Uterine bleeding is abundant abnormal bleeding from the uterus. In medicine, they are called dysfunctional, as they are the most prominent evidence of hormonal disorders in women.
- in the period of sexual development or juvenile age (12-18 years),
- reproductive age (18-45 years),
- period of extinction of ovarian function (menopausal period - 45-55 years).
The development of this pathology is due to a number of reasons that determine several types of uterine bleeding: dysfunctional, organic, and such that are due to systemic diseases (diseases of the kidneys, liver, blood, thyroid gland).
Dysfunctional uterine bleeding is characterized by an excessively abundant and prolonged discharge, caused by a violation of the hormonal regulation of the menstrual cycle. In turn, they are divided into ovulatory and anovulatory.
Ovulatory uterine bleeding is characterized by the preservation of ovulation, as well as shortening or lengthening the gap between menstruation. This condition occurs most often against the background of inflammatory diseases of the genital organs or adhesions in the pelvis. Often before and after menstruation, as well as in the middle of the menstrual cycle, spotting is noted. Since ovulatory bleeding occurs most often in women of childbearing age, they are accompanied by miscarriage and infertility.
Anovulatory uterine bleeding is characterized by the absence of ovulation, which during a long period of existence can lead to the development of hyperplasia, fibroids, endometriosis, and even endometrial cancer. This pathology most often occurs in premenopause (premenopausal period).
Organic uterine bleeding is associated with diseases such as endometrial polyp, uterine fibroids, endometriosis, inflammatory diseases of the uterus and appendages, cancer of the body of the uterus or cervix. This type of disease is chronic in nature and is characterized by the occurrence of bleeding of varying intensity and duration on any day of the menstrual cycle.
Causes of uterine bleeding
Risk factors for the development of dysfunctional uterine bleeding in different periods of a woman’s life depend on her age.
At the age of 12-18 years, uterine bleeding is caused by a violation of hormonal regulation at the stage of its formation for a number of reasons:
- physical or mental trauma,
- dysfunction of the thyroid gland and adrenal glands,
- malnutrition, hypovitaminosis,
- the consequences of a complicated course of pregnancy and pathological delivery,
- history of pubertal childhood infectious diseases: whooping cough, mumps, measles, chickenpox, chronic tonsillitis, influenza, etc.,
- sometimes tuberculosis of the female genital organs or bleeding disorders.
In reproductive age, uterine bleeding is observed less frequently and is accompanied by ovarian dysfunction. This happens for the following reasons:
- overwork, chronic neuropsychic tension, stressful situations,
- ovarian tumors,
- endometriosis of the uterus, chronic endometritis,
- malignant tumors and polyps of the uterus and cervix,
- climate change,
- uterine fibroids,
- violation of the functions of the hypothalamus-pituitary caused by the use of certain drugs,
- ectopic pregnancy, miscarriages, medical or surgical abortion,
- poor environmental conditions in the place of permanent residence, harmful working conditions,
- various infectious and inflammatory diseases of the female reproductive system.
Most often, uterine bleeding occurs in women in the period of premenopause, which is caused by a natural decrease in gonadotropins, which are secreted by the pituitary gland. In this regard, the menopausal period is accompanied by an irregular release of hormones, which leads to a violation of the ovulatory cycle, folliculogenesis, the development of the corpus luteum.
The occurrence of uterine bleeding at the age of 45-55 years indicates the absence of other pathologies that can cause them. In this case, the causes of uterine bleeding include:
- uterine myoma,
- uterine polyps,
- hormonal ovarian tumors.
Uterine hemorrhages are expressed by metrorrhagia, acyclic bleeding, an increase in the duration of menstruation and the amount of secretions secreted.
Since uterine bleeding is essentially similar to menstruation, every woman should be able to recognize the symptoms of blood loss. Pathological bleeding can be determined by the following symptoms:
- lasting for more than a week abundant discharge with signs of anemia: low blood pressure, fatigue, weakness, pallor of the skin, headaches, dizziness,
- the presence in the discharge of a large number of blood clots,
- the degree of profusion is so high that the lining gets wet for an hour, and a woman often feels fatigued, and even unable to go to work,
- the bleeding is accompanied by severe lower abdominal pain and pulling pain in the lumbar region,
- bleeding after intercourse is also a sign of uterine bleeding.
In women of reproductive age, detection of uterine bleeding begins with curettage of the walls of the uterus and cervical canal. The resulting scraping is sent for histological examination. This procedure is not only diagnostic, but also has a healing effect, since it removes the defective endometrial layer, blood clots, and the reduction of the uterine muscles helps to stop bleeding.
Additional diagnostic methods include:
Regardless of the age of the woman, the treatment of uterine bleeding has the following objectives:
- stopping bleeding and blood loss replacement,
- elimination of the cause of this condition,
- rehabilitation of patients.
With severe uterine bleeding, the patient must be given first emergency help, which is to stop the bleeding. It comes down to injections of contraction and hemostatic drugs, the introduction of tampons soaked in with special medicines, or emergency scraping. Minor bleeding stops as therapy progresses.
How to stop uterine bleeding
To stop uterine bleeding before the arrival of the doctor can be as follows. A woman must be laid on a hard, flat, horizontal surface. She should put a pillow under her feet, and put a hot water bottle or ice pack on her stomach. It is strictly forbidden to warm the lower abdomen.
As a first aid for uterine bleeding, Tranexam is used, which contributes to the rapid cessation of bleeding and the dissolution of blood clots. Depending on the activity of uterine bleeding, Tranexam is used either in the form of tablets or in the form of intravenous injections.
The following drugs and hemostatic agents are recommended for the urgent symptomatic treatment of uterine bleeding: Dition, Vikasol, Etamzilat, calcium supplements, aminocaproic acid. The use of Dietz and Vikasol in uterine bleeding contributes to the increase in blood clotting, and also prevents bleeding and improves blood circulation and blood circulation.
Any bleeding from the genital organs, which is different from normal menstruation, should alert the woman and give rise to a gynecologist. Be extremely attentive to your health!
Age causes of uterine bleeding
During certain periods of a woman’s life, bleeding can occur for a variety of reasons. Therefore, they need to be considered separately.
So, the bulk of gynecological pathologies in girls and girls 12-18 years of age is associated with a violation of the regulation of hormones. The provoking factors of this state are very different:
- Physical, moral injury.
- Dysfunction of the thyroid gland, pathology of the adrenal cortex.
- Children's infectious diseases (flu, mumps, measles, chickenpox, chronic tonsillitis, etc.).
- Complicated during pregnancy and difficult delivery to the mother.
- Tuberculosis of the genital organs.
- Blood coagulation disorders.
In women of childbearing age, bleeding in women is uterine, mainly associated with dysfunction of the ovaries. The cause of ovarian dysfunction may be:
- General overwork, stress, constant neuropsychic tension.
- Unfavorable living conditions (regions with developed metallurgical, mining, chemical industry).
- Occupational harm.
- Climate change.
- Various infectious and inflammatory diseases of the female genital sphere.
- Uterine fibroids.
- Ovarian tumors.
- Malignant and benign tumors on the cervix and in the uterus itself.
- Ectopic pregnancy.
- Medical or surgical abortion, curettage.
- Medications that lead to dysfunction of the pituitary and hypothalamus.
As a percentage of other gynecological diseases, uterine bleeding is the most common pathology in women of premenopausal and menopausal age.
This is due to the extinction of the functions of the pituitary gland. There is a gradual decrease in the production of pituitary gonadotropins, the release of hormones, respectively, becomes irregular, with the result that the cyclical nature of ovulation is disturbed, folliculogenesis develops, the corpus luteum increases.
Particularly often uterine bleeding is observed in menopausal syndrome, when the symptoms of menopause in women are most pronounced. This is explained by the fact that during this period the deficiency of the hormone progesterone is especially acute, resulting in the growth of the endometrium and hyperestrogenism.
At the slightest suspicion of bleeding during menstruation, in the middle of the cycle, during the period of childbearing, during menopause, the woman is obliged to consult a gynecologist without delay.
Only timely detection of any pathology, accurate identification of their causes and adequate treatment will help to avoid serious health problems.
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How to independently determine uterine bleeding - symptoms of blood loss
At any age, a characteristic symptom of bleeding in a woman is prolonged heavy discharge, lasting more than a week with signs of anemia, confirmed by a blood test and the following symptoms:
- Weakness, fatigue
- Dizziness, headaches
- Paleness of the skin
- Hypotension - low blood pressure
- What it means copious discharge is when a tampon is filled or the pads get soaked in an hour, if you have to change the pads even at night. Sometimes a woman is not able to go to work, can not do household chores, and most of the time is forced to lie down and rest.
- In addition to intensity, bleeding discharge is characterized by the presence of a significant number of blood clots.
- Bleeding is also considered the release of blood after sexual intercourse.
- If menstruation lasts more than a week with significant lower abdominal pain and lower back pain.
Uterine bleeding at the age of 12-18
In this period, uterine bleeding appears in almost 20% of all gynecological pathologies in girls, this is due to a violation of the formation of hormonal regulation for a number of reasons:
- Mental or physical injuries are provoking factors.
