From this article you will learn: what is uterine bleeding, the mechanism of development of pathology. Its distinctive features, the main reasons for the appearance. Characteristic symptoms and methods of diagnosis, treatment and prognosis for recovery.
The mechanism of development of uterine bleeding
Uterine bleeding is a gynecological complication with the main characteristic - the discharge of blood from the uterus, which occurs against the background of hormonal failures in the bodythese are dysfunctional bleeding) or changes in the structure of the uterine tissues( organic bleeding).
What happens in pathology? Under the influence of hormonal disorders( a deficiency or excess of progesterone, estrogen, a violation of the functions of the adrenal cortex, the thyroid gland), the inner layer of the uterus( endometrium) greatly increases in size. Since it is permeated with a variety of blood vessels, its increase, untimely and uneven rejection causes profuse dysfunctional bleeding( normally a small layer is excreted regularly, at the time of menstruation).
Blood supply to the female reproductive system. Click on photo to enlarge Surgical interventions, endocrine diseases, trauma lead to the appearance of structural changes in the uterus( scars, polyps, myom, oncology) and vascular pathology( weakness of the vascular walls).This combination becomes the cause of organic uterine bleeding.
This condition in 95% is a serious complication of the underlying pathology( myoma, liver disease), which is dangerous due to its consequences. Constant and unprofitable bleeding threatens the development of anemia( anemia), heavy blood loss( due to trauma, rupture) can lead to the removal of the uterus, hemorrhagic shock and death.
Acute uterine bleeding should be stopped, under conditions of surgical resuscitation or gynecological hospital( the number of deaths is 15%).
The prognosis of treatment of chronic uterine bleeding depends on the general hormonal background of the organism and accompanying diseases, usually this symptom can be eliminated completely, this is done by the attending physician-gynecologist.
Patients with pathology are registered for life.
Mechanism of development of uterine bleeding
Ovarian functions control the hypothalamic-pituitary brain system. For normal maturation of the fetal egg, its exit from the ovary, fertilization or excretion requires a whole list of hormones.
Physiology of the normal menstrual cycle. Click on the picture to enlarge Uterine bleeding develops with excess or insufficient production.
- FSH( follicle-stimulating) and LH( luteinizing) hormones are responsible for the formation of a yellow body( temporary gland of the ovary) and maturation of the follicle( an unfertilized ovum).With their insufficiency or excess, the follicle does not mature or ripen, but does not leave the ovary( there is no phase of ovulation).
- Since the phase of ovulation is absent, the yellow body is not formed or ripens( it is hormonal dependent processes).
- At this point in the body, the amount of progesterone( the hormone regulating the menstrual cycle and the operation of the ovaries) is reduced, but the amount of estrogen is increased( responsible for increasing the endometrium layer for the fertilized egg).
- Under the influence of hyperestrogenia, vascular disorders appear, the endometrium intensifies, unevenly, thickly and is irregularly excreted( cycle disturbances).
- Extraordinary rejection occurs in layers,( under the influence of progesterone compensation mechanisms and estrogen reduction) and is accompanied by bleeding from the remaining endometrium and open vessels in the uterine cavity.
- Prolonged hyperestrogenism is a risk factor and a trigger mechanism for the development of structural changes in the uterus, the appearance of polyps, fibroids, neoplasms. They begin to bleed when increased in volume, damaged or injured in any way.
- Structural( organic) bleeding includes damage due to mechanical rupture, decreased uterine tone, usually very abundant.
The nature of bleeding depends largely on the viscosity and speed of blood clotting, the ability of the vessels inside the uterus to contract. It can be plentiful, uninvited, stretched in time( up to several weeks), it can stop on its own, but it must be repeated after a while.
Causes of
Causes of uterine bleeding are hormonal disorders and organ structure changes.
The most common pathologies and conditions against which bleeding may occur:
| Bleeding type | Causes of |
|---|---|
| Bleeding against changes in tissue structure( organic) | Traumas due to medical procedures( abortion) Spontaneous abortion( miscarriage) or its threat Ectopic pregnancy Placenta abutment or defects in its location during pregnancy Pathological, severe labor Postpartum deformity, decrease( ) Endometriosis Polyps Myoma Cervical cancer Chorionepithelioma( neoplasm in the uterus) Liver diseases Vascular diseases( atherosclerosis, vasculitis) |
| Bleeding against hormonal disorders of the menstrual cycle regulation( dysfunctional) | Single cysts or polycystic ovary  Polycystic ovary. Click on the image to enlarge Thyroid Disease( thyrotoxicosis) Pituitary Diseases( Iscenco-Cushing's Disease) Infectious-inflammatory diseases( cervicitis, colpitis) Sexual infections( gonorrhea) Puberty Climax Use of oral contraceptives Nervous stress Avitaminosis, anemia Climate change |
At what age can bleeding occur?
