When is menstruation considered bleeding? What is the difference between menstruation and bleeding? Causes of gynecological bleeding

Changes in the nature of menstruation occur in the first months from their onset, while taking hormonal contraceptives, during pregnancy and after childbirth.

How to identify and distinguish between heavy periods and bleeding

Menstrual bleeding is completely individual for all women. On average, it lasts up to five days, begins after an equal number of days, and the amount of blood is also approximately the same. Any changes in the nature of the discharge may indicate the presence of pathology in the body. Heavy periods or bleeding: how to tell the difference?

During “critical days,” an average of about fifty milliliters of blood is released per 24 hours. In the first days, the spotting is bright, then it becomes darker and comes out in portions. are also individual. They are repeated with every menstruation. Often portions of blood flow out during physical exertion, sudden standing up, or jumping.

These secretions may contain impurities that are insignificant in quantity and volume - lumps of mucus, clots. The number of lumps is approximately the same for one woman. Menstrual blood has a certain peculiar, subtle odor, characteristic of the smell of fresh meat.

Difference between menstrual and uterine bleeding

During pregnancy, spotting may occur. The reason here is a rupture of the tube during the development of pregnancy outside the uterine cavity, placental abruption or its incorrect location (at the uterine os itself or directly above it). This situation threatens the development of shock and death of the mother and child.

After childbirth, metrorrhagia is possible due to a complicated birth process (trauma of the birth canal), the development of inflammation of the uterine mucosa, and the remains of a child’s place in the cavity of the reproductive organ.

Symptoms

This condition is dangerous due to the development of hemorrhagic shock or anemia. How to distinguish uterine bleeding from menstrual bleeding? Symptoms that will help you recognize normal periods and bleeding:

• change in the nature of menstruation;
• increasing its duration;
• the volume of blood released increases;
• disappearance of clots.

With significant blood leakage, the amount of fluid in the bloodstream decreases. The patient develops symptoms of shock:

• pads get wet more intensely than usual;
• the woman breaks into a sweat;
• blood pressure decreases;
• the heart beats quickly;
• dizziness occurs;
• chills appear;
• the skin and mucous membranes become pale;
• the body becomes covered in sweat;
• when standing up suddenly, the patient’s condition worsens;
• possible loss of consciousness;
• vomiting may occur;
• facial features become sharper.

When discharge occurs in small quantities for a long time, the woman’s body gets used to it. In this case, anemia develops:

• the discharge becomes lighter than usual over time;
• the woman gets tired quickly;
• there is a feeling of lethargy, drowsiness;
• the skin loses its shine, becomes dry, pale or yellowish;
• nails peel and break quickly, hair falls out;
• often feel dizzy;
• if a woman stands up suddenly, she may lose consciousness;
• rapid heartbeat;
• schoolgirls begin to learn the material poorly;
• In a blood test, the level of red blood cells and hemoglobin decreases.

These symptoms should alert a woman to the need to go and consult a doctor.

Help

Any physical activity should be kept to a minimum. The diet of these patients should include fresh foods, beef, and liver. Dishes are prepared using culinary technologies, steamed.

From the first minutes after the start of intense bleeding, the woman should go to lie down. You need to place a pillow under her pelvis or raise her legs up. This position will prevent the patient from losing consciousness. Symptoms in this condition decrease and blood flow to the head improves.

You need to put a regular heating pad with cold water on your lower abdomen. When exposed to cold, the muscle layer of the uterus contracts, the lumen of the blood vessels narrows, and this helps reduce bleeding.

The patient needs to unfasten tight clothing and remove the belt. You need to open the window slightly to let in fresh air. The patient takes a lot of liquid in small sips. After this, you need to immediately call an ambulance.

Herbs

Herbalists recommend using decoctions of oak bark, nettle, cinquefoil, wheatgrass, and viburnum bark as effective hemostatic agents. Particularly noteworthy are nettles, rose hips and oak bark. Nettle is rich in vitamin K, rosehip is rich in vitamin C and iron. These compounds can stop bleeding and help prevent anemia.

The bark of oak and viburnum is harvested from older plants. A decoction of them is infused for up to an hour and taken a tablespoon before meals. So, the bleeding will soon stop.