- Hypovitaminosis, malnutrition
- Impaired function of the adrenal cortex and thyroid gland
- Various serious childhood infectious diseases also affect the appearance of signs of uterine bleeding in adolescent girls - influenza, chronic tonsillitis, chickenpox, measles (see symptoms of measles in adults), mumps, whooping cough (signs of whooping cough in a child), etc.
- If the girl was born to a mother with a complicated course of pregnancy and pathological childbirth.
- Rarely, but there are cases when bleeding disorders are caused by bleeding disorders or tuberculosis of the female genital organs.
Uterine bleeding menopause
This is the most common pathology that occurs in women during the premenopausal period - 15% among all gynecological diseases of this age category. This is due to the natural decrease in gonadotropins secreted by the pituitary gland, therefore, during the period of menopause, the release of hormones occurs irregularly, disrupting the cycle of ovulation, the development of the corpus luteum, folliculogenesis. Particularly often, uterine bleeding is accompanied by menopausal syndrome - in 30% of cases, when the signs of menopause in women are marked and intense. With a progesterone deficiency characteristic of menopause, hyperestrogenism and growth of the endometrium develops.
If a woman at the age of 45-55 has uterine bleeding, other pathologies that can cause them should be excluded, so the woman should be hysteroscopy twice - before and after diagnostic curettage. The most common causes of uterine bleeding in this case are:
- Uterine myoma
- Uterus polyps
- Rarely - hormone-active ovarian tumors
Common causes of uterine bleeding
- Thyroid dysfunction - with diseases such as hyperthyroidism and hypothyroidism, the risk of uterine bleeding symptoms increases.
- Violation of hormonal levels. This is the most common cause of uterine bleeding in young girls and women after 45 years. With a normal hormonal background, when the balance between progesterone and estrogen is optimal, blood loss during menstruation is usually minimal. When this imbalance is broken, uterine bleeding occurs.
- Diseases of the circulatory system. With a decrease in platelet levels, as well as with other blood diseases, bleeding in women is also possible.
- Uterine fibroids. Especially heavy bleeding opens in women with internal uterine myoma, when the only way out is surgery.
- Adenomyosis. This disease is characterized by splicing of the inner and muscular layer of the uterus, menstruation with adenomyosis becomes painful, long and abundant, since the menstruating area increases significantly.
- Polyps. These are benign formations that often occur in women of childbearing age. With a significant number or size, their removal is indicated, since they are the cause of uterine bleeding and painful menstruation.
- Ectopic pregnancy, miscarriage, premature detachment of the placenta. These complications during pregnancy have recently become quite common in women. In case of any bleeding during pregnancy, a woman should immediately call an “Ambulance”, because the bleeding can threaten the life of not only the baby, but also the expectant mother.
- Malignant neoplasms of the genital organs. This is the most serious cause of possible bleeding, and regardless of the localization of the tumor - the uterus, cervix, ovaries, for any bleeding a woman should first of all exclude cancer, because nowadays cancer tension increases with each passing year and no longer has clear age limits. Oncology is found in very young women as well as in menopausal women.
- Breakthrough uterine bleeding. This reason is directly related to the use of intrauterine contraceptives - coils or taking hormonal contraceptives. Especially increases the risk of bleeding after a simultaneous intake and contraceptives, and anticoagulants (aspirin). Breakthrough bleeding may be minor, at the beginning of the use of hormonal contraceptives, as an adaptation to the drug. In these cases, you should review the dosage or cancel the drug, if this does not help, then you should look for another cause of uterine bleeding. Also, blood loss occurs on the background of damage to the uterus intrauterine device, while it should be removed as soon as possible.
If something unusual occurs during menstruation, in the middle of the cycle, during pregnancy or during the premenopausal period, at the slightest suspicion of incipient bleeding, the woman should immediately consult her gynecologist for advice, examination and determination of the true cause of uterine bleeding, since only knowing the exact diagnosis can begin adequate and timely treatment.
For emergency symptomatic treatment of uterine bleeding, experts recommend the following hemostatic agents: etamzilat, vikasol, dicinone, aminocaproic acid, calcium supplements.
Briefly about the physiology of the menstrual cycle
For a simplified understanding of this complex system, the regulation of the cycle can be compared to a five-story building, where each lower floor submits to an upper floor, but it is absolutely clear that the upper floor cannot function independently without its “subordinates.” Such a comparison reflects the main principle: the existence of direct and inverse links between all levels of regulation.
So, on the first "floor of the building" is the uterus.That it is the main executive body and is subject to the influence of all higher levels. Now it becomes clear that uterine bleeding is a symptom that can appear if there is a violation at any level. And this means that effective treatment should be carried out not only with hemostatic preparations, which in essence is a struggle with the consequence. The most important thing is to find the cause.
- We rise above the "second floor": here are the ovaries. They are an endocrine gland and produce a large amount of hormones: estrogens, progesterone, androgens. Estrogens predominate in the first phase of the cycle, and progesterone in the second. However, the ovaries are also not autonomous and are subject to the regulation levels above.
- On the “third floor” is the pituitary gland, which produces:
- follicle-stimulating hormone (FSH) - responsible for the maturation processes of the dominant follicle in the ovaries,
- luteinizing hormone (LH) - its peak causes ovulation (the release of an egg) in the ovaries.
- The “fourth floor” is occupied by the hypothalamus. The so-called "liberins" stimulate the pituitary gland, and the "statins" - on the contrary, suppress the production of hormones. In addition, for the normal functioning of the reproductive system is important cyclical hormones in the blood. Numerous studies prove that normal hormones of the hypothalamus enter the bloodstream every hour.
- And finally, the "fifth floor" rightfully occupies the bark of the big hemispheres, that is, the central nervous system. And this means that any stress, difficult situations that occur to us - all this affects the regulation of the menstrual cycle. This explains the cause of bleeding in women under stress.
Depending on the age factor:
- Juvenile - occur in adolescent girls, ranging from the age of menarche (first menstruation) to 18 years.
- Reproductive age is typical for women over 18 and up to the time of menopause.
- Climacteric - occur in women who are in the menopausal period.
In relation to pregnancy:
- Uterine bleeding during pregnancy:
- in the first trimester (up to 12 weeks)
- in the II trimester (from 13 to 26 weeks),
- in the third trimester (from 27 to 40 weeks).
- Postpartum hemorrhage:
- in the early postpartum period (within 2 hours after birth),
- in the late postpartum period (for 42 days after delivery).
Juvenile bleeding is the result of a violation of the hormonal regulation of the menstrual cycle in girls. The main problem is that girls rarely go to a gynecologist for many reasons with this problem:
- Feel free to tell parents about cycle violations,
- It is a mistake to think that menstruation will become regular after a while. However, many studies have been conducted on the basis of which it can be concluded: in the absence of treatment of cycle disorders in the pubertal period, persistent abnormal changes in the menstrual and, most importantly, in the reproductive function of the female body continue to develop.
- Girls confuse menstruation with uterine bleeding.
How to distinguish normal menstruation from bleeding in the menstrual period?
Criteria for normal menstruation:
- The duration of the menstrual period does not exceed 7 days,
- The volume of blood lost does not exceed 80 ml
- Menstrual blood should not be present. abundant blood clots.
At first glance, fairly simple and clear criteria, but to calculate the loss of blood in milliliters is not always possible. In addition, the system for assessing blood loss by visual method is very subjective and fraught with many errors. Even experienced doctors can not always determine the amount of blood loss "by eye", so for young girls it is very difficult.
For this reason, according to statistics, about 20% of uterine bleeding is mistaken for menstruation, which means that every fifth girl from this risk group is subject to prolonged chronic blood loss (anemization).
In this connection, a completely fair question arises: by what other signs can pathological blood loss be distinguished from physiological?
Typically, these girls have characteristic symptoms:
- Pale skin,
- Brittle, dry hair,
- Dull nails,
- Expressed weakness, fatigue,
- Reduced performance
- Fainting may occur,
Causes and treatment of uterine bleeding in girls
The main reason for such violations of the menstrual cycle is to change the hormonal status, namely:
- Disruption of the production of progesterone hormone by the ovaries,
- Changing the ratio of pituitary hormones (increased follicle-stimulating hormone (FSH) and reduced luteinizing hormone (LH). Insufficient LH levels also lead to the fact that ovulation does not occur,
- Excessive estrogen in the body,
- Pathology of the thyroid gland, adrenal glands.
Important! For the full functioning of the female reproductive system is important not only the quantitative content of hormones (their concentration in the blood), but also the ratio of one to another. In other words, if according to the results of the study, the concentration of sex hormones fit into the physiological norm, then this does not indicate complete well-being. For this reason, only a doctor can properly evaluate the results of laboratory tests.
In addition, the causes of uterine bleeding are also:
- Blood coagulation disorders (thrombocytopathy, von Willebrand disease, hemorrhagic vasculitis, thrombocytopenic purpura),
- Various malformations of the uterus,
- Adenomyosis is manifested by prolonged menstrual bleeding, which is accompanied by severe pain in the lower abdomen,
- Oncological diseases of the blood (leukemia),
- Ovarian cysts,
- Pituitary tumors,
- Inflammatory diseases of the female genital organs sometimes lead to uterine bleeding,
- Increased endometrial thickness or polyp in the uterine cavity.
