What kind of blood flows in the genitals? The most common diseases that cause bleeding. If blood appears in semen

Uterine bleeding a formidable symptom of various diseases of the female body. Failure to provide adequate assistance can lead to tragic consequences. Stopping uterine bleeding is not an easy task due to the many causes. So what are the causes of bleeding and how to properly provide help?

Anatomy of the uterus

1) perimetry– a layer that covers the outside of the uterus and passes into the wall of the abdominal cavity;

2)myometrium– the most massive layer of the uterus, consisting of muscle fibers, containing a large number of vessels feeding the uterus;

3)endometrium- the membrane lining the inside of the uterine cavity. It is the endometrium that thickens during the menstrual cycle and prepares for the implantation of the fertilized egg.

The endometrium is divided into 2 layers: main (basal) and functional, which is rejected monthly if fertilization of the egg does not occur. The rejection of the functional layer of the endometrium is what we call menstruation. However, if there is a failure in the hormonal system, the rejection of the functional layer may not be effective. As a result, part of the endometrium remains, and with it many dilated glands and vessels that begin to bleed. This is how they arise dysfunctional uterine bleeding.

Types and causes of uterine bleeding

1) bleeding as a result of disorders in various organs and systems, 2) bleeding associated with disorders in the sexual sphere.

Nongenital causes of bleeding (extragenital)

• Infectious diseases (influenza, measles, typhoid fever, sepsis);
• Blood diseases (hemorrhagic vasculitis, hemophilia, deficiency of vitamin K and C, etc.;
• Liver disease (cirrhosis);
• Diseases of the cardiovascular system (high blood pressure, atherosclerosis, etc.);
• Decreased thyroid function.

1. Uterine bleeding as a result of disorders in the sexual sphere (genital).

Genital causes associated with pregnancy (early periods)

1. Disturbed pregnancy (uterine, ectopic)
2. Disease of the ovum (hydatidiform mole, chorionepithelioma-malignant tumor)

• Causes in late pregnancy
  • Placenta previa
  • Scar on the uterus
  • Processes of tissue destruction on the cervix
  • Other obstetric causes
• Causes during childbirth
  • Premature placental abruption
  • Placenta previa
  • Low-lying placenta
  • Uterine rupture
  • Injuries to the vagina and vulva
  • Delay in discharge of separated placenta
  • Strangulation of the placenta
  • Violation of placenta attachment
  • Injuries of the soft birth canal
• Causes after childbirth
  • Decreased uterine tone
  • Injuries of the soft genital tract
  • Retention of parts of the placenta
  • Chorionepithelioma

Genital causes not related to pregnancy

1. Discirculatory uterine bleeding

• Juvenile (during puberty 12-18 years);
• Reproductive (during puberty 18-45 years);
• Menopause (period of menopause);

1. Tumors

• Uterus
• Ovarian

1. Ovarian rupture, ovarian cyst rupture
2. Uterine injuries
3. Infectious and inflammatory diseases

Dysfunctional uterine bleeding (DUB)

Normally, the amount of blood loss is 30-40 ml, the upper limit of normal is 80 ml. With DUB, heavy bleeding of more than 100 ml occurs, which may or may not coincide with the time of menstruation.

There are bleedings that coincide in time with menstruation - menorrhagia, abundant and long-lasting. As well as bleeding that occurs between periods - metrorrhagia, they have varying intensity and are irregular.

Dysfunctional uterine bleeding widespread among women, especially between the ages of 30 and 40. The main cause of DUB is a disruption of the ovulation process.

The impossibility of the ovulation process is caused by a malfunction in the woman’s hormonal system (changes in the level and rhythm of secretion of luteinizing and follicle-stimulating hormone). As a result, the mucous membrane of the uterus (endometrium) grows with insufficient development of glands and blood vessels, accumulation and stagnation of blood occurs, blood circulation is impaired, and the permeability of blood vessels changes. This creates favorable conditions for bleeding to occur. And when the endometrium is rejected, it is not rejected evenly, which results in bleeding of varying severity and duration.

In addition, during such hormonal disorders at the level of the uterus, the function of platelets (the main cells of the coagulation system) decreases and blood thinning processes increase, which further increases bleeding.

Factors causing disruption of the hormonal system

• Chronic and acute infectious diseases
• Reduced amount of vitamins (hypovitaminosis)
• Physical overload
• Mental trauma

• Emotional and mental stress
• Complicated abortions and childbirth
• Diseases of the endocrine glands (thyroid gland, etc.)
• Inflammatory diseases of the genital organs

• Acute and chronic infectious diseases
• Neuropsychic trauma

Symptoms of uterine bleeding

• Weakness, dizziness
• Pale skin
• Possible nausea, vomiting
• Fainting
• Rapid and weak pulse
• Lower blood pressure

• Discharge of blood from the vagina
• During menstruation, discharge of a large number of blood clots. The pad or tampon gets wet quickly and abundantly. Frequently change the gasket at night (every 1-2 hours).
• Increased duration of bleeding (more than 7-8 days). Normally, menstrual bleeding lasts 3-8 days.
• Possible bleeding after intercourse
• Dysfunctional uterine bleeding is almost painless
• Bleeding often does not coincide with the period of menstruation

Uterine bleeding that appears after a delay in menstruation, as a rule, indicates their functional nature.