Conclusion

The appearance of intense and prolonged bleeding can lead to the development of anemia or be complicated by shock. A gynecologist knows how to distinguish menstruation. The regimen for such patients should be gentle. As first aid, you need to lay the woman down, place cold on her stomach, and give her something to drink.

httpss://youtu.be/iEqGQYNM0yg

Every woman understands well that menstruation is an absolutely normal occurrence. However, it is not always possible to immediately determine whether it is menstruation or normal bleeding. How to distinguish menstruation from bleeding? First of all, it is worth noting that there are a number of manifestations of the body that indicate the presence of pathology.

Discharge during menstruation is normal

The average interval for the menstrual cycle is three to five weeks. On the other hand, the period of menstruation ranges from three days to one week. Anything that does not fall within these boundaries may be a pathology.

Every girl's menstruation symptoms are quite similar. Typically, menstruation begins in the form of light discharge, which intensifies over time. By the end of menstruation, the discharge gradually disappears. At first, the blood discharge is characterized by a bright red color. Later they change their color to dark brown or black.

Clots during menstruation are also considered normal, since during this period blood clots form in the fair sex. The color of these clots can be either dark red or bright red. Discharge without clots should alert a woman, as this is a deviation from the norm. In this case, it is recommended to consult a doctor. In addition, you should seek specialized help if you doubt whether you are having menstruation or normal bleeding, or if you experience constant pain these days.

Difference between bleeding and menstruation

It will be possible to distinguish from bleeding directly during the interview with the patient. It is typical for a woman to become accustomed to the characteristics of her own secretions. If there are any differences during the cycle, the girl will definitely notice it. The lady should pay attention to the following factors:

• Increased volume of menstruation;
• Continuous bleeding;
• The discharge becomes liquid;
• The discharge is scarlet, deep red or crimson in color;
• The presence of clots in blood discharge is not observed;
• The special smell of blood disappears.

Thus, if you notice that the course of your current periods is different from the previous ones, you should contact a specialist to find out what is causing this. Only a doctor can name the main cause of the pathology.

Causes of bleeding

Let's look at the most common causes of uterine bleeding:

• Malignant neoplasms of the uterus;
• Climax;
• Childbirth;
• Endometriosis;
• Young age;
• Inflammatory diseases;
• Pregnancy;
• Hormonal imbalance;
• Blood diseases;
• Hormonal drugs;
• Ovarian diseases;
• Benign neoplasm.

First of all, it is worth understanding that in adolescence, as well as during menopause, menstrual irregularities are quite often observed. If this problem has been bothering a girl for a long time, she may well get used to the irregular cycle. Sometimes the appearance of bleeding may not be detected immediately. Girls whose current menstruation is their first cannot yet know all the features of this process. Usually, the cycle of young ladies gradually stabilizes, and the amount of discharge becomes normal.

In addition, bleeding may occur as a result of taking hormonal contraceptives. In this case, it is strictly recommended to consult a doctor for advice. If necessary, you will be prescribed pills that will help restore the balance of the necessary hormones, after which such discharge will stop.

If the patient complains of massive discharge without inclusions and clots, or of prolonged discharge, which is accompanied by the leakage of a small amount of dark blood, then most likely the cause is a benign neoplasm. Also, spotting can make itself felt during pregnancy. In this case, the cause may be a ruptured tube, as well as detachment or improper placement of the placenta. The consequences can be fatal for both the woman and her child.

Classification of discharge

In total, there are three main types of uterine bleeding: normal, conditionally normal and pathological.

Symptoms

Since this condition is quite dangerous for a woman’s health, it is worth considering in more detail the symptoms of both uterine and menstrual bleeding. It will help you learn to recognize and differentiate between these two types of bleeding. A small list of symptoms that can help you distinguish bleeding from menstruation:

• An increase in the volume of blood released;
• Increased duration, as well as changes in the nature of menstruation;
• Disappearance of clots.