Treatment methods for juvenile uterine bleeding
Treatment should be primarily aimed at:
- Stop bleeding as soon as possible,
- Treatment of anemia with high blood loss,
- Elimination of the very cause of bleeding in order to prevent the recurrence of this situation.
Unfortunately, sometimes the treatment stops on the first two points, and until the cause is clarified, the case never comes. But this is fundamentally wrong, since it is useless to struggle solely with the consequence. In addition, the lack of treatment of the cause itself leads not only to the risk of recurrent bleeding, but also to reproductive impairment in the future.
Hemostatic agents include:
Drugs that affect the blood coagulation system. The drug “Tranexam” (“Tranexamic acid”) has proven itself very well. It is especially important that it can be used for almost all causes of bleeding. With a strong blood loss, it is necessary to inject the drug intravenously in a dilution diluted with saline. The hemostatic activity of Tranexam is very high and lasts for 17 hours after administration of the drug. In the future, if you stop bleeding and continuing bleeding, you can switch to the tablet form of this drug. Aminocaproic acid has a similar effect as Tranex. However, numerous studies have shown that the effectiveness of Tranexam is several times greater.
- Calcium chloride solution 10% is also effective for uterine bleeding. It can be administered intravenously (slowly!), Or in the form of a drip infusion with saline. It is strictly impossible to prick intramuscularly this drug, as it can cause muscle tissue necrosis.
- Drugs that contribute to the reduction of the uterus, such as "Oxytocin". Due to the contraction of the muscle fibers of the uterus, a spasm of the blood vessels occurs, and as a result the bleeding stops.
- Strengthen the vascular wall can be a drug such as "Ascroturin."
- Special attention should be paid to such a method of uterine bleeding as the use of hormonal drugs. In case of heavy bleeding, the following scheme is effective: administration of 2-3 pills of combined oral contraceptives (Marvelon, Regulon) on the first day, and 1 tablet for 21 days in the following days.
- The introduction of fresh frozen plasma for uterine bleeding is also justified. Especially if, according to laboratory tests, there are signs of a violation of the blood coagulation system.
Treatment of complications of uterine bleeding, such as anemia:
- In severe anemia, when hemoglobin is less than 59 g / l, it is impossible to do without red cell transfusion.
- Effectively increase the level of hemoglobin intravenous iron preparations, such as "Likferr", "Venofer", "Argeferr", "Ferrigekt." Infusion 1 pack of these drugs is enough to increase hemoglobin by 20-30 g / l over a fast period of time. Their only drawback is the high price.
- In case of mild anemia, it is enough to do with tablets (“Sorbifer”, “Ferrum-lek”, “Ferro-Folgamma”, “Fenüls”, “Maltofer”).
- In parallel with the use of iron preparations, it is possible to take vitamins of group B. The alternation scheme of intramuscular injections of vitamins B6 (Pyridoxine Chloride) and B12 (Cyancobalamin) every other day is most effective.
- Do not forget about the diet: eating meat, liver, apples, plums, carrots, beets.
Stage three - elimination of the cause of bleeding:
- When a pathology of the blood system is detected, a consultation with a hematologist is necessary, and, if necessary, continued treatment in the hematology department.
When proven hormonal disorders can be prescribed combined oral contraceptives for 3 months.
- When progesterone deficiency must be taken in the second phase of the menstrual cycle "Duphaston" for 3-6 months.
- For functional disorders at the level of the hypothalamus, it is enough to adhere to vitamin therapy, and also to undergo a course of endonasal electrophoresis with vitamin B1 for the correction of the cycle. It is also effective prescription drugs "Glycine", "Nootropil", "Asparkam" for the normalization of metabolic processes in the central nervous system.
- If the girl had a psychological trauma or stress, it is advisable to consult a psychologist.
- When confirming the diagnosis of "adenomyosis", treatment of this pathology is necessary.
During all three stages of treatment, practically in 90% of girls, normal menstrual function is completely restored during the first year, as well as episodes of recurrent uterine bleeding.
Uterine bleeding in women of reproductive age
According to statistics every third woman had uterine bleeding at least once in her life. This means that the study of this problem should be given due attention.
- Violations of the hormonal status. Changes at any level of the menstrual cycle can cause bleeding,
- Endometriosis, in particular - adenomyosis. This disease is the introduction of endometrioid cells in the muscle wall of the uterus, which significantly reduces its contractility, as well as causes pain. A distinctive feature of this pathology is the appearance of bleeding after menstruation or in front of them,
Blood coagulation defects,
- Endometrial pathology (hyperplasia). If the thickness of the inner lining of the uterus exceeds 14 mm, then we can speak of hyperplasia. This is one of the most common causes of bleeding,
- Polyp cavity of the uterus. This formation is detected, as a rule, when conducting ultrasound,
- Myomatous nodes (especially those that grow towards the uterus, they are called submucous). Currently there is a tendency to increase the number of women with uterine myoma. Moreover, the disease is “younger”, which means that it is no longer a rarity of large uterus in very young girls, 19-20 years old. A certain contribution to the development of this disease is an imbalance of estrogen and progesterone in the body,
- The intrauterine device can also cause bleeding, especially if it is not positioned correctly in the uterus.
- A complete or incomplete spontaneous abortion,
- An ectopic pregnancy can also cause uterine bleeding.
Principles of treatment
Given the variety of causes of bleeding in women of reproductive age, for proper treatment it is first necessary to conduct a thorough diagnosis.
- With hormonal disorders it is necessary to make a correction. For progesterone deficiency, use replacement therapy with Duphaston.
- When functional disorders it is enough to carry out treatment with hemostatic drugs (“Tranexam”, “Aminocaproic acid”, “Etamzilat”), and then take vitamins according to the cycle: in the first phase (from 5 to 15 days) folic acid of 1t. 2 times a day, vitamin C 0.5 mg 2 times a day, in the second phase of the cycle (from 16 to 28 days) vitamin E and 1 caps. 1 per day. A course of physiotherapy can be added to the treatment: magnetic therapy on the area of the uterus, as well as endonasal electrophoresis with thiamine (vitamin B1).
- If the diagnosis of adenomyosis is confirmed, then after hemostatic drugs it is necessary to treat this pathology.
- In the presence of endometrial hyperplasia and a polyp in the uterine cavity, it is necessary to perform a surgical stop of bleeding, namely: therapeutic and diagnostic curettage of the uterus cavity. This method is good because it effectively stops the bleeding, and also the obtained histological preparation (scraping from the uterus cavity) is sent for research to cytomorphologists. Based on the data obtained, the doctor may prescribe a specific treatment.
types of uterine myomas
With submucous myoma of the uterus It also sometimes helps to stop the bleeding from curettage of the uterus. But with a large size of the node, which deforms the uterine cavity, urgent surgical intervention is necessary. However, despite many fears, this operation is not always performed by open laparotomic access (with an abdominal incision). If the myoma node is not very large and is located “on the leg”, then this surgical intervention can be performed using a hysteroresectoscope. This tool is an optical camera with a cutting loop. The hysteroresectoscope is inserted into the uterine cavity by vaginal access and under visual control (the image from the camera in the uterus is displayed on a large monitor), the doctor cuts off the myoma node. This method is very effective, and most importantly, the recovery period of the patient after surgery is very short. However, sometimes an open operation is still required to remove nodes. The scope of surgery is determined by the attending physician. For women of reproductive age, obstetrician-gynecologists try to do with organ-preserving operations in order to leave the opportunity to have a child in the future.
The main principle of treatment of uterine bleeding in women of reproductive age is the preservation of its childbearing and menstrual function.
Bleeding during pregnancy
Obstetric bleeding to this day is one of the main causes of maternal mortality. Несмотря на развитие новых методов диагностики и лечения, этих кровотечений не удается полностью избежать даже в самых лучших клиниках и перинатальных центрах.
Причины кровотечений при беременности:
- Chorion detachment (early) or placental detachment,
- Antiphospholipid syndrome,
- Hellp syndrome
- Disorders of the blood coagulation system of a pregnant woman,
- Threatening spontaneous abortion,
- Started or accomplished uterine rupture.
Treatment of obstetric hemorrhages is a difficult task for the doctor, since many factors influence tactics: fetal condition, gestational age, is there a threat to the mother’s life, the amount of bleeding, etc.
The basic principles of treatment:
In the early stages of pregnancy with chorionic detachment, the hormonal drug Duphaston is effective. In case of placental abruption, the volume of bleeding plays a large role: with minor and moderate bleeding, doctors try to keep the pregnancy. For this purpose, hemostatic agents are administered (Tranexam, Dicynon). In case of severe bleeding, signs of fetal hypoxia, emergency surgery is necessary. The earlier a cesarean section is performed, the more chances there are to save two lives: mother and child.
Important! Bleeding during pregnancy is an extremely unfavorable symptom. Only a doctor should provide expert assistance in such a situation; there should be no methods of treating folk remedies at home!
Uterine bleeding after childbirth
According to statistics, 2% of all births are complicated by postpartum hemorrhage.