Cyclic, abundant bleeding more often occurs with fibroids, adenomyosis and blood diseases.

First aid for uterine bleeding

Uterine bleeding a formidable signal about a violation in a woman’s body. And accordingly, you should respond to it very seriously. First of all, you need to call an ambulance or see a doctor. Only a doctor is able to adequately assess the situation, since there are many reasons that can cause uterine bleeding and only medical experience allows you to take a holistic look at the problem.

Step by step guide:

What not to do

• Apply a warm heating pad
• Do douching
• Take a warm bath
• Take medications that contract the uterus without consulting a doctor.

What to do

Help steps, what to do?	How to do it?	For what?
What can you do yourself at home?
Bed rest	Lay on the bed (lying on your back), raise your legs, place a bolster or pillow under your feet.	This will allow blood to wash vital organs (brain, liver, kidneys) and in case of significant blood loss, the risk of loss of consciousness and severe complications is reduced.
Coldness in the lower abdomen	You can use an ice pack only after wrapping it in cloth to avoid frostbite. Or you can put a heating pad, a bottle filled with cold water, etc. Place the ice for 10-15 minutes, then take a 5-minute break, repeat for 1-2 hours.	Cold constricts blood vessels, thereby reducing bleeding.
Replenish fluid loss from the body	In case of blood loss, it is necessary to replace the lost volume of fluid from the bloodstream. Without the ability to put in an IV, drinking plenty of fluids will do. Water, sweet tea, rosehip tea, etc.	Water will reduce the amount of fluid lost along with blood. Glucose will nourish the tissues and mainly the nerve cells of the brain. Tea with rose hips (which contains a large amount of vitamin C) helps to protect the walls of blood vessels, which also reduces bleeding.
Medicines(hemostatic drugs) Drug treatment should be resorted to only after consultation with a specialist doctor or in emergency situations.	Dicynone inside 0.25 g. 4 times a day Calcium gluconate 3-4 times a day, 1 tablet. inside. Aminocaproic acid- 30 ml orally 3-5 times a day; Ascorbic acid up to 1 gr. per day. Vikasol - orally 0.015 g 3 times a day Nettle, water pepper in the form of tinctures orally, 100 ml 3 times a day. The products increase the tone and activity of the uterine muscles.	Taking hemostatic drugs requires consultation with a specialist doctor, especially if the woman is pregnant. In addition to the hemostatic effect, drugs can cause various side effects.
Medical care used in the hospital:
Stopping bleeding with hormonal drugs(with DMK)	Monophasic combined oral contraceptives (COCs) are used as hormonal agents: Regulon, Janine, Non-ovlon, etc. Mode of application: On the first day, use 3-6 tablets until bleeding stops. Then, every subsequent day, the dose is reduced by 1 tablet from the original amount. So if on the first day you take 5 tablets, then the next day you take 4. And so they reduce it to 1 tablet per day, which should be taken for 21 days. Also, gestogens (noethistirone 5 mg, linestrenol 10 mg, dydrogesterone 10 mg) can be used as a hormonal stop of bleeding. But this type of bleeding control is slower and is not used in women with severe anemia. Mode of application: 3-5 tablets per day until bleeding stops. Then every 2-3 days the dose is reduced by 1 tablet. The total period of use is no more than 10 tablets, 2 tablets per day.	To whom and under what conditions can uterine bleeding be stopped using hormonal drugs: Young women who have not given birth and are not at risk for the development of tumor processes in the endometrium. If curettage for diagnostic purposes was carried out no more than 3 months ago, and no pathological processes in the endometrium were detected.
Hemostatic drugs	Aminocaproic acid: Application: 30 ml orally 3-5 times a day or 100 ml 5% solution intravenously. Dicynone(sodium etamsylate) intramuscularly 2 ml 1-4 times a day for 7 days or orally 0.25 g. 4 times a day; Tranexam: for profuse bleeding 1000-1500 mg, 3-4 times a day, 3-4 days. Vikasol IM 1% -1 ml or orally 0.015 g 3 times a day, for 3 days; Askorutin 0.25 g orally 3 times a day, for 7 days, strengthens the vascular wall; Drugs that increase uterine tone: Oxytocin(pituitrin) – 5 units – 1 ml, IM; 1 ml intravenously in 500 ml of 5% glucose solution per day, up to 7 days; Ergotal– 0.05% -1 ml IM Not for uterine fibroids!	Aminocaproic acid: has a hemostatic effect mainly due to the inhibition of processes that provide blood thinning. The drug can dramatically increase blood clotting due to the massive release of substances that activate the coagulation system from the tissues. Therefore, the drug is contraindicated in DIC syndrome. Dicynone (etamsylate): has a rapid hemostatic effect. Increases platelet activity and number. Does not cause increased blood clotting and can be used for a long time. It is effective both when administered intravenously and when taken orally. Oxytocin: a hormonal drug obtained from the brain gland (pituitary gland) of cattle. It has a direct stimulating effect on the muscle tone of the uterus, causing it to contract. It also constricts blood vessels and reduces diuresis. In obstetric practice, it is usually used for decreased uterine tone, bleeding in the early postpartum period and to stimulate labor. The drug is contraindicated for myocarditis, high blood pressure, malpositioned fetus, thrombophlebitis, kidney pathology in pregnant women, etc. Tranexam– a drug that has a pronounced hemostatic effect, and also has anti-inflammatory, anti-allergic, anti-infectious and anti-tumor effects. When used simultaneously with other hemostatic drugs, the risk of blood clots increases.
Surgical methods to stop bleeding	- Scraping uterine cavity and cervical canal. -Cold treatment (cryosurgery), use special devices with liquid nitrogen to destroy the upper modified layer of the uterus. - Endometrial ablation, removal of the endometrium using a laser, loop or ball electrode, as well as using electromagnetic energy. When exposed to various types of energy, the endometrium “evaporates.”	Scraping is the most effective and main method of stopping bleeding in women of the reproductive and menopausal periods. Cryotherapy- The procedure has no contraindications. Gives a lasting healing effect. Endometrial ablation – performed on patients who are not interested in having children.
Traditional recipes for stopping bleeding Important! Traditional medicine recipes should be used as an addition to the main treatment and should be discussed with a specialist doctor.
Compound:	Method of preparation and use	Effect
Nettle	1 tbsp. dried leaves, pour 200 ml of boiling water, leave for 30 minutes. Take half a glass 3 times a day.	Contains large doses of vitamin C, which helps strengthen blood vessels. Increases blood clotting, increases uterine tone.
Viburnum bark	1 tbsp. crushed bark, pour 200 ml of boiling water, heat for 10 minutes. over heat, strain. Take 3-4 times a day, 2 tbsp.	It has a vasoconstrictor, analgesic and antiseptic effect.
Horsetail	Prepare the infusion: 2 tsp. for 200 ml. boiling water 1 table each. take a spoon every 2 hours.	It has hemostatic, anti-inflammatory, wound healing, and diuretic effects.
water pepper	1 tbsp. chopped herbs pour 200 ml of boiling water. Leave for 60 minutes. 1 tbsp. take 3 times a day.	Accelerates blood clotting processes, reduces the permeability and fragility of blood vessels, has an analgesic and wound-healing effect. A good antiseptic.
Highlander	3-4 tsp. herbs pour 200 ml of boiling water. Leave for 60 minutes. 1 tbsp. take 3 times a day half an hour before meals.	Has a strong hemostatic effect.
Shepherd's Purse	10 gr. herbs pour 200 ml of boiling water. Take 3 times a day, 1 tbsp.	Used for decreased uterine tone and bleeding. Increases the tone of the uterine muscles and promotes contraction of the uterine muscles.
Yarrow	1 des.l. herbs pour 200 ml of boiling water, leave for 60 minutes. Take 3-4 times a day, 1/3 cup half an hour before meals.	Drink tea after bleeding stops, for prevention.