As a result of the pouring out of blood, the amount of fluid in the bloodstream decreases. In this case, the following symptoms of shock may occur:

• Cardiopalmus;
• Excessive sweating;
• The occurrence of chills;
• Sharpening of facial features;
• Reduced blood pressure;
• Dizziness;
• Periodic occurrence of vomiting;
• The gaskets begin to get wet much faster than before;
• Loss of consciousness;
• Paleness of the skin and mucous membranes.

The following symptoms are typical for the development of anemia:

• The discharge becomes lighter;
• Cardiopalmus;
• Decreased levels of hemoglobin and red blood cells;
• Dizziness;
• Layering and brittleness of nails, hair loss;
• Lethargy;
• Fatigue quickly;
• Poor assimilation of the information received.

If you still cannot independently distinguish between menstruation and uterine bleeding, then you need to seek help from a doctor. He will not only help you understand the type of bleeding, but also prescribe treatment if necessary.

What to do, treatment

• Drink plenty of fluids;
• Reduce physical activity;
• Relax in the fresh air more often;
• Do not visit steam rooms or take baths;
• Avoid alcoholic drinks and coffee.

Experts recommend taking various decoctions to restore blood in the body. Nettle, viburnum bark, wheatgrass, oak bark and cinquefoil are perfect for this. The most effective are decoctions of nettle, oak bark and rose hips. They help stop bleeding and also perform a preventive function.

Causes of uterine bleeding

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

Symptoms of uterine bleeding

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

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

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

Types of uterine bleeding

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

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

Juvenile uterine bleeding

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

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

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

Uterine bleeding during the reproductive period

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

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

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

Bleeding associated with pregnancy and childbirth

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

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

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

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

Uterine bleeding during menopause

Dysfunctional uterine bleeding

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

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

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

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

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

Breakthrough uterine bleeding

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

Which doctor should I contact if I have uterine bleeding?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Treatment of uterine bleeding

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

Hemostatic agents used for uterine
bleeding

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

Dicinone for uterine bleeding

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

Dicinone is contraindicated in the following cases:

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

What to do with prolonged uterine bleeding?

Main signs of anemia:

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

Folk remedies

How to distinguish periods from bleeding When is bloody vaginal discharge normal, and when is it pathological and requires medical attention, perhaps urgently?

To understand this, it would be correct to consider the most common situations as a result of which such questions arise.

The main differences between uterine bleeding:

• too short a period from the beginning of the last menstruation, less than 21 days, when there were no gynecological manipulations, surgeries, or taking hormonal medications;
• heavy periods lasting more than 7 days and with blood loss of more than 120 grams (you need to change pads more often than once every 2-3 hours, they get wet through), starting on time or with a delay - this should be regarded as bleeding. This is where the difference lies.

Exactly the same signs distinguish cyclic spotting from bleeding in women during menopause. After the onset of menopause (this is the absence of menstruation for 12 months), there can be no menstruation. The ovaries are gone. And all spotting is uterine bleeding, most often associated with precancerous or cancerous diseases.

Discharge after an abortion or miscarriage can be considered menstruation and a new cycle can be counted from this day. The next critical days will be in about 1-1.5 months.

Blood during pregnancy

A pregnant woman cannot have any periods. Remember this! If you are sure that you are carrying a child, and you start bleeding or have spotting, you should regard this as a pathology.

Possible options.

1. Threat of miscarriage. In the early stages, miscarriages occur very often. At least one in eight expectant mothers lose a child in the first trimester. This cannot always be prevented. Sometimes progesterone medications help. But if the embryo has severe developmental defects, a miscarriage will occur in any case. This is how nature has programmed it so that the strongest survive.
2. Ectopic pregnancy. In addition to blood, the woman notes pain from one of the ovaries. A deadly condition if surgery is not performed and the fertilized egg is not removed. Possible rupture of the fallopian tube (the most common location of the fertilized egg).
3. Frozen pregnancy. If the embryo dies, sooner or later, the fertilized egg will be rejected and bleeding will occur. But, at least in Russia, they won’t expect a spontaneous miscarriage. The woman will be referred for curettage to avoid an infectious process and for psychological comfort.

Discharge after childbirth

Normally, postpartum discharge lasts 4-6 weeks. Immediately after birth they are very abundant. But after 3-5 days they become similar to moderate menstrual ones. After which they normally decline.

