uterine fibroids.
Laboratory diagnosis includes screening for infections (smear and culture) and the study of hormonal status.
ultrasound scan to determine the size and condition of the uterus and endometrium, fibroids or polyps are seen, as well as to detect structural changes in the ovaries.If
to determine the cause of uterine bleeding is required to examine the state of the endometrium, perform diagnostic biopsies, curettage or hysteroscopy.
uterine bleeding after childbirth, abortion and monthly
postpartum bleeding often associated with remaining in the uterine cavity parts of the placenta (afterbirth), hypo- and atony of the uterus with either placental polyp.
Physiological births involve complete detachment of the placenta from the uterine wall and its rejection of the fetus after birth.If the uterus after the birth is part of the placenta, its muscular wall can not fully cut and pinch uterine bleeding vessels.
reason for the delay units placenta often is it too tight attachment or increment its lobules to the uterine wall.After birth, they remain in the uterus and provoke uterine bleeding.
also a source of postpartum hemorrhage sometimes are not slices of the placenta, and its shell remaining in the uterus due to improper management of labor, or the presence of infection in the uterus.
foreign elements in the uterus after childbirth provoke not only a strong bleeding, they contribute to the infection.In case of infection to the abundant uterine bleeding join signs of acute inflammation: fever, severe pain, the admixture of pus in the mother separated.
Sometimes massive uterine bleeding have given birth appear after discharge from the hospital for 8 - 21 hours.
Usually, when properly administered by the separated birth the placenta carefully inspected for integrity.If there is a defect in the placenta (missing pieces), broken shell visible (or they do not exist), the fact that they set the delay in the uterine cavity.In this case, made manual inspection and emptying of the uterus.
process of childbirth is accompanied by intense stress on the muscular wall of the uterus.Sometimes, if there is a multiple pregnancy or polyhydramnios, uterine muscles are forced to reboot so that after delivery completely or partially loses its ability to restore the size of the uterus to prenatal indicators.Reduced whether the lack of uterine tone provokes postpartum uterine bleeding, they are called hypo or atonic.
similar mechanism of uterine bleeding after abortion is available.Bleeding after an abortion often associated with incorrect implementation of uterine evacuation procedure.If the uterine cavity is part of the fruit, it becomes the source of bleeding and infection of the uterus.
Strong uterine bleeding with clots and severe pain after an abortion on the background of a sharp deterioration of health may indicate perforation (puncture) uterine wall.
uterine bleeding after the next menstruation can have many causes, which may have a harmless cause or causes serious disease.Among these are more often:
- ovarian dysfunction;
- side effects from the beginning (first three months), hormonal contraceptives, or incorrect use (eg, abrupt withdrawal);
- ectopic pregnancy;
- uterine fibroids or cervical polyp;
- oncological gynecological pathology.
Dysfunctional uterine bleeding
considered dysfunctional uterine bleeding associated with the violation of the regulatory function of the pituitary and hypothalamus, where the absence of diseases of the uterus and appendages appear hormonal dysfunction, changing the menstrual cycle.Since the largest number of hormonal fluctuations accounted for the young (14 - 18) and premenopausal (18-45 years) age, the largest number of registered disfunktsionalnyh uterine bleeding among patients in these age groups.
Dysfunctional uterine bleeding are not uncommon and are diagnosed almost every fifth address to the gynecologist patient.
The normal menstrual cycle is divided into two equal phases separating the period of ovulation - the release of the mature egg outside the ovary.Ovulation is in the middle of the cycle.After oocyte leaves the ovary, in the place where it matures, forming the corpus luteum.
In the first phase of the menstrual dominated by estrogen, the second place is occupied by their progestins (progesterone).
Dysfunctional bleeding caused by hormonal secretion rhythm disturbances, as well as changes in the number of sex steroids.
Clinic dysfunctional bleeding is closely related to the presence or absence of ovulation, so they are divided into:
- ovulatory (ovulation is) in reproductive age;
- anovulatory (no ovulation) inherent in most young girls and women experiencing menopause.
Underlying all dysfunctional bleeding is menstrual disorders.It may take the following forms:
- «abnormal» heavy menstruation (regular or irregular), continuing more than a week;
- menstruation with a small (less than 20 days) or long (over 35 days) intervals;
- absence of menstruation more than six months, in the absence of pregnancy, lactation and menopause.
In the absence of ovulation, menstruation becomes irregular, they come with long delays.Typically, after a delay of one and a half month or two months, there is excessive bleeding that lasts longer than a week.There may be uterine bleeding with clots.A large amount of blood to accumulate in the uterine cavity, does not have time to evacuate in a timely manner and form clots - pieces of coagulated blood.The presence of blood clots also may indicate a violation of the coagulation system or to reduce the tone of the uterine wall (eg after childbirth or abortion).
regularly recurring significant blood loss often leads to a concomitant anemia.
Treatment of dysfunctional uterine bleeding involves a detailed diagnosis of their causes.It is necessary to determine which of the links in the hormonal regulation violations have occurred, to properly compensate them.
Treatment of uterine bleeding
Treatment options for uterine bleeding always involves a detailed study of their causes.
Postpartum uterine bleeding during the delay portions of the placenta or fetal membranes to stop the uterine cavity without revision impossible.After delivery, the uterus retains large size, and the cervix has not yet returned to its original size and freely passes the hand.Subject to all rules of antiseptic hand-made survey uterine cavity to find the "culprit" bleeding.Discovered by a fragment of the placenta or fetal membranes removed, and then carried out the prevention of infectious complications.
bleeding after abortion is associated with delayed fetal parts, was stopped by scraping the uterine cavity.
Juvenile uterine bleeding are treated in several stages.Originally produced hemostasis.If the bleeding is mild and the patient's condition is not violated, resort to symptomatic hemostasis.