Prevention of dyscirculatory uterine bleeding

1. General restorative measures: proper work and rest schedule, healthy eating, avoidance of stressful situations and negative emotions.
2. Taking anti-inflammatory drugs for the first time for 1-2 months (mefenamic acid 50 mg, 3 times a day; nimesulide 100 mg 2 times a day).
3. For the first time 1-2 months, taking hemostatic drugs (aminocaproic acid and its derivatives).
4. Treatment with hormones (estrogen-gestagen drugs, progestin drugs). The average duration of treatment is 3-6 months. The ineffectiveness of hormonal therapy may indicate an incorrectly identified cause of bleeding, or incorrect selection of the drug or its dose, individual sensitivity, or premature termination of the course.
5. Vitamins: vitamin C 1 g. per day from the 16th day of the cycle, for 10 days; folic acid 1 tablet. knocking from the 5th day of the cycle for 10 days; tocopherol acetate for 2 months, multivitamin and mineral preparations containing iron and zinc.
6. Drugs that calm and stabilize the nervous system (tincture, valerian, novopassit, etc.).
7. Physical education, fitness, swimming, jogging, yoga, dancing, etc. are useful.

Bleeding may be caused by various gynecological problems.

diseases, pathology of pregnancy, childbirth and early postpartum

rioda. Bleeding from a woman’s genital tract occurs much less frequently

associated with injury or diseases of the blood system and other systems.

BLEEDING IN DISEASES OF THE GENITAL SYSTEM. In gynecological

patients bleeding may be associated with various functional and

organic diseases of the genital organs. There are cyclic and

acyclic bleeding. The former (menorrhagia) are characterized by cyclic

emerging bleeding from the genital tract, longer (more than

5-6 days) and more abundant (blood loss more than 50-100 ml) in contrast to

normal menstruation. Acyclic bleeding occurs between

menstruation (metrorrhagia). In case of severe disorders, it is impossible to detect a cyclic

personality bleeding, so patients lose their understanding of menstruation

cycle and inform the doctor about bleeding that occurs at the most inopportune

limited time. Such bleeding is also called metrorrhagia.