It is bad if the discharge stops after a short period of time, but it is noticeable that the uterus has not yet returned to its original size (the tummy remains). This means that there are still lochia in the uterus, it’s just “lazy”, it doesn’t want to contract, or perhaps the cervical canal is in spasm and doesn’t release them. An ultrasound will help figure this out. Often in such a situation, blood still appears, but it is very dark (since it has been in the uterus for a long time, it has had time to oxidize and darken), there may be large clots. This is not menstruation, and not the norm. If there is subinvolution of the uterus (slowing down of the reverse development of the uterus), intramuscular injections of Oxytocin for three days are usually sufficient, even if they were previously given in the maternity hospital. If an inflammatory process, endometritis, is diagnosed, antibiotics are required.

Another situation is when the uterus seems to have contracted, the lochia has almost stopped, but suddenly it begins to pour. Moreover, less than 5 weeks have passed since birth. This is real bleeding. And it is most likely caused by a placental polyp - a piece of placenta remaining in the uterus. The diagnosis is made using ultrasound and confirmed by histological material. It is taken during hysteroscopy or curettage. Unfortunately, we can’t do without them.

The earliest time real menstruation can begin after childbirth is 6 weeks. Moreover, regardless of whether there was a caesarean section or the woman gave birth naturally. With breastfeeding (BF), menstruation usually begins later than with artificial or mixed feeding. But not always.

After 6-8 weeks, you can expect your period for those who breastfeed their babies according to the schedule, once every 3-4 hours and with long breaks at night. Those who feed very often, on demand, should expect their critical days a few months after the introduction of complementary foods. Sometimes they are not present until the very end of lactation, even if it lasts 2 years or more. This is due to hormonal levels.

Blood after obstetric manipulations and operations

With any invasive gynecological procedure associated with penetration into the tissue of the cervix or body of the uterus, vagina, there will be bleeding due to the formation of a wound surface. But in different ways.

Cervical biopsy

After this procedure, bloody or bloody discharge occurs for 2-5 days, but in volume no more than menstruation. It is carried out in a hospital setting and the woman is left under observation for several hours. If heavy bleeding suddenly opens up, this happens if a large vessel is touched, it is coagulated (“cauterized”) or the woman is given a hemostatic sponge (to stop bleeding). There is no need to remove it; it dissolves itself into the vagina. But on top of the sponge, so that it holds better, insert a cotton swab. You need to get it yourself after a few hours.

Typically, a cervical biopsy is performed midway through the menstrual cycle. After it, bleeding occurs that is not related to the functioning of the reproductive organs and hormonal levels. And menstruation, essentially a new cycle, begins approximately two weeks from the day of the procedure.

Cauterization of erosion

It should be done immediately after menstruation so that the wound has time to heal before the next menstruation. The discharge after cauterization is usually sanguineous - that is, like blood diluted with water. However, sometimes severe bleeding occurs, then doctors use hemostatic sponges to stop it and coagulate the bleeding vessels.

Approximately 10-14 days after cauterization of the erosion, bloody or spotting discharge may occur again. But they stop within 1-2 days (if they are not the beginning of menstruation). They occur due to the removal of a scab (a crust from a wound).

Sometimes minor spotting persists for longer than 1-2 weeks. It is explainable. For example, after diathermocoagulation (cauterization with electric current), the cervix heals in 6-8 weeks. The same amount of discharge can be observed if there is no other reason for its appearance.

Conization of the cervix

This is the removal of the affected part of the cervix in the form of a cone. The intensity and duration of bleeding depends on the area of ​​the wound surface. There is usually light red discharge for a couple of weeks.

Conization is usually performed immediately after menstruation, in the first half of the menstrual cycle. That is, you need to wait for your period on the normal days of your cycle. If the discharge from conization remains by the time it starts, you will notice an increase in it. Don't be alarmed, everything is normal.

Curettage or hysteroscopy

They are done on the last day of the menstrual cycle, but before the onset of menstrual bleeding, so as not to disrupt the cycle. The day on which the procedure was performed can usually be considered the first day of a new cycle. The discharge is bloody, the same in abundance as normal menstruation, lasting up to 7 days.