The most common causes are:
- Decreased uterine tone after childbirth (may be due to overdistension of the uterus with a large fetus, polyhydramnios),
- Increment of the placenta to the inner surface of the uterus,
- Delay of parts of the placenta in the uterus,
- Cervical tears in labor
- Continued rupture of the cervix to the lower segment of the uterus,
- Pathology of blood coagulation system
- Discrepancy of seams after Cesarean section.
Treatment of postpartum hemorrhage should be carried out as soon as possible, since uterine bleeding after childbirth can be very massive and lead to serious blood loss.
It is necessary to immediately begin the intravenous infusion of uterine-reducing drugs: Oxytocin, Methylergobrevin, Pabal.
- The introduction of hemostatic drugs "Tranexam", "Aminocaproic acid", "Etamzilat", 10% solution of calcium chloride.
- Replacement of blood loss with saline solutions (saline, 5% glucose solution), as well as colloidal preparations (Venofundin, Stabizol, ReoHES, Infukol).
- With a large blood loss (more than 1000 ml), one cannot do without erythrocyte mass and fresh frozen plasma, as it contains coagulation factors.
- Be sure to introduce drugs - inhibitors of the enzymes "Gordoks", "Contrykal" or "Trasilol". Without these drugs, it is not effective to inject fresh frozen plasma, since coagulation factors will be destroyed by blood enzymes.
- When parts of the placenta are retained in the uterus, it is necessary under intravenous anesthesia to carry out manual control of the uterus in order to remove the remnants of the placental tissue and membrane.
- When the neck breaks it is necessary to take in all the torn tissue. If the gap from the cervix has moved to the lower segment of the uterus, then an emergency operation is necessary.
- After all therapeutic measures have been taken, a cold load (weighing about 1.5 kg) must be put on the lower abdomen for 20 minutes every 2 hours. This contributes to the reduction of the uterus.
Important! The first 24 hours after birth are the most dangerous for the development of bleeding. Therefore, during this period should be carried out round the clock monitoring of the status of women.
After discharge from the maternity hospital, for the prevention of bleeding, a woman should independently take the means to reduce the uterus: tincture of water pepper or nettle decoction. These tools help the uterus return to normal size.
Bleeding in women in menopause
Spotting with menopause is always a warning sign. This should not be taken lightly and irresponsibly.
The main causes of bleeding in menopause:
- Endometrial hyperplasia,
- Precancerous processes in the endometrium,
- Endometrial cancer,
- Submucous uterine myoma,
- "Forgotten" intrauterine device.
Obviously, there are not so many reasons, but they are all very serious.
The main difference in medical tactics for uterine bleeding in women in menopause is oncological alertness.
Principles of treatment:
If ultrasound reveals endometrial or polyp pathology due to oncologic vigilance, a surgical method of stopping bleeding prevails among all methods of treatment, namely: curettage of the uterus and cervical canal. This is necessary in order to send the material obtained during surgery for histological examination and in time exclude or confirm the oncological process. ATgreat Studies have shown that in 70% of cases, endometrial cancer appears in women in menopause and the first symptom is uterine bleeding. After scraping the uterus, hemostatic agents are injected.
- If a submucous myoma is detected, a hysteroresectoscopy can be performed followed by removal of the node. With larger nodes, the uterus is removed with appendages.
- If a spiral is found in the uterus, which is installed more than 5 years ago, then it must be removed. After extracting the helix, it is very important to ensure the integrity of the walls of the uterus. After surgery, further anti-inflammatory therapy is necessary.
- With a decrease in hemoglobin level, you need to take iron supplements (intravenously or as tablets), depending on the level of hemoglobin.
The predominance of surgical tactics in respect of uterine bleeding during menopause allows time to recognize the benign or malignant nature of the pathological process.
Depending on the age of the woman, the causes of uterine bleeding are different. It means that medical tactics with the elimination of the cause can not be of the same type and universal for all patients.
In addition, it is necessary to take into account the principle of "continuity" of pathologies. The essence of the principle is that the lack of treatment of dysfunctional uterine bleeding in the pubertal period can lead to chronic anovulation and endocrine sterility at reproductive age. And this, in turn, is a “springboard” for the development of benign and malignant pathological processes of the endometrium in menopause. It is for this reason that uterine bleeding must be taken seriously at any age.
1. Juvenile bleeding.
YuMK - This is acyclic uterine bleeding in girls of puberty.
a) predisposing factors: constitutional features (asthenic, intersexual, infantile), increased allergization, adverse clinical-geographical and material and domestic factors, the influence of damaging factors in the ante-and intranatal period (premature birth, gestosis, rhesus-conflict), frequent infectious diseases in childhood.
b) resolving factors: mental shocks, physical overload, brain concussion, colds.
Pathogenesis: based on dysfunction of the hypothalamic-pituitary system. The immaturity of the pituitary structures of the hypothalamus leads to disruption of cyclic formation and release of gonadotropins, which disrupts folliculogenesis in the ovaries and leads to anovulation, in which atresia of follicles that have not reached the ovulatory stage of maturity occurs. At the same time, steroidogenesis of the ovary is disrupted, estrogen production is relatively monotonous, but long-lasting, progesterone is formed in small quantities. Progesterone deficiency is primarily reflected on the endometrium. Stimulating effect E2 causes proliferation of the endometrium. With progesterone deficiency, the endometrium does not undergo secretory transformation, but it hyperplashes and undergoes glandular-cystic changes. Uterine bleeding occurs due to congestive plethora, dilated capillaries, development of areas of necrosis and uneven rejection of the endometrium. Contributes to long-term bleeding reduction in the contractile activity of the uterus during its hypoplasia.
There are two types of UMK:
a) hypoestrogenic type - endometrial hyperplasia develops slowly, the subsequent bleeding is not so much copious as long
b) hyperestrogenic type - endometrial hyperplasia develops rapidly, followed by incomplete rejection and bleeding
Clinic: occurs most often in the first 2 years after menarche, but sometimes already with menarche, occurs after a delay of menstruation for different periods, lasts up to 7 days or more, varying in intensity, always painless, rather quickly leads to anemization even with a small blood loss and secondary disorders coagulation of the blood (thrombocytopenia, slowing down of coagulation, reducing the prothrombin index, slowing the reaction of a blood clot). Until the end of puberty, ovulatory bleeding in the form of hyperpolymenorrhea is characteristic due to insufficient production of LH by the pituitary and inadequate development of the corpus luteum.
Diagnostics: should be conducted in conjunction with a pediatrician, hematologist, endocrinologist, neuropathologist, otorhinolaryngologist.
When hypoestrogenic type:
1. External gynecological examination: proper development of the external genital organs, pale pink color of the mucous and vulva, thin hymen.
2. Vaginoscopy: a pale pink mucosa, folding is mild, the cervix is subconical or conical, the pupil phenomenon is +/- or +, the discharge is scarce, bloody, without the admixture of mucus.
3. Rectoabdominal examination: typically located uterus, the angle between the body and the cervix is not pronounced, the size of the uterus corresponds to the age, the ovaries are not palpated.
4. Functional diagnostic tests: monophasic basal temperature, KPI 20-40%, the length of the tension of the cervical mucus 3-4 cm
When hyperestrogenic type:
1. External research: correct development of the external genital organs, succulent vulva, fringed juicy hymen
2. Vaginoscopy: pink mucous membranes, folding is well expressed, the cervix is cylindrical, the pupil phenomenon is ++, +++ or ++++, the discharge is copious, bloody, with an admixture of 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, KPI 50-80%, tension length of cervical mucus 7-8 cm.
Ultrasound examination is shown to all patients with UMK to clarify the status of internal genital organs.
The basic principles of therapy:
1. Therapeutic and protective regime a) organization of proper labor and rest b) elimination of negative emotions c) creation of physical and mental rest d) balanced nutrition e) rational therapy after concomitant diseases.
2. Non-hormonal hemostatic therapy (with moderate blood loss and menstrual age not more than 2 years, with no signs of organic pathology of the uterus and ovaries):
a) uterotonic drugs fractional (oxytocin)
b) haemostatic agents (calcium gluconate, dicynone, ascorbic acid, vikasol)
c) fortifying treatment (glucose solution, vitamin B6, B12, folic acid, cocarboxylase or ATP)
d) antianemic therapy (hemostimulin, ferroplex, blood transfusion with hemoglobin values below 70 g / l)
3. Phytotherapy (mastodinone, nettle extract, shepherd's bags, water pepper)
4. Physiotherapy: electrostimulation of the cervix, electrophoresis of novocaine to the region of the cervical sympathetic ganglia, endonasal electrophoresis with vitamin B1, acupuncture, local hypothermia - treatment of cervix tampons with ether
5. Hormone therapy - in the absence of the effect of symptomatic therapy, heavy bleeding in the absence of anemia, the presence of contraindications to diagnostic curettage of the uterus. Combined estrogen-progestin preparations are used with ethinyl estradiol 50 mg / tab (anteovin, ovulen, 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, not amenable to conservative therapy, recurrent bleeding with no effect from symptomatic and hormonal therapy, suspicion of adenomyosis, suspicion of organic myometrial pathology.
Further treatment depends on the histological data: in case of endometrial hyperplasia or adenomyosis, pure gestagens are prescribed (duphaston, provera, primolyut-nor).