Bleeding such as menorrhagia occurs with endometritis, uterine fibroids,

endometriosis. With these diseases, the contractile mode changes -

uterus, which determines the intensification and prolongation of menstrual flow

bleeding. Menorrhagia occurs much less frequently in cancer of the body.

ki. Sometimes cyclic bleeding can be a symptom of diseases

other systems (Werlhof's disease, cardiovascular diseases,

neither liver, thyroid gland, etc.).

Symptoms. Prolongation of the period of uterine bleeding and increase in the amount

quality of lost blood. As a result of recurrences of such bleeding,

develop posthemorrhagic anemia (see). Along with menorrhagia-noted-

There are also other symptoms inherent in a particular disease.

Diagnosis. In acute endometritis, the patient may have an increase in temperature

rature, pain in the lower abdomen. During vaginal examination in case of acute

the inflammatory process is found to be slightly enlarged and painful

uterus; Often the infection simultaneously affects the uterine appendages (salpi-

nogoophoritis). Chronic endometritis occurs without a temperature reaction

and is rarely accompanied by pain. For chronic endometritis

The uterus can be slightly enlarged or normal in size, dense, painless

painful or weakly sensitive to palpation. Characteristics

the disease is associated with a complicated course of post-abortion (more often)

or postpartum (less often) period.

With multiple uterine fibroids, patients, in addition to menorrhagia, may complain

be based on pain (with necrosis of the node) or dysfunction of the urinary tract

zyra or rectum, if the growth of the nodes is directed towards these organs.

Submucosal (submucosal) mimoma of the uterus is accompanied not only by cyclic

ical, but also acyclic bleeding. During vaginal examination

find an increase in the size of the uterus, which has an uneven tuberous surface

surface, dense consistency, painless on palpation. When sub-

With mucosal fibroids, the size of the uterus may be normal.

Endometriosis of the uterine body is accompanied not only by the phenomena of menorrhagia,

but also severe painful menstruation (algomenorrhea). Algodis-

menorrhea is progressive. During vaginal examination you

is an enlargement of the uterus. Cervical endometriosis leads to

the occurrence of menorrhagia, but is not accompanied, unlike endometriosis of the body

uterus soreness. Endometriosis of the uterine body is characterized by its enlargement

size (up to 8-10 weeks of pregnancy), while unlike fibroids on the surface

The uterus is smooth, not lumpy. Relatively often, endometriosis

ki is combined with endometriosis of the ovaries and retrocervical cells.

Bleeding such as metrorrhagia is most often dysfunctional

nature, less often they are associated with organic lesions of the uterus (body cancer,

cervical cancer) or ovarian cancer (extrogen-producing tumors).

Dysfunctional uterine bleeding (DUB) is not associated with extrauterine

nital diseases or organic processes in the genitals,

a are caused by disorders of the menstrual cycle regulation system: hypo-

thalamus - pituitary gland - ovaries - uterus. Most often, functional disorders

of this nature arise in the central links of cycle regulation (hypothala-

mus and pituitary gland). DMK - polyethylological fertilization. The basis of pathogenesis

DMC are caused by stressful moments, intoxication (often of a tonsillogenic nature)

tera), endocrine function disorders, etc. In most cases, DUB is

are anovular, i.e. occur in the absence of ovulation in the ovaries -

atresia and persistence of the follicle. In atresia, follicles develop into

for a short time and do not undergo ovulation. As a result

there is no corpus luteum that produces progesterone, under the influence of which

when secretory transformations of the endometrium occur and

menstruation. Follicular atresia is accompanied by low production of est.

Rogenov. In contrast, persistence is characterized by a long

rapid development of the follicle with the formation of significant amounts of estro-

gene hormones. With persistence, ovulation and development also do not occur.

tia of the corpus luteum. In pathologically overgrown under the influence of estrogens

endometrium, vascular disorders occur, leading to necrotic

changes in the mucous membrane; the overgrown endometrium begins to shed

escape from the walls of the uterus, which is accompanied by prolonged and often abundant

bleeding. There is a delay before bleeding occurs

menstruation for 2 weeks or more.

DMCs occur at different age periods of a woman’s life: during

formation of menstrual function (juvenile bleeding) during childbearing

ny period and in the premenopausal period (menopausal bleeding).

Symptoms. The occurrence of bleeding is usually preceded by a temporary

amenorrhea lasting from several weeks to 1-3 months. Amid the delay

bleeding appears during menstruation. It can be abundant or scanty

long, relatively short (10-14 days) or very long (1-2 months).

Absence of pain during bleeding is typical for DUB. Prolonged bleeding

disease, especially of a recurrent nature, leads to the development of secondary

anemia. Anemia occurs especially often during juvenile bleeding in

girls with infantilism traits.

The diagnosis is based on medical history (indications of stressful situations

ations, intoxications, inflammatory diseases of the genital organs, etc.),

the presence of characteristic delays in menstruation with subsequent occurrence

prolonged bleeding. Vaginal examination reveals a small

enlargement of the uterus (this sign is absent in juvenile age) and acid

significant change in one or two ovaries.