If the procedure was performed urgently, for example, on the 10-14th day of the cycle, then the woman will first expect postoperative bleeding (similar in nature to menstruation), and then, 2-3 weeks later, again, but now menstruation according to the calendar.

Discharge when taking birth control pills

In the first months of taking a contraceptive (meaning regular, regular contraception with pills), women may experience light bleeding before the pills in the package run out, that is, before the break. In this way, the body “gets used” to the drug. But if this continues for more than 3-4 months, it makes sense to change the contraceptive to one that has a different composition.

Normally, in women taking oral contraceptives according to a regimen that does not skip pills, discharge begins during the break between packs of the drug. This is not even real menstruation, but so-called withdrawal or menstrual-like bleeding. However, despite the menacing name - “bleeding”, blood loss during it is less than during normal menstruation. All thanks to the hormonal action of tablets that block ovulation and prevent the endometrium from growing too much.

If a woman stops taking pills without finishing the pack, she will experience spotting within 7 days. This is also withdrawal bleeding, which should be regarded as menstruation. Even if it started 2 weeks after the previous one. It is provoked by your actions - premature termination of taking the pills. But it usually lasts no more than 5-7 days, not too much.

A reader contacted us with the following problem: “I started getting smudges while taking hormonal medications. I thought it was my period. I quit taking pills. Two days later the bleeding started. What to do?"

The gynecologist’s answer: “Initially it was discharge associated with “getting used to” the drug. But since the woman stopped taking the pills, she experienced withdrawal bleeding (menstruation began). Thus, the cycle is broken. But it doesn’t matter if it doesn’t happen again in the future. If no more than 5 days have passed since the start of bleeding, you can start taking pills. But don’t stop taking them until the end of the package, even if a spot appears.”

When taking an emergency contraceptive drug (for example, Escapelle or Postinor), many women experience menstrual-like bleeding after 1-3 days, which gynecologists consider to be a new menstrual cycle. Even if it started 2 weeks after your period. See a doctor if it lasts more than 7 days and is unusually heavy. Because of such cycle disturbances, emergency contraception should be used as little as possible.

Implantation bleeding, ovulation or periods

Around the middle of the menstrual cycle, ovulation occurs in women of reproductive age - the follicle ruptures in the ovary and releases a mature egg, ready for fertilization. This is accompanied by a short-term drop in progesterone levels, which in some women causes short-term spotting.

About a week after ovulation or 3 weeks from the first day of your last menstrual period, you may start to bleed a little again. This happens with implantation bleeding, that is, when an already fertilized egg tries to penetrate the mother’s tissue for further development.

With late ovulation, implantation bleeding can begin on days when your next period was expected or even occur when there is already a slight delay. This happens with late ovulation, with an irregular cycle.

How to distinguish discharge during implantation from normal menstruation? The volume of discharge differs significantly. When pregnancy begins, this is literally a few drops. The woman thinks that she is beginning to have red days, but the discharge suddenly stops and does not return. And another 3 days after this, you can take a pregnancy test, since the hCG hormone will already be produced. In this case, the test done earlier, on the first day of the delay, as recommended by gynecologists, may be negative.

How to stop bleeding

Since it leads to iron deficiency anemia, in addition to the enormous inconvenience experienced by a woman who is forced to constantly change tampons and pads, urgent measures are needed.

The method to stop the bleeding will be chosen depending on its cause. Earlier in the article, we briefly reviewed them, as well as the measures that doctors take.

Let’s summarize everything point by point and add additional information.

• Spotting in a healthy woman does not require treatment, as it is most often a reaction to hormonal birth control (if taken), ovulation, or implantation of the fertilized egg.
• If ultrasound shows a pathology, for example, placental polyp or endometrial polyp, endometrial hyperplasia, curettage is performed while simultaneously taking histological material. Thus, the bleeding stops, and the exact cause of what happened is clarified.
• If bleeding is associated with endometriosis (adenomyosis), hormonal drugs are prescribed.
• If the cervix bleeds, a thorough examination and treatment is carried out. In turn, treatment in the form of cauterization, conization, or even amputation of the cervix again leads to bleeding. But this is absolutely normal and does not last long.
• Heavy postpartum bleeding is usually associated with poor uterine contractility. Treatment is intramuscular injections of Oxytocin.
• Bleeding during pregnancy is a sign of a threatened miscarriage. Requires hospitalization in a hospital, the prescription of progesterone and hemostatic drugs.