Uterine dysfunctional bleeding due to hormonal disorders may appear:
- At the age of 12 to 18 years( juvenile, 20% of cases).Common causes of hormonal disorders during this period are stress, avitaminosis, poor nutrition, physical trauma, dysfunction of the thyroid gland, infectious diseases( measles, chickenpox, rubella).
- At the age of 18 to 45 years( reproductive, up to 5%).The cause of bleeding is inflammation( colpitis, cervicitis), stress, poor nutrition, oral contraceptives.
- At the age of 45 to 55 years( menopause, 15%), a regular decrease in the production of sex hormones, the development of benign( polyps) and malignant( cervical cancer) neoplasms leads to disorders.
Organic bleeding occurs in women of reproductive and menopausal age( in 95%), in children and adolescents, the most frequent cause is mechanical damage to tissues.
Symptoms of
Uterine bleeding of any kind is a dangerous symptom, their appearance is an occasion for treatment. Emergency treatment requires acute blood loss( sudden abundant discharge of blood), they are accompanied by severe symptoms( weakness, pressure drop, increased heart rate, loss of consciousness, ability to work), sometimes with sharp pains in the abdomen. In this case, human life depends on timely assistance.
In cases of uncommon but frequent bleeding, symptoms are not as pronounced, although weakness and progressive anemia gradually worsen the quality of life and impair ability. The patient develops fatigue, dizziness, and decreases blood pressure.
Bleeding is characterized by the release of any amount of blood( not necessarily abundant):
- between cycles or during menstruation;
- in the menopause, after a sustained absence of menstruation for more than 12 months;
- after medical procedures and delivery in combination with high fever and abdominal pain.
Characteristics of uterine bleeding:
- blood separation;
- lowering blood pressure;
- increased heart rate;
- weakness;
- increased fatigue;
- drowsiness;
- dizziness;
- headaches;
- pallor of the skin.
With a large loss of blood, the main symptoms change fast enough, the condition is complicated by loss of consciousness, hemorrhagic shock. With prolonged, unceasing bleeding( after abortion) in combination with a high temperature( up to 40 ° C) and severe abdominal pain, purulent postoperative complications and sepsis( common purulent infection) may develop.
Small uterine bleeding slowly leads to the development of iron deficiency anemia. After a decrease in hemoglobin less than 50 G / L, the condition is complicated by metabolic and gas exchange disorders, the development of heart failure and other pathologies.
Symptoms of anemia Simultaneously, the underlying disease progresses, against which bleeding arose as a symptom, leading to the appearance of polyps, fibroids, other neoplasms. But the most life-threatening complication is the danger of acute blood loss.
How to distinguish from menstruation
How to distinguish between uterine bleeding from menstruation, especially if the discharge coincided with the cycle:
- The cyclicity of menstruation is disrupted.
- Gaps between bleedings increase( up to 1.5 months) or decrease( less than 20 days).
- Allocations can be abundant or moderately copious, scarce.
- Lasts for more than 7 days.
- With bloody discharge, large pieces of the endometrium are removed.
| Signs of acute uterine bleeding | Condition accompanied by |
|---|---|
| Sudden profuse blood loss in a short period of time Blood has a bright scarlet( arterial) or dark color( venous) | Severe weakness Pale Sudden drowsiness Dizziness Lowering blood pressure Tachycardia( heart palpitations) Losing consciousness |
The result can be a hemorrhagic shock( due to loss of blood), and if you do not stop the blood on time - death in the rezltate blood loss.
Diagnostics
To diagnose the pathology that caused the appearance of uterine bleeding, sometimes a whole range of methods is needed:
The gynecologist collects information about the pathology and performs an external examination, the history of the disease includes information:
- on the cycling of menstruation;
- start and end date of the last monthly;
- on physical development and age;
- results of consultation of endocrinologist, neurologist.
To confirm the diagnosis:
- using ultrasound( ultrasound) of the pelvic organs and hysteroscopy draw conclusions about the condition of the ovaries and the inner layer of the uterus - the endometrium, identify associated pathologies( myoma, polyps), control the process of ovulation;
- to determine the size of the ovaries in the period between monthly appoint echogram;
- makes a graph of the basal temperature( changes in body temperature due to the effect of production of sex hormones throughout the cycle);
- to exclude the pathology of the pituitary and hypothalamus, produce echoencephalography, radiography, MRI or CT of the brain;
- with ultrasound check the condition of the adrenal and thyroid gland;
- in the laboratory check the hormonal profile( donate blood to LH, FSH, estrogen, progesterone, prolactin);
- determine the level of other hormones( TSH, T3, T4, cortisol, testosterone);
- total blood counts( hemoglobin, number of leukocytes);
- coagulation factors( prothrombin index, coagulogram, platelet count in blood formula, bleeding time and coagulability);
- smear analysis from the vagina and cervix for the presence of an inflammatory process, pathogenic microflora or cancer cells;
- part of the endometrium is examined for the presence of cancer cells.