Prevention of relapse UMK:
1. All girls are given hormone therapy for the regulation of the menstrual cycle:
a) hypoestrogenic type: combined estrogen-progestin drugs (logest, novik, regulon)
b) hyperestrogenic type: gestagen preparations (provera, primolyut-nor, dufaston)
During the period of rehabilitation after the cancellation of hormonal drugs - mastodinone or vitamin therapy: folic acid, vitamin E, glutamic acid, vitamin C.
2. For the purpose of immunocorrection with recurrent UMK, the administration of licopid is indicated.
3. Organization of the correct mode of mental, physical labor and active recreation, the elimination of negative emotions, the creation of physical and mental rest, the normalization of body weight, a balanced diet, etc.
Causes of bleeding unrelated to the reproductive system
All systems and organs interact with each other. Ailment of one system can affect the other, showing different symptoms. Extragenital causes of vaginal bleeding:
- changes in thyroid function (hypothyroidism, hyperthyroidism),
- diseases of the heart and blood vessels (hypertension),
- hepatitis, cirrhosis,
- blood diseases
- hypovitaminosis (lack of vitamins affecting the condition of blood vessels and blood coagulation),
- various infectious diseases
- prolonged stress and emotional overload, physical exhaustion.
These causes are a specific manifestation of the underlying disease, and require primary treatment.
Bleeding in women with reproductive system involvement
If pregnancy has not yet been established, then an early miscarriage or an ectopic pregnancy should be assumed. Other causes include endometriosis, uterine fibroids, anovulatory menorrhagia. Due to the fact that oncopathology has become younger in recent years, we should not forget about cervical cancer. A feature of blood discharge in cervical cancer is that the discharge has a specific odor and appears more often after sexual intercourse.
In the late trimester of pregnancy, the causes can be:
- previa placenta,
- premature placental abruption,
- scar on the body of the uterus.
During pregnancy, in the presence of bleeding of any nature and intensity, a woman is advised to immediately seek medical help at the antenatal clinic or call an ambulance.
Causes of blood loss not related to carrying a child:
- neoplasms of the uterus and ovaries,
- ovarian apoplexy,
- various inflammatory diseases,
- cervical erosion,
Women with the above pathology should be systematically examined by doctors.
Uterine hemorrhages at different ages
All uterine bleeding is divided into pathological and physiological. Therefore, the chronological stage of the individual development of the reproductive system is first determined.
Bleeding conditionally divided into age periods:
- juvenile (from 10 to 18 years),
- reproductive (fertile period from 18 to 50 years),
- menopausal period (time of extinction of ovarian function),
- postmenopausal (final completion of menstruation).
Most often, signs of uterine bleeding in women are found from 28 to 40 years old, but can appear at any age. The main cause of uterine bleeding most often at this age is a violation of the ovulation process.
The ongoing shift in the hormonal system provokes the growth of the mucous membrane in the uterus, resulting in stagnation and accumulation of blood, thereby disrupting blood circulation. After the permeability of blood vessels changes, the conditions for the development of bleeding are formed. The uterus becomes a place of accumulation of blood.
If the number of platelets decreases, which makes the blood thinner, it increases blood loss and aggravates post-hemorrhagic anemia. Ведь крови может быть потеряно много.Although the female body is adapted to certain monthly expenses and subsequent replenishment.
For each age period, the causes may be different, as there are certain features at each age. But you can highlight the main points that affect equally bad, despite their age.
Factors that negatively affect the hormonal system:
- acute and chronic infectious diseases,
- lack of vitamins and microelements,
- psychological trauma and emotional stress
- physical exhaustion,
- thyroid disease (hypothyroidism, hyperthyroidism),
- inflammatory diseases of the genitourinary system,
- complicated childbirth and abortion.
In a certain age category there are risks for a particular disease. For example, hypovitaminosis is characteristic, to a greater extent, for young age and those who are in the postmenopausal period. Accordingly, abortion for women with complete completion of menstrual function is casuistry.
Differences bleeding from normal menstruation
How much blood does a woman lose? With the usual monthly 70-100 ml for the entire period, but again, may be more intense. When menorrhagia can lose about 120 ml more per day. How to understand that this is not just menstruation, but true blood loss?
Symptoms of uterine bleeding:
- weakness accompanied by dizziness
- marbling of the skin
- may be vomiting and nausea, but not necessarily
- faint or faint,
- weak pulse, rapid heartbeat, tachycardia,
- hypotension, pressure decreases,
- the presence of vaginal blood,
- during the period of menstruation clots, pads, and tampons are very quickly filled,
- at night you have to change hygiene products more than twice,
- for the duration of such bleeding more than eight days, and in normal normal menstruation last up to a week,
- not accompanied by pain,
- may appear after sex,
- most often do not coincide with the monthly.
Bleeding that occurs after a delayed menstruation, as a rule, carries a functional character. If the discharge is abundant in volume and cyclical, then this may indicate uterine fibroids and systemic blood pathologies. The appearance of bleeding in the postmenopausal period, that is, a year after the last menstruation in women is interpreted as a clear pathology. In this case, it is necessary to urgently exclude a malignant neoplasm. But, as a rule, discharge at this age is rather scarce and occurs as a result of atrophy of the vulva and vagina.
The presence of bleeding is alarming and can speak of many diseases. The problem of bleeding remains relevant today. Failure to provide timely medical care can end in tragedy.
For the purpose of prophylaxis, it is necessary to visit a gynecologist once a year, if necessary, a hematologist and an endocrinologist. In addition, strengthen your body, adhere to a balanced diet and do measured physical activity.
Types and causes of bleeding
Bleeding in a female divided into several types, depending on the reasons for their cause. Symptoms of overt pathology can be recognized by long-lasting secretions. Uterine bleeding is not uncommon and occurs more often in women of reproductive age, but it occurs in menopause and in girls. The appearance of such a situation requires an appeal to the doctor, especially if the discharge is abundant and not associated with the menstrual cycle.
Uterine bleeding at the time of occurrence can be divided into 2 types:
- Menorrhagia is a condition in which menstrual flow lengthens and increases. In some ways this is considered a variant of the physiological norm.
- Metrorrhagia - intercyclic uterine bleeding of various etiologies.
The occurrence of this pathology has its own reasons:
- Ovarian dysfunction often provoke uterine menstrual-like blood secretion.
- Sex hormone imbalance. When this happens uterine bleeding, which can occur at any age. Because of this, quite often in women the menstrual cycle is broken.
- Cervical erosion. One of the provoking factors are various pathologies of the female reproductive organs. In contact with a similar defect, for example, during a gynecological examination or during sexual intercourse, uterine bleeding begins. As a rule, they are not abundant, but they bring discomfort to the woman. This condition is sometimes accompanied by pain in the abdomen.
- Injuries during intercourse in some cases lead to the appearance of blood in women. This can occur when accidental damage to the blood vessels of the cervix and does not pose a serious danger in the case when the uterine discharge of blood passes during the day and is not abundant. If the situation does not change, but only progresses, it is necessary to urgently consult a doctor.
- Endometrial polyps, especially if they are damaged (for example, through sexual contact), can exfoliate, then there is abundant uterine bleeding. That is why it is so important to diagnose and remove them in time.
- Endometriosis. The centers of this pathology, resulting from the growth of endometrial cells in the wrong place, often bleed. Uterine discharge while thick and color of chocolate.
- Stressful conditions can lead to heavy bleeding.
- Miscarriage. Its main symptoms are abdominal pain and heavy uterine bleeding.
- The consequences of abortion. When this manipulation takes place in the form of curettage, then the bloody uterine discharge is quite abundant. If they do not pass for a long time and are progressing, then an ambulance should be called, since the fragments of the ovum remaining in the uterus can lead to quite serious consequences.
As can be seen, bleeding in women can occur for various reasons and quite often are a symptom of various diseases of the reproductive system.
Depending on age, this pathology can be divided into 3 types:
- juvenile uterine bleeding occurring in girls under 18 years of age. Often they coincide in time with the monthly, but are more abundant and take a slightly longer time interval,
- uterine bleeding of the reproductive period. May occur for several reasons caused by various diseases of the reproductive system,
- copious uterine discharge of blood sometimes occurs during menopause. During this period, such states are especially dangerous, since they can be a sign of malignant cell degeneration.
How is the treatment carried out?
Treatment of bleeding first begins with the diagnosis. To do this, the doctor collects the necessary tests and, summing up all the symptoms, determines a particular disease.
The first aid in such conditions may be recipes of traditional medicine, but this does not help cure the cause itself, but only slightly stop uterine bleeding. If there is no possibility to immediately consult a doctor, then you can brew nettles and, after drinking broth, lie down for a while.
When ovarian dysfunction due to hormone failure, the doctor may prescribe special drugs that can balance the balance between estrogen and progesterone. If uterine bleeding is not too heavy, phytopreparations are suggested in some cases. However, if the pathology is serious, then the gynecologist may recommend taking oral contraceptives that will help not only level the balance of hormones, but will also be an excellent means of protection from unwanted pregnancy.