A good article on the topic - the most modern hemostatic drugs, folk remedies and dosage regimens. .

Menstrual flow is a normal occurrence for the female body. The duration of the menstrual cycle is usually from 28 to 35 days, and the duration of discharge is from 3 to 7 days. All deviations from these indicators are considered to be a pathology that must be diagnosed and subsequently treated.

Causes of gynecological bleeding

In very young girls, the monthly cycle may be irregular. After 1.5-2 years, it gradually stabilizes with minimal deviations in timing. Disruptions in the menstrual cycle in an adult woman of childbearing age are noted in the presence of inflammatory processes in the organs of the genitourinary system or other serious diseases.

If the onset of menstruation is delayed, you should promptly contact a gynecologist to undergo an appropriate examination. If the cyclicity is unstable, a woman may mistake uterine bleeding for menstruation, which is a symptom of the disease. Sudden bleeding may occur in the following cases:

• use of an intrauterine device;
• endometriosis;
• uterine fibroids;
• cystic formations in the cervix;
• the presence of tumor formations;
• against the background of inflammatory diseases of the uterine appendages;
• in the first months after childbirth;
• in case of repeated cases of termination of pregnancy.

Differences between normal menstruation and bleeding

If menstrual flow begins on time, but is heavy, you should be very careful. Some basic signs will help you distinguish normal menstruation from bleeding:

• Menstrual flow lasts more than a week.
• A pad or tampon becomes completely wet in less than 1 hour, and this is observed throughout the day.
• The discharge contains a large number of blood clots.
• Fatigue, weakness, and decreased blood pressure appear due to large blood loss.
• There is intense pain in the lower abdomen.
• Bloody discharge appears immediately after sexual intercourse.

If you have one or more of these symptoms, you should consult a doctor.

How to distinguish bleeding during pregnancy from menstruation

If you have had unprotected sexual intercourse in the recent past, spotting before your period may be a sign of pregnancy.

This type of bleeding is called implantation bleeding. As a rule, we are talking about scanty pinkish discharge, formed due to the attachment of the fertilized egg to the wall of the uterus. In combination with other signs - nausea, dizziness, general malaise, this condition means the presence of pregnancy.

How to distinguish bleeding from menstruation after childbirth

A special type of discharge is the so-called lochia, which occurs immediately after the birth of the child. The duration of such discharge is up to 10 weeks. This is a normal condition in which the remains of the placenta are removed from the woman’s body. In the first 2 weeks, the discharge has a bright bloody color, later it becomes lighter - brown or pinkish.

Lochia can be distinguished from menstrual discharge by the volume of fluid. In the first days after natural childbirth, up to 500 ml is considered normal, for a caesarean section - 1000 ml. The daily rate of monthly discharge should not exceed 100 ml.

Bleeding during this period can be suspected in the following cases:

• After 6-8 weeks after the onset of lochia, the discharge again acquired a bright scarlet color.
• The discharge has an unpleasant odor.
• The discharge is too abundant and thin, without the presence of clots.
• The sanitary pad is changed every 1-1.5 hours.
• There is an increase in temperature, slow pulse, general weakness, and headache.

What to do?

If you notice signs of uterine bleeding, you can do the following as first aid:

• drink plenty of water;
• eliminate physical activity;
• do not take a bath;
• avoid overheating;
• give up coffee and alcoholic drinks;
• Ensure a state of rest by placing ice or a heating pad with cold water on the lower abdomen.

Be sure to consult a doctor for diagnosis and treatment. In addition to prescribing hemostatic and hormonal drugs, a diagnostic curettage procedure is usually performed. This method allows not only to stop bleeding, but also to determine the cause of its occurrence. It should be noted that in nulliparous women this method of treatment is used only in exceptional cases.