Uterine bleeding can occur with physiological and a number of pathological conditions. Since the woman herself can not determine the source of the bleeding, the manifestation of uterine bleeding is vaginal bleeding. Uterine bleeding can be an absolutely physiological phenomenon in two cases: during menstruation, if its duration is not more than 7 days and the frequency of onset is not less than 1 time in 25 days. Also, uterine bleeding in the form of short-term bloody discharge may be normal during ovulation.
What uterine bleeding is considered pathological.
Uterine bleeding can occur in women of different ages. Pathological vaginal bleeding occurs in such cases.
Increased duration of menstruation (menorrhagia), increased amount of bleeding (menorrhagia and hypermenorrhea) and too frequent monthly (polymentorrhea).
Bleeding, not related to menstruation, arising irregularly – metrorrhagia.
Bleeding in the postmenopausal period (if more than 6 months have elapsed since the last normal monthly period).
Also uterine bleeding can occur in pregnant women in early and late periods.
Why there is uterine bleeding.
The main mechanisms of development of uterine bleeding are as follows.
Hormonal disturbances in the regulation of the relationship between the elements of the axis of the hypothalamus-hypophysis-ovary-endometrium.
Structural, inflammatory and other gynecological disorders (including tumors).
Violations of the blood coagulation system.
The most common mechanism of uterine bleeding is this: during the anovulatory cycle (the follicle does not ripen), the yellow body does not develop. As a consequence, in the second phase of the cycle, progesterone (one of the female sex hormones) is not produced in sufficient quantities. At the same time, estradiol (another female sex hormone) continues to be produced in excess. Under the influence of estradiol, there is an increased growth of the endometrium (the inner layer of the uterus), which becomes so thick that the blood vessels stop providing it adequately with blood. As a result, the endometrium dies and undergoes sloughing. The process of mending is incomplete, accompanied by uterine bleeding and prolonged for a long time.
The most common causes of uterine bleeding.
Bleeding during early pregnancy occurs with spontaneous abortion. In this vaginal bleeding begins immediately or after some time after the start of abortion due to the flow of accumulated blood. Also, bleeding can occur with ectopic (ectopic) pregnancy.
Bleeding in late pregnancy can be associated with rupture of the placenta, bladder drift, placenta polyps and with placenta previa.
Uterine bleeding may be a symptom of such diseases associated with changes in the structure of the reproductive organs, such as adenomyosis (endometriosis of the uterus), uterine cancer, cervical or vaginal cancer, endometrial hyperplasia, submucosal nodes in uterine myomas or birth nodes, cervical polyps and endometrium.
Vaginal bleeding may be signs of atrophic vaginitis, cervicitis, foreign body of the vagina, with damage to the cervix, uterus or vagina.
Uterine bleeding for ovarian failure can occur with such conditions: dysfunctional uterine bleeding, functional ovarian cysts. syndrome of polycystic ovaries (polycystosis.
Endocrine disorders: hypothyroidism or hyperprolactinaemia.
Vaginal bleeding due to a clotting disorder develops in hereditary diseases of the clotting system, with liver diseases, with the administration of certain medications.
Uterine bleeding can occur with the use of contraceptives and hormone therapy. Most often in cases of the appointment of such drugs as Depo Provera, with hormone replacement therapy, with an intrauterine device, with levonorgestrel implants and in case of long passes in the reception of contraceptives.
When to consult a doctor with uterine bleeding.
Treatment of uterine bleeding.
Treatment of uterine bleeding depends on the cause that causes it. Most often, the treatment is conservative and consists of the use of drugs that increase the blood’s ability to clot and drugs that correct hormonal imbalance. The correct choice of these medicines takes into account many factors that are brought together by a doctor. If the bleeding is not eliminated by a medicamental method or is based on a cause that can not be eliminated conservatively, surgical treatment is performed. Surgical treatment can consist both in medical-diagnostic scraping of the endometrium, and in hysterectomy (removal of the uterus).