Uterine blood secretion during erosion is treated by eliminating the damaged area. For this, the pathological area is cauterized with a laser or cryodestruction is performed.
If during a rough intercourse a vessel accidentally breaks through and a blood clot does not form for a long time, then the doctor stops uterine bleeding in the hospital.
Polyps and endometriosis, the symptoms of which are often similar and manifest discomfort during sexual intercourse, as well as spotting, require mandatory treatment. Uterine bleeding with them can be of different intensity. In any case, the doctor must eliminate the pathological formation. Often this is done with a laser.
Stress often causes bleeding in women. In this case, the gynecologist applies the means of accelerating blood coagulation and hot injections.
If the pathology has arisen as a result of a miscarriage or after an abortion, then in any case it is impossible to postpone the visit to the doctor, because the consequences can be fatal.
If the symptoms of uterine bleeding are progressive, then this should be taken seriously. It must be remembered that it is important to eliminate not the manifestation of the pathology itself, but its cause. And here without an experienced specialist can not do. Quite often, bleeding is accompanied by the following symptoms:
In any case, the danger increases with an increase in the volume of lost fluid.
Periodic acyclic blood secretions can lead to anemia and the development of infertility. If they are caused by hyperplastic processes in the endometrium, then one cannot do without curettage. At the same time, new ones begin to form in the place of the modified cells.
Drugs that are an auxiliary method of treatment in this condition: Ditsinon, Tranexam, Vikasol, Ascorutin and others.
When uterine bleeding can not take a bath, especially hot.
Before the visit to the doctor, you can:
- lie on your back and put your legs just above the level of the body, for example, on a roller or a low pillow,
- drink as much liquid as possible
- You can take a tablet Vikasola or Ditsinona, as well as brew nettles.
In any case, it is impossible to engage in self-treatment in any case!
What it is
Dysfunctional uterine bleeding is a functional condition of the body, characterized by the absence of a violation of the structure of the genital organs, systemic diseases and complications of pregnancy. The main reason is the lack of cyclic release of ovarian hormones into the blood. Spontaneous endocrine glands.
By age parameters are distinguished:
In 80% of cases, bleeding is associated with impaired ovulation (anovulatory). Lead to hormonal dysfunction. But in 20% of women, ovulatory function is preserved.
Clinical picture of DMK
Change of periods of absence of menstruation from 2 to 6 months with copious and prolonged discharge is characteristic of dysfunctional uterine bleeding. Monthly lasts longer than a week. The volume of blood loss is over 150 ml per period.
On feeling during bleeding and a week after the end dizziness, palpitations, shortness of breath, weakness. Symptomatic due to acute blood loss, oxygen starvation of tissues, metabolic disorders. Feel cramps in the abdomen, periodic cramping pain.
The main role in the development of dysfunctional uterine bleeding is played by the weakening of the connections between the hypothalamic-pituitary-adrenal system and the ovaries.
In the hypothalamus, hormones are produced that act on the ovaries, stimulate follicle development and ovulation in them. These are follicle-stimulating and luteinizing hormones. With a lack of them in the blood does not develop the yellow body of the ovary, which produces progesterone.
Progesterone affects the growth and maturation of the endometrium - the inner lining of the uterus. For the development and rejection of the endometrium takes time. The duration of exposure to the uterine hormone explains the delayed menstruation. The bleeding begins with a jump in estrogen and a drop in progesterone levels.
Hormonal imbalance slows down blood clotting time. A blood clot forms a long time. His bleeding is washed away from the uterus.
Bleeding that occurs from the onset of menstruation to the age of 18 years is called juvenile. Make up one fifth of all gynecological diseases.
The reasons for the violation of the cycle at a young age are:
- emotional turmoil
- physical fatigue,
- failure of the endocrine system.
Changing environmental factors require the selection of an individual amount of hormones. As a consequence, the release occurs irregularly. The body adjusts to the optimal mode and hormonal background. The endocrine system adapts to the outside world.
For the diagnosis using a survey, examination, clinical and laboratory confirmation. The first is data collection. Find out the age of the first menstruation and the time of onset of bleeding. Then establish the duration of the violation of the cycle and the nature of normal periods. Determine blood loss. Necessarily interested in past diseases, medications.
With the help of inspection exclude the violation of the structure of organs that could cause a cycle failure.
The level of the gomons of the reproductive system (estrogen, progesterone, cortisol, luteinizing, follicle-stimulating) and the thyroid gland (thyrotropic, tetraiodothyronine, triiodothyronine, antithyrotrophic hormone) is examined in the laboratory. An assessment of the time of formation of a thrombus.
Computed tomography of the skull allows you to examine the Turkish saddle. This is the place in the head where the pituitary gland is located. It secretes hormones that regulate ovarian function. Pituitary tumor leads to disruption of hormone production.
An ultrasound of the internal organs, the thyroid gland, the adrenal glands is performed to exclude tumors and cysts that can lead to hormonal imbalance.
When there are dysfunctional uterine bleeding, treatment is aimed at normalizing hormonal levels, stabilizing blood clotting, strengthening the nervous system, improving metabolism.
The following groups of medicinal substances are used:
- hormonal contraceptives according to an individual scheme (Regulon, Yarin),
- hemostatic drugs (Tranexanoic acid, etamzilat),
- iron-containing drugs (Sorbifer, Totem, Ferrum-lek),
- exchange drugs (Riboxin, Mildronate),
- blood components (red blood cell mass, blood plasma),
- complex vitamins (Supradin, Revit),
- sedative therapy (valerian, motherwort, corvaldine).
With a progressive deterioration of the condition, a decrease in the hemoglobin content in the blood to 70 g / l and below, a hysteroscopy is performed with cauterization of the bleeding vessel, curettage of the uterus cavity. The material must be sent for histopathological examination.
MQD of reproductive age
Dysfunctional uterine bleeding of reproductive age is a menstrual disorder that occurs at the age of 18 - 45 years.
The causes of pathology are:
- exercise stress,
- climate change
- inflammatory diseases,
- systematic medication
Diagnosis is standard. It starts with finding out the moment of occurrence and duration of bleeding, the volume of blood loss, the time of violation of the menstrual cycle. It is important to exclude the pathology of other organs: uterus, liver, blood.
During clinical and laboratory examination draws attention to the clinical analysis of blood. Of particular importance is the level of hemoglobin, red blood cells, hematocrit, platelets, leukocytes.
An important diagnostic study is hysteroscopy. It allows you to find out the condition of the uterus, sighting take a suspicious area for research.
In the reproductive period, the main place in the treatment is curettage of the uterus. It helps to get rid of clots. The uterus is reduced, the vessels are clamped. Bleeding stops.
As a rehabilitation treatment is used:
- hemostatic therapy (Tranexam intravenously, Dicynon intramuscularly),
- iron preparations (sorbifer, totem),
- infusion therapy (blood plasma, ringer's solution, saline),
- vitamins (group B, vitamin C),
- sedatives (Valerian, Sedavit, Novopasid).
For the recovery period, you need good nutrition, rejection of bad habits, reduced physical activity.
MQD during premenopause and menopause
Bleeding in the premenopausal and menopausal periods account for 15% of gynecological pathology. Dysfunctional uterine bleeding in the premenopausal period is an irregular spotting that occurs between the ages of 45 and one year after the end of the last menstruation.
Menopausal bleeding is a condition that occurs no earlier than a year after the last menstrual period.
The reason for the appearance of irregular secretions is the spontaneous activity of the ovaries. Estrogen is released into the blood. The state of hyperestrogenia leads to the proliferation of the endometrium. This entails proliferative diseases of the reproductive system - uterine cavity polyps, leiomyoma, ovarian tumors.
For the diagnosis using transvaginal ultrasound of the genital organs. Find out the state of the endometrium, the muscles of the uterus, ovaries.
Dysfunctional uterine bleeding is diagnosed using hysteroscopy, examining the uterus twice: before and after scraping. Mandatory therapeutic and diagnostic procedure is curettage of the uterus. The resulting material is sent for histological examination. Проведение гистероскопии после соскоба позволяет увидеть состояние глубокого слоя эндометрия и внутренних стенок матки.
The first step in the treatment is curettage of the uterus. After receiving the results and data of hysteroscopy, hormone treatment is carried out (Differelin, 17-OPK). If the examination results are unsatisfactory, removal of the uterus with appendages is indicated.
Dysfunctional uterine bleeding is fraught with complications. The most dangerous cause of bleeding is death as a result of acute abundant blood loss. It comes as a result of hemorrhagic shock and multiorgan failure. But this is extremely rare.
Dysfunctional uterine bleeding can cause anemia, leading to a general bad feeling: heartbeat, fatigue, shortness of breath. It develops against the background of chronic iron deficiency in the body. It is a consequence of oxygen starvation of tissues.
Long-term hormonal imbalance, lack of follicle and full ovulation leads to infertility. Ovarian capsule thickens. Oocytes become more difficult to exit. A woman is not able to conceive a child.
Prevention of DMK
The main prevention of disorders of hormonal imbalance is considered to be protection from inflammatory diseases, early detection and treatment.
Vitamin therapy in the autumn-spring period strengthens the immune system, stimulates the defense mechanisms, and normalizes the body's work.