Differential diagnosis of DUB largely depends on

age of the patient. In juvenile age, DMC must be differentiated

from blood diseases (Werlhof's disease), estrogen-producing tumors

ovary (granulosa cell tumor). During childbearing age, MMC should be

distinguished from bleeding due to the onset or incomplete spontaneous

free abortion, ectopic pregnancy (see), hydatidiform mole, ho-

ryonepithelioma, submucous uterine fibroids, cancer of the cervix and uterine body. IN

premenopausal age DMC must be differentiated from cervical cancer

ki and body of the uterus, uterine mima, estrogen-producing ovarian tumor

(granulosa cell tumor, thecoma).

The diagnosis of Werlhof's disease is made on the basis of a blood test for thrombus

bocytes (thrombocytopenia). A hormonally active ovarian tumor is determined by

detected during vaginal examination, as well as when using endoscopy

chemical (laparoscopy; culdoscopy) and ultrasound methods. When self-

In voluntary abortion, an enlarged and softened uterus is found, slightly open

cervix and other signs of pregnancy. Ectopic pregnancy ha-

characterized by severe pain symptoms, internal blood

course, unilateral enlargement of the uterine appendages, their sharp painful

ness and other symptoms. Uterine fibroids are diagnosed based on their

increase, the presence of a characteristic bumpy surface, dense consistency

tendencies. For the diagnosis of submucosal mimoma, they are used in hospital conditions.

Nara additional research methods (hysteroscopy, hysterography,

ultrasonography). Cervical cancer is detected during examination

patient using mirrors. Endometrial cancer is diagnosed mainly based on

new data from uterine curettage. Hydatidiform mole and chorionepithelioma

are rare, so differential diagnosis of DUB with these conditions

diseases is of little practical importance.

Urgent Care. In case of menorrhagia due to extra-

genital disease, endometritis, uterine fibroids and endometriosis are administered

uterine contractants. For minor bleeding, limit

by administering drugs orally; for stronger drugs, parentere-

ral. Oxytocin is administered intramuscularly, 1 ml (5 units) 1 - 2 times a day.

Methylergometrine is also administered intramuscularly (1 ml of 0.02% solution). At

administration of oxytocin, the uterus relaxes again after a rapid contraction,

which leads to renewed bleeding. When administering methylergometrine

uterine contractions are longer in nature, which is more reliable with

from a hemostasis point of view. Methylergometrine can be administered after a while

time after administration of oxytocin. For bleeding caused by fibroids

uterus, the introduction of substances that cause strong contractions of the muscles of the uterus

ki should be performed with great caution due to the risk of ischemia and

necrosis of the tumor node. For relatively minor menorrhagia, contractile

the uterus is given orally: ergotal 1 mg 2-3 times a day, ergometrine

maleate 0.2 g 2-3 times a day. With more severe menorrhagia, these benefits

parathas are administered parenterally. Along with drugs of the ergot group, they are administered

vikasol (1-2 ml of 1% solution intramuscularly), calcium gluconate (10 ml of 10%

solution intramuscularly), aminocaproic acid (50-100 ml of 5% solution

intravenously). For minor bleeding, this drug is given orally (from

calculating 0.1 g per 1 kg of body weight), having previously dissolved the powder in

sweet water. Usually, with the help of such measures it is possible to weaken, but not

stop the bleeding completely. Along with drug therapy

apply cold to the lower abdomen (ice pack for 20-30 minutes after a break -

For DUB, symptomatic therapy described above usually or does not provide

pronounced positive result, or causes temporary hemostatic

pouring effect. Therefore, immediately after hospitalization or in case of emergency

day delay in hospitalization along with the introduction of uterine contractions

agents and drugs that increase blood clotting must be started

use of hormonal hemostasis. In patients with juvenile uterine

bleeding, stopping bleeding begins immediately with hormonal he-

Mostaza. During childbearing age, this treatment method is usually used

only after they are convinced of the absence of precancer or endocrine cancer

metry (the need for preliminary diagnostic curettage!).

During the premenopausal period, stopping DUB in all cases begins with

for diagnostic separate (body and cervical canal) curettage

uterine mucosa. If such an intervention was undertaken

relatively recently, then if endometrial cancer is excluded, we can start in

the procedure for providing emergency assistance is to stop bleeding with the help of a

monal drugs.

Estrogens for hemostasis are prescribed in large doses: 0.1% solution of est.

radiol dipropionate 1 ml intramuscularly every 2-3 and or ethinyl estre-

diol (microfollin) 0.05 mg every 2-3 and (tie more than 5 tablets per day -

ki). Hemostasis usually occurs within the first 2 days. Then doses of estro-

genes are gradually reduced and introduced over another 10-15 days. Combi-

lated estrogen progestogen drugs (bisecurin, nonovlon) are prescribed

for the purpose of hemostasis, 4-5 tablets per day at intervals of 2-3 hours. Usually

bleeding stops within 24-48 hours from the start of treatment. Then when

The number of tablets is gradually reduced (one per day) until the appointment

only one tablet per day. The general course of therapy is 21 days. Hemostasis with use

the use of pure gestagens (norkolut, progesterone) is used less frequently

due to the risk of increased bleeding in the first days of treatment, which is dangerous in

anemic patients.

With profuse bleeding due to advanced cervical cancer

sometimes when providing emergency care you have to resort to tight

vaginal ponade (see).