Based on these studies, a conclusion is made about the causes of uterine bleeding in women.
ultrasound of the pelvic organs. Click on the image to enlarge Treatment methods
Bleeding can be stopped, it is vital, especially when blood loss is acute and life threatening, in 85% of cases it can be done( in 15% the pathology ends in a lethal outcome).
Treatment of any bleeding is performed in a hospital, acute blood loss requires emergency measures to provide first aid and call "Unexpected".
Objectives:
- Stop the blood.
- Restore blood loss.
- Eliminate the cause of the symptom.
- Prevent recurrence of bleeding.
We use medical therapy, infusion methods of blood volume recovery and surgical methods, the latter are used in case the bleeding does not stop with medications.
How to provide first aid
How to help before the arrival of physicians:
| What can not be done | What to do |
|---|---|
| Stand, sit, lie on your side with your knees pulled up to the chin( in the "embryo" position) | Lay the patient exactly, on his back, without a pillowunder the head |
| Make warm baths and syringings | Place a roller under the feet, slightly lifting them( 30-45 cm from the surface) |
| Apply a hot water bottle to the stomach | Put a plastic bottle, ice-warmer or ice water on the area of the uterus. |
| Peteь hot drinks | Provide copious cold drink( still water, sweet tea, dogrose broth) |
| Take medication without consulting a doctor |
Drug therapy
| etamzilate, dicinone, aminocaproic acid, oxytocin, menadione | Increase blood clotting and platelet count, affect the tone of the uterine walls, cause it to contract, eliminate bleeding | ||
| Progesterone preparations | Norethisterone, levonorgestrel | Increase the amount of progesterone, stop bleeding with ineffectiveness of homeostatic drugs | |
| Oral contraceptives and gestagens | Dydrogesterone, zhanin, regulon | Contain estrogen and progestogen combinations, stop bleeding more slowly than progesterone preparations, therefore, they are more often used to prevent the recurrence( recurrence) of | |
| Vitamins | Routin( R), ascorbic, folic acid( B9), other vitamins of group B( B6, B12) | Increase the tone and strengthen the vessels | |
| Preparations of iron | Maltofer, totem, tardiferon, | Restore hemoglobin level |
Causes and treatment of uterine cronesThe waxes are directly dependent on each other: by identifying and curing the underlying disease, you can get rid of life-threatening consequences forever.
Infusion methods
Infusion methods( transfusion) are used to restore the volume of lost fluid, the number of erythrocytes and platelets.
| The name of the tool | The effect of |
|---|---|
| Trisol, acesol, haemodesis | Increase the fluid volume in the body, restore the electrolyte balance, prevent hypovolemic shock( from fluid loss) |
| Washed red blood cells and blood plasma | Quickly restore the amount of red blood cells and fluids neededfor normal gas exchange and blood supply |
| Donor platelets | Helps restore blood coagulation factors |
Surgical treatment methods
imenyayut if failed to stop uterine bleeding in other ways( the patient's condition deteriorates, the hemoglobin falls below 70 g / l, the volume of blood decreases rapidly).
Procedures are performed on a gynecological chair, local or general anesthesia is allowed. With the help of gynecological instruments( dilators), the access to the uterine cavity is opened, before the operation the condition of the inner layer is determined with the aid of a hysteroscope( an optical device in the tube that is inserted into the uterine cavity).
| Method name | How the |
|---|---|
| is performed How to remove the uterus cavity | Remove the endometrial layer in the uterine cavity by scraping with a special device( curette) |
| Cryodestruction( destruction of tissues by cold exposure) | Endometrium is treated with liquid nitrogen using a special device - cryodestructor |
| Laser ablation( burning) | Endometrium is destroyed by inserting into the uterine cavity a device with a radiation source |
Prophylaxis of
Prophylaxis of rebleeding consists of observingSeveral rules:
- mandatory elimination of the underlying cause of the symptom;
- regular examination( at least 2 times a year);
- appeals to the gynecologist when there are any changes in the menstrual cycle and other alarming signs;
- administration and administration of oral contraceptives only on the advice and under the supervision of the attending physician;
- pregnancy planning;
- a healthy diet and lifestyle;
- eliminate stressful situations.
Forecast
In 85% of cases, bleeding is stopped by drugs with medication for a period of 3 to 7 days, surgical methods allow it to be done almost immediately, only residual effects remain( 2-3 small bleeding) by 2-3.
15% of bleeding can not be stopped, and they end in a lethal outcome. This is due to a combination of numerous factors and the causes of the appearance of a symptom( a long-progressing underlying disease, concomitant pathologies, development of malignant complications, late treatment).
Bleeding is one of the most common gynecological pathologies( from 20%), the most common are menopausal women( 15%) and girls of juvenile age( 12-18 years, 20%).