Emotional stability strengthens the connections between the nervous and endocrine systems. Sets the cyclical release of hormones in the blood.
Dysfunctional uterine bleeding is a common gynecological problem at any age. Requires differential diagnosis with organic pathology of the reproductive system and the disease of other organs. Patients are subject to observation and dispensary registration at the gynecologist.
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Uterine bleeding juvenile period
The abundance of menstrual bleeding is the main cause of health problems in premenopausal women. Treatment that avoids unnecessary surgery is an attractive treatment option, but in practice there are many different procedures and uncertainties regarding the most effective treatment. Danazol inhibits estrogen and progesterone receptors in the endometrium, causing endometrial atrophy and reducing menstrual loss and amenorrhea in some women. To determine the efficacy and tolerability of danazol when used for heavy menstrual bleeding in women of childbearing age.
The main cause of bleeding is considered to be a disorder during the production of female sex hormones. In addition, there are many factors that can trigger bleeding from the uterus. These include:
- Diseases of the hematopoietic system.
- Pathologies that develop during pregnancy.
- Traumatic injuries of the genitals.
- Pathological processes in the uterus, as well as its appendages.
- Various gynecological diseases.
- The presence of tumor neoplasms, both benign and oncological in nature.
- Complications from childbirth.
- Pathology of the liver.
- Endocrine diseases.
- The use of intrauterine contraception
- Prolonged use of hormonal contraceptives.
- Changes in climatic conditions.
- Frequent stressful situations.
- Genital tuberculosis.
- Disorders of the adrenal cortex
- Pathology of the thyroid gland.
- The presence of inflammatory processes in the reproductive system.
A characteristic feature of this pathology is considered to be abundant discharge of blood, lasting more than a week. In addition, for uterine bleeding is characterized by the presence of such symptoms:
Symptoms of dysfunctional uterine bleeding
We conducted a search in the Specialized Register of the Group of Menstrual Disorders and Subfertility. Attempts were also made to identify trials from the citation lists of the included trials and related review articles. We excluded tests, including women with postmenopausal bleeding, intermenstrual bleeding and the pathological causes of heavy menstrual bleeding.
Receive and analyze data. Quality assessment and data extraction were carried out independently by two reviewers. The main results were menstrual blood loss, the number of women experiencing side effects, weight gain, seizures due to side effects, and dysmenorrhea. If the data could not be obtained in a form suitable for meta-analysis, they were presented in a descriptive format.
- General weakening of the body.
- The presence of bloody clots in the discharge.
- Sanitary pads should be replaced once per hour or more often.
- Pain in the lower abdomen.
- The development of anemia.
- Blanching of the skin.
- Slow pulse.
- Loss of consciousness.
How to bleed from menstruation?
Uterine bleeding differs from typical menstruation by a number of characteristic signs. These include the following factors:
Danazol appears to be an effective treatment for severe menstrual bleeding compared with other treatments. Clinical care recommendations are limited due to the limited number of clinical trials and the small sample sizes of the included studies. Further studies are unlikely to be conducted in the future, and this review will not be updated unless such studies are identified.
Many data were not presented in a format suitable for meta-analysis, and the results are based on a small number of tests, all of which have low statistical power. There were no randomized clinical trials comparing danazol with trannexamic acid or levonorgestrel-releasing intrauterine system.
- A significant increase in the volume of blood secreted (over eighty milliliters per day).
- Passion for the duration of discharge (Menorrhagia).
- Bleeding is observed in the intermenstrual period (Polymenorrhea).
- Bleeding occurs during menopause, which is not typical for menstruation.
- Metrorrhagia, characterized by disruptions in the regularity of the menstrual cycle, is also a pathological manifestation.
- In the presence of at least a few of the above symptoms, we are talking about uterine bleeding.
The presented pathology can differ in a number of signs, caused by the causes of occurrence, as well as some associated factors. The classification highlights such varieties:
How to stop the bleeding?
In case of uterine bleeding, an ambulance brigade must be urgently called. And before the arrival of doctors, you should do everything possible to alleviate the condition of the woman. Remember that not only health but also the patient's life depends on timely and competently rendered first aid. So, in order to stop severe uterine bleeding on your own, you need to do the following:
It is normal for your body that the uterus is completely empty. Every woman's body is different. Abnormal uterine bleeding in women of childbearing age includes a higher frequency of bleeding, an increase in the amount of blood or long periods. This bleeding can be ovulatory, anovulatory or anatomical. Any uterine bleeding that appears after menopause qualifies as abnormal. Causes of abnormal uterine bleeding.
There are several possible causes of abnormal uterine bleeding, but, nevertheless, the cause is still unknown in about 40 percent of women, even after a thorough examination. Ovulatory bleeding Bleeding that occurs around the middle of the menstrual cycle most likely leads to ovulatory bleeding. This is stimulated by a rapidly changing hormonal balance during ovulation, which includes an increase in progesterone levels, while the concentration of estrogen decreases.
- Give the injured hemostatic drugs (etamzilat, Dition, etc.).
- After the medication is taken, the patient should be laid down, and a pad should be placed under her feet.
- On the lower abdomen it is recommended to apply a heating pad with ice or just something cold.
- With a sharp drop in blood pressure, give the patient a drink of hot sweet tea.
Treatment of this pathology should be aimed at stopping bleeding and preventing possible recurrences. In many ways, therapy depends on the factors that provoked the occurrence of bleeding. If the cause of the disease was a certain disease, the appropriate systematic treatment is prescribed by the doctor.
This bleeding is usually a light spot and lasts several hours or less than two days. This usually occurs as a brownish boot. Ovulatory bleeding treatment is usually not required if it is not extensive and causes great discomfort. In these rare cases, estrogen replacement therapy can be used for several days. Anovulatory bleeding Anovulatory cycle is a type of menstrual cycle that does not have ovulation. Anovulatory cycles are very common in young women in the early reproductive period and are one of the most common causes of infertility among older women.
The following therapeutic measures are applied to directly stop bleeding from the uterus:
- The introduction of estrogen, androgen, and progesterone.
- The course of treatment with hemostatic drugs.
- Hormonal drugs to normalize the menstrual cycle.
After the bleeding is stopped, the patient is prescribed a course of infusion therapy aimed at eliminating its consequences. Indeed, severe bleeding can cause complications such as severe forms of anemia and other pathological conditions. To avoid this, it is recommended to take iron preparations, immunomodulatory drugs, vitamins, etc.
Why does bleeding occur?
Ovulation can be stimulated with hormone replacement therapy with high success rates. Anatomical bleeding Anatomical bleeding is caused by a morphological abnormality or abnormal formation present in the uterus. Uterine polyps are benign endometrial tumors. Its most pronounced symptom is abnormal bleeding, irregular or excessive. This bleeding can occur during or between periods, before or after menopause.
Uterine bleeding is a serious pathology, indicating problems in the female body. Therefore, in order to avoid the development of complications, at the first signs of this problem, it is necessary to seek medical help. Self-treatment in this case is absolutely contraindicated!
Uterine bleeding in menopause
Uterine polyps are diagnosed by gynecological examination. If bleeding is very common or polyps are large and large, they should be surgically removed by a gynecologist. Hormone therapy with progesterone analogues is usually short-lived. Cervical cancer and cervical cancer can also cause bleeding at an unusual time during reproduction or after menopause. Infection Infection of internal genital organs is a very common cause of abnormal bleeding. In addition to bleeding, infections of the genitalia present with pelvic pain, a faint odor of vaginal secretion, and sometimes systemic symptoms such as health and fever.
Uterine bleeding is one of the most important dangers that await a woman. And to face them there is a probability in women of absolutely any age. However, the observations of gynecologists and dry medical statistics show that it is most likely that uterine bleeding develops in girls who are in their teens, or in women who are about to start menopause.
Always contact your gynecologist if you notice bleeding between periods or significant changes in the frequency of periods and the number of menstrual bleeding. Severe bleeding or bleeding is a symptom of the underlying disease. Diagnosis and treatment are usually directed against the disease.
Nonsteroidal anti-inflammatory drugs
Therapy for menorrhagia includes anti-inflammatory drugs, intrauterine devices for the release of hormones and so on. Women with menorrhagia, especially colic, receive nonsteroidal anti-inflammatory drugs or analgesics. Sometimes they reduce bleeding. These include mefenamic acid, naproxen and ibuprofen.
Doctors - gynecologists. Abundant and long-lasting uterine bleeding is defined by such a term as "menorrhagia". Before you talk about what are the types of uterine bleeding, and about the reasons that cause them, you need to understand what is considered the norm, and that it is still a pathology.
As you know, after the onset of puberty, and until the very menopause a woman has monthly menstruation, accompanied by the release of blood from the vagina. Such bleeding occurs as a result of the fact that the internal mucous membrane of the uterus, called the endometrium, monthly, on certain days of the menstrual cycle, exfoliates, and the vessels of the uterine mucosa burst. As a result of the combination of all these factors, menstrual bleeding occurs.
Intrauterine devices, releasing hormone
Most women benefit from the introduction of intrauterine hormones. The intrauterine system of levonorgestrel is such a device. This device is inserted into the uterus and will be stored inside for almost five years. Some women may take oral contraceptive pills. They contain estrogen and progesterone.