Hospitalization. Regardless of the cause of uterine bleeding with

profuse bleeding, the patient must be urgently hospitalized in a

non-ecological department.

In case of profuse bleeding, transportation

carried out on a stretcher, with large blood loss - with the head down

BLEEDING DURING PREGNANCY AND CHILDREN. Bleeding from the genitals

paths women can meet both in the first and second half

pregnancy. The causes of these bleedings are different.

In the first half of pregnancy, bleeding is mainly due to

spontaneous abortion. Significantly less bloody discharge from the mother’s

ki are associated with ectopic pregnancy (see), as well as with the development

trophoblastic diseases (hydatidiform mole and chorionepithelioma).

Symptoms. Spontaneous abortion is accompanied by the appearance of blood

discharge from the genital tract, the severity of which depends on

depending on the stages of development of abortion.

With a threatened abortion, the patient complains mainly of heaviness below

abdomen, slight cramping pain; Often these phenomena are combined

with scanty spotting dark bloody discharge. With vaginal

examination, the cervical canal is closed, the uterus is soft, easily excitable,

its size corresponds to the period of pregnancy. The self-propagation that began

voluntary abortion is characterized by increased bloody discharge from the

galina and more intense cramping pain in the lower abdomen. At

vaginal examination reveals a slightly open external ma-

precise pharynx, the size of the uterus corresponds to the period of pregnancy.

Abortion in progress represents the next stage in the development of self-producing

free abortion, in which the fertilized egg exfoliates from the walls of the uterus and

expelled into the cervical canal. This stage of abortion is accompanied by significant

body bleeding. During a vaginal examination, discolourations are revealed

digging the external pharynx and the cervical canal, in the lumen of which a

blood clots and parts of the fertilized egg are formed. The size of the uterus is slightly smaller

gestational age.

Incomplete abortion is characterized by the expulsion of most of the fertilized egg.

and the presence of their remains in the uterus, as a result of which the uterus cannot contract

crawl. This stage is characterized by severe, sometimes profuse bleeding.

nim. The pain is minor. During vaginal examination, the cervical canal

ki are freely passable for a finger, the size of the uterus is always smaller than expected

expected period of pregnancy. Complete abortion (rare) is accompanied by

due to the expulsion of all parts of the fertilized egg from the uterus. As a result of this, blood

the course is significantly less than with an incomplete miscarriage. Lower abdominal pain

almost absent. The cervical canal is passable for the finger, the uterus is significant

significantly less than the gestational age, dense.

When an infection occurs, an infected miscarriage develops (usually

only incomplete). The clinical picture is characterized by bleeding,

pain in the lower abdomen, fever, chills, changes in the picture

blood (leukocytosis, shift of the leukocyte formula to the left, increase in ESR).

A vaginal examination should determine whether there is an infection.

limited (affecting only the uterus), or it has gone beyond this

organ (complicated febrile miscarriage, septic abortion). In case of complications

In a febrile abortion, the uterine appendages are most often affected,

which can be palpated during vaginal examination.

Emergency care and hospitalization. Patients with all forms of self-proliferation

voluntary abortions are subject to urgent hospitalization. In the presence of profuse

of bleeding, the doctor on the spot is forced to perform a digital

removal of the remains of the fertilized egg (see). To contract the uterus during abortion in

progress, incomplete and complete miscarriage, apply cold to the lower abdomen and contract

uterine-sparing agents (oxytocin 1 ml intramuscularly). Application of the drug

ergot group compounds (methylergometrine, ergotal, etc.) are contraindicated

due to the property of simultaneously causing spasm along with uterine contractions

her neck. In a hospital, treatment is determined by the stage of the process and installation

the presence or absence of infection. When threatening and started

During abortion, means are used to maintain pregnancy. At

In case of ongoing abortion and incomplete miscarriage, they resort to instrumental removal

remnants of the fertilized egg. Infected abortion is subject to intensive anti-

bacterial, infusion and desensitizing therapy. Scraping

uteruses are produced only for vital reasons (profuse bleeding

Bleeding in the second half of pregnancy and during childbirth is caused by

caught mainly by the incorrect location of the placenta (placenta previa)

cents), its premature separation from the walls of the uterus (premature

abruption of a normally located placenta), retained placenta or its

parts in the uterus, as well as partial placenta accreta. Expressiveness

bleeding can vary - from spotting to profuse

bleeding.

Symptoms. Placenta previa is characterized by the appearance of bloody

discharge from the genital tract at the end of pregnancy or at the beginning of labor. Cro-

The bleeding is painless, which is very typical for this pathology. When on-

external obstetric examination reveals a high location of the pre-

lying part. With significant bleeding, the fetus quickly develops

signs of intrauterine hypoxia (decrease in heart rate, deaf

and arrhythmic tones). The uterus is always painful on palpation. Vaginal

research to clarify the diagnosis outside the maternity hospital is absolutely

contraindicated due to the risk of profuse bleeding!