The progesterone component especially helps reduce bleeding. Some women may only need progesterone. For such women can be appointed nestriston. Common side effects with progesterone alone: weight gain, weight gain, swelling, tenderness of the chest, headaches, and acne.
Typically, the onset of menstruation occurs every 23 - 34 days, depending on the characteristics of the menstrual cycle of each woman. Menstruation lasts on average from three to seven days. As a rule, the average blood loss per day during normal menstruation is no more than 40 ml. However, very much depends on the individual characteristics of the body of each particular woman. Some women are “lucky” less than others - their menstruation can be especially long and, most unpleasantly, abundant - blood loss can exceed 80 ml. per day.
Gonadotropin-releasing hormone agonists
Это позволяет сгущать кровь и уменьшает склонность к кровотечению. Gonadotropin-releasing agonists are used in the short term to reduce blood flow. Surgery for fibroids and uterine polyps may be suggested to prevent excessive bleeding. Myoma removal is called myomectomy.
Some women may have surgery to remove the endometrium or the lining of the uterus. This is called endometrial resection. Sometimes the endometrium can be burned or cauterized with electricity. This is called endometrial ablation. This can be done with the help of laser beams.
Of course, measuring blood loss is almost impossible. That is why gynecologists have developed a fairly simple test that any woman can easily conduct absolutely independently. To do this, she just needs to watch a tampon or pad. In the event that they are completely soaked through with blood in less than one hour, the woman should be alert and seek the help of a gynecologist.
Symptoms of uterine bleeding
Sometimes the blade can be used for ablation. Microwaves, hot liquid balloons are other treatment options. Sometimes a woman may require complete removal of the uterus as a measure to stop uterine bleeding.
What is important is the choice of procedures. Many patients may also choose a specific therapy. Patients are recommended relative efficacy of treatment, the likelihood of side effects, the need for contraception, the possible consequences for fertility, etc.
As a rule, such an intensity of bleeding occurs precisely when uterine bleeding or too heavy menstruation, which is also quite a serious pathology requiring immediate medical intervention. A woman in no case should not ignore such phenomena, because they can entail rather serious negative consequences for the female body.
Therapy is specifically aimed at stopping bleeding, avoiding and correcting anemia and improving the daily quality of life for women. In many cases, there is no underlying condition for explaining menorrhagia. Yoga and relaxation techniques can help these women. Regular exercise also helps some women.
Reduce stress to control flow. Marie, a 49-year-old administrative assistant, comes to you for an annual medical examination. She tells you that her menstrual periods are becoming increasingly irregular and unpredictable. Prior to this, his menstrual cycle was 30 days, but over the past 6 months it ranged from 24 to 40 days. Her menstrual period has been abundant since her second pregnancy 21 years ago, and the problem worsens. During the first two days of her period, she should change her super-sized tampon and towel after 1 hour or 2, so as not to spoil the clothes, she has minor cramps, but there are no significant blood clots.
There is also a special test that is designed to help a woman evaluate her real condition. A woman should consult a doctor if:
- A pad or tampon gets completely wet in less than one hour, and as a result, a woman has to use a much larger pad than usual.
- The woman has to wake up repeatedly in the middle of the night in order to replace the gasket.
- During menstruation, there is a large amount of blood clots in the discharge.
- As a result of menstruation, for some time a woman almost completely “falls out” of her usual way of life - she cannot attend work, do usual household chores, and is forced to spend most of her time lying in bed.
- A woman feels not just tired, but really exhausted and weak.
- In the study of a complete blood count, a woman is diagnosed with iron deficiency anemia, for the occurrence of which there are no other reasons.
- During menstruation, a woman constantly experiences intense pain in the lumbar region and lower abdomen.
The more questions a woman gave a positive answer, the sooner she needs to seek help from a doctor - a gynecologist.
Causes of uterine bleeding
No matter how strange it may seem, but the reasons for particularly heavy menstruation are unknown to gynecologists until now. That is why such menstruation in gynecology are called dysfunctional uterine bleeding. However, in addition to such menstruation, there is a sufficiently large number of uterine bleeding, the causes of which are known for certain. So, such reasons can be:
- Violation of the hormonal background of the female body
In the event that a woman's hormones are in a normal state, an optimal balance is maintained between such female hormones as estrogen and progesterone. And precisely because of this, menstruation begins in a timely manner, and blood loss with them is minimal.
It is thanks to these above-mentioned hormones that a natural monthly modification of the uterine mucosa occurs - the buildup and subsequent detachment of the endometrium. And in the event that a hormonal imbalance occurs in a woman’s body, the endometrium grows especially strongly. Yes, and his rejection occurs unnatural way, not simultaneously, but for a certain time. As a result, uterine bleeding begins.
It is this hormonal imbalance that causes frequent uterine bleeding in adolescent girls and women who are about to start menopause. The highest risk of developing such uterine bleeding during the first one and a half years after the start of the menstrual cycle is teenage girls. This is explained quite simply - in adolescence, the teenage girl’s hormonal system is not yet fully debugged, since it is only “included” in the overall work of the body. And for women who are awaiting the onset of menopause, the hormonal system, by contrast, has already ceased its full functioning. And in fact, and in another situation, very often there is a fairly strong hormonal imbalance, which later may lead to uterine bleeding.
- Thyroid disease
Another factor that increases the risk of uterine bleeding is impaired proper operation of the thyroid gland. The causes of such disorders can be diseases such as hyperthyroidism and hypothyroidism.
- Circulatory diseases
Sometimes, gynecologists face cases in which various blood diseases are the main culprits in the occurrence of uterine bleeding, accompanied by a significant decrease in the platelet count in the blood. Platelets are needed to stop any bleeding, including uterine.
In the event that uterine bleeding is caused by a woman’s uterine fibroid, the woman’s menstruation is much more abundant and prolonged. The strongest uterine bleeding occur in submicose - internal - uterine myoma. In such cases, drug therapy does not bring any benefit. In order to alleviate the condition of a woman, she is shown surgical intervention, the purpose of which is to remove uterine fibroids.
With this disease, the following happens: the fusion of the inner and muscular layer of the uterus occurs. Because of this, the area of the menstrual surface of the uterus is greatly increased. But the contractility of the uterus is significantly deteriorating. Menstruation in a woman becomes extremely long, abundant and painful.
Quite often, the cause of heavy painful menstruation, as well as the development of acyclic uterine bleeding. As a rule, such uterine polyps are most often observed in women of reproductive age. In order to remove them, a woman needs an operative surgical intervention - curettage of the uterus.
- Complicated during pregnancy
It’s not sad to talk about it, but quite often the cause of uterine bleeding is a complication of the course of pregnancy - either miscarriage in early pregnancy, or ectopic pregnancy, or premature detachment of the placenta. In these cases, the woman should as soon as possible seek medical care at the nearest medical institution, where there is a gynecologist, or call the ambulance team.
- Oncological diseases of the genital organs
Cancers such as malignant tumors of the ovaries, cervix and body of the uterus also often lead to the development of fairly strong uterine bleeding. In such cases, the price of delay can be the life of a woman.
The occurrence of uterine bleeding can be one of the side effects of the use of such non-hormonal intrauterine bleeding, like the IUD. And, moreover, if a woman using such a contraceptive takes such drugs as aspirin and other anticoagulants, the risk of uterine bleeding increases several times.
Visit to the gynecologist
In the event that a woman notices that her menstruation has become extremely painful, prolonged or excessively abundant, she should as soon as possible seek medical help from a gynecologist. If a woman has a special calendar in which she notes all the features of her menstrual cycle - beginning, end, richness - you must take it with you.
Such information will greatly assist the doctor in such a crucial matter as the diagnosis of the disorder and the choice of the optimal treatment tactics. The doctor will perform a classical gynecological examination, take a smear from the uterus pharynx. As a rule, the doctor prescribes a woman a few additional studies, including ultrasound examination of the uterus. Ultrasound will exclude or confirm the presence of certain gynecological diseases.
In cases where a woman suffers from uterine bleeding, the doctor will prescribe a blood test. The results of the general blood test will help determine if there is any inflammatory process in the woman’s body, as well as whether iron deficiency anemia has not developed as a result of regular blood loss.
In addition, a blood test aimed at studying the state of the hormonal background of a diseased woman will be performed. As mentioned above, hormonal disorders often become the culprit for the development of uterine bleeding. It is on the basis of data from such a blood test that the doctor will prescribe a woman for a study.
In some cases, to accurately diagnose the cause of the development of uterine bleeding, the doctor may prescribe a special diagnostic curettage of the uterus to the woman. It depends on the condition of the woman’s endometrium that the treatment chosen by the doctor depends. Also, the study of the endometrium will certainly determine whether a woman has malignant tumors in the uterus. And, moreover, such a scraping is very often an excellent therapeutic tool. And after it is held uterine bleeding forever leave a woman.
This article will not describe how to treat uterine bleeding, for a number of understandable reasons: the causes of uterine bleeding can be very different. And the treatment that greatly alleviates the condition of one woman can harm another. The main task of a woman is to consult a gynecologist in a timely manner. And the rest is the care of the doctor.