In case of premature abruption of a normally located placenta, if

it occurs over a considerable period, the woman complains of pain in

abdomen and uterine tension. Blood appears from the external genital tract,

however, the degree of external bleeding does not correspond to anemia

patient, since a significant part of the blood accumulates between the uterus and

placenta (retroplacental hematoma). Sometimes external bleeding

there may not be. During external obstetric examination, the uterus is tense

and painful, especially on the side of the placenta. The fetus quickly

symptoms of intrauterine hypoxia increase. Significant detachment of the pla-

cents quickly leads to collapse (pallor of the skin, threadlike

rapid pulse, decreased blood pressure).

Bleeding in the third stage of labor is mainly associated with a violation

separation and discharge of the placenta. Under normal conditions, within 10-20 minutes

After the baby is born, the placenta separates from the walls of the uterus and

birth of placenta. This process is accompanied by moderate blood loss - in

average 100-200 ml (upper limit of physiological blood loss 250 ml

blood). Blood loss over 400 ml requires emergency care.

If bleeding occurs in the third stage of labor, first of all

you should make sure that the placenta has completely separated from the walls of the uterus. On the-

The most accurate technique is when the hand, placed with the edge above the pubis,

exert pressure on the lower segment of the uterus through the anterior abdominal wall

ku. If the umbilical cord does not retract into the vagina, then the last

poured from the walls of the uterus completely and is located in the uterus. If, when pressing,

When the umbilical cord is retracted with the hand above the womb, the afterbirth is pulled away from the walls of the uterus

shared incompletely. Depending on whether it separated or did not separate

afterbirth from the walls of the uterus, the procedure for providing emergency care will vary

Emergency care and hospitalization. With placenta previa and possible

In the event of bleeding, the patient must be urgently hospitalized

maternity hospital. In the hospital, a vaginal examination to clarify the diagnosis

Nose is performed only in the presence of a deployed operating room! At the same time

premature abruption of a normally located placenta, the patient is also not

must be urgently taken to the maternity hospital.

If bleeding occurs in the third stage of labor and there is a

positive signs of placenta separation, the woman should be offered

urinate, and then push, and the placenta is often born spontaneously

Surely the bleeding stops. After the birth of the placenta, his attention

carefully inspected. If the placenta lobules are intact, then external

uterine massage. If the placenta is not completely separated (signs of separation

placenta are negative) nothing should be done at home

any manipulations to separate and release the placenta, as this may

lead to increased bleeding. The woman should urgently be

to be taken to the maternity hospital.

In all cases of bleeding during pregnancy and

during childbirth, during transportation of the patient, cardiotonic drugs must be administered

medications and give oxygen to breathe. In case of severe bleeding and development

When the patient collapses in the ambulance, they begin blood transfusion.

Postpartum hypotensive bleeding usually occurs in the first

hours after childbirth and is mainly due to insufficient contractility

activity of the uterus due to anomalies of labor, overstretching

uterine problems (large fetus, twins, polyhydramnios, etc.), infantilism, pre-

ongoing inflammatory diseases (metroendometritis), the presence of tumor

leu (fibroids).

Symptoms, hypotonic bleeding often begins in the third

during childbirth and then continues into the early postpartum period. In other

In some cases, bleeding occurs during an uncomplicated course of the third

period of childbirth. The main symptom is continuous bleeding from the vagina.

out ways. On external examination, the uterus is flabby, contracts poorly

response to external massage. Blood is released in portions. Leaking blood

forms clots, which distinguishes hypotonic bleeding from hypofibritis

nogenemic.

Diagnosis. Hypotonic bleeding should be distinguished from bleeding

in the early postpartum period associated with cervical rupture or

vaginal walls. When the cervix or vaginal wall ruptures, blood

scarlet color, the tone of the uterus remains good.

Emergency care and hospitalization. If hypotensive bleeding

occurred during home birth, urine should be released through a catheter

(if the woman does not urinate on her own), introduce uterine contractions

agents (oxytocin 1 ml intramuscularly or intravenously along with 20 ml

40% glucose solution, methylergometrine 1 ml intramuscularly), produce

external massage of the uterus, place an ice pack on the lower abdomen and in case

continued bleeding until the ambulance arrives, apply pressure

aorta with a fist. In addition, it is necessary to carefully examine the placenta and ensure

to live in its integrity.

After hospitalization in the maternity hospital, a complex of measures is urgently started.

measures to stop bleeding and compensate for blood loss. For this

perform a manual examination of the uterus (under ether-oxygen or acid

but-oxygen anesthesia or after intravenous administration of epontol), pro-

uterine contracting agents should be administered (mainly intravenously

through an IV). At the same time, a set of measures is carried out, such as

aimed at compensating blood loss (blood transfusions and blood substitutes)

lei), regulation of cardiac activity and the function of other vital

organs. In case of secondary bleeding disorders, which is often caused by

causes severe hypotonic bleeding, administer fibrinogen (6-8 g

intravenously), aminocaproic acid (5% solution 100 ml intravenously

pelno), a transfusion of warm donor blood is performed.

BLEEDING DUE TO INJURY OF THE FEMALE GENITAL ORGANS. Bleeding may

occur during defloration during the first sexual intercourse (usually

some bleeding is not profuse), as well as bruises and wounds as a result

fall, impact, etc.

Symptoms. When the hymen ruptures, the patient complains of bleeding

discharge from the genital tract and pain at the vaginal opening. Upon examination

vestibule of the vagina, tissue swelling and bleeding from the torn

noah hymen. For bruises and damage to the external genitalia,

new external bleeding most often occurs due to injury

clitoral area (bleeding may be profuse). Traumatic re-

The reduction may be manifested by the development of a hematoma in the external genitalia

organs, while there is no external bleeding, and the patient complains

to bursting pain and inability to sit.

Urgent Care. Local application of cold (ice pack on the

external genital organs), rest, painkillers (1 ml

50% analgin intramuscularly or 1 ml of 1% promedol solution subcutaneously). On

external genitalia are applied with a pressure bandage, less often it is necessary

resort to vaginal tamponade.

Hospitalization. For severe bleeding from a deep laceration

hymen, with injury to the clitoris, as well as with growing hematoma

external genitalia with damage to surrounding tissues is necessary

hospitalization in the gynecological or surgical department.

Sometimes it can be quite difficult to distinguish between normal natural causes of spotting and sources caused by diseases and disorders of the female reproductive system that provoke spotting. There may be bright scarlet and abundant or small light brown.

It becomes possible to identify their origin only after an accurate diagnosis and biopsy.

Gynecologists also pay attention to accompanying symptoms, such as obvious itching, burning, pain, redness or allergic swelling.

Normal indicators of the health of the female reproductive system are full discharge from the vagina and uterus. Every qualified gynecologist can explain why they go and visit regularly during an appointment.

The mucous membranes of internal organs have their own protective microflora, which provokes the excretion of transparent mucus.

Causes of natural discharge:

1. microorganisms and epithelial cells of the vagina and uterus;
2. vaginal lubrication. Observed after sexual intercourse;
3. protective function of the cervical canal.

There is another type - periodic bleeding menstrual flow. Traditionally, bleeding occurs differently for everyone and has an individual character. The daily amount is from 5-6 grams to 15-18 grams of liquid. The duration does not exceed 8 - 9 days. The rest of the menstrual cycle has a creamy or denser consistency of the composition.

During the first 14 days after menstruation, whitish or barely visible mucus may be detected. The next period is ovulation. Lasts no more than 1-2 days. The volume of mucus increases. It should not have a strong unpleasant odor or cause discomfort.

Why is there bleeding?

When pathological processes or disturbances in the functioning of the female genital organs occur, regardless of menstruation and completely without a natural reason, there is a discharge with blood. They can continue for an indefinite period of time and it is impossible to predict their cessation.

Why does bleeding appear and what are they?

1. implantation Observed at conception. At the moment when the fetus attaches to the uterine wall. May last for several days. Slight spotting;
2. abnormal course of pregnancy. At the beginning of pregnancy, it indicates a miscarriage, or ectopic flow; at the end, spotting warns of the threat of placental abruption and premature birth;
3. disruption of the menstrual cycle or ovulation period;
4. contraceptive drugs. Uncontrolled use leads to blood clots;
5. intrauterine device. Has an irritating effect on the walls of the uterus.

Vaginal discharge with blood also has other sources.

Which may be gynecological problems and diseases:

1. endometriosis. Unnatural growth of the inner layer of the walls of the uterus;
2. uterine fibroids. A benign neoplasm in the muscle layer of an organ;
3. polycystic ovary syndrome;
4. cancerous tumors of the female reproductive system;
5. endometritis. Inflammatory process of the mucous membrane of the inner layer of the uterine body;
6. endometrial hyperplasia. Benign growth inside the body of the uterus;
7. cervicitis. Inflammatory process in the vagina;
8. infections of the female reproductive organs;
9. hormonal disorders. Poor blood clotting, increased prolactin, increased sex and thyroid hormones.

If the bleeding is not menstrual in nature and is not associated with the IUD or taking hormonal medications, additional examination is necessary for the presence of pathologies or inflammatory processes in the uterus and vagina.

Brown vaginal discharge in women

The norm for the appearance of brown spotting impurities in vaginal discharge is the period before or after the expected menstruation. The duration should not exceed 2-3 days. Sometimes you can observe these signs during the period of ovulation.

But why is there a constant brown discharge:

1. beginning of sexual activity;
2. installation of a spiral;
3. taking contraceptives;
4. venereal diseases;
5. genital injuries;
6. tumor neoplasms;
7. cysts. They have a cavity. Contain liquid inside;
8. changes in the endometrium, the mucous membrane of the inner surface of the uterus.

Prolonged stress, nervous disorders, and changes in hormonal levels are also causes of disturbances in natural vaginal discharge.

Discharge during pregnancy and after it

During pregnancy and before the birth itself, the woman is under the strict supervision of a qualified gynecologist. If there is any sign of a problem in the course of pregnancy, you should immediately inform your doctor.

The greatest danger for the expectant mother, as well as her fetus, can be brown or spotting bloody discharge, which has its own reasons:

• attachment of the fertilized egg to the body of the uterus. This occurs in the early stages and does not pose any danger to the child. Cause: minor damage to blood vessels;
• lack of progesterone. May cause spontaneous abortion, miscarriage, or premature birth
• ectopic pregnancy. It is observed when the unborn baby develops in the fallopian tube, which will lead to its rupture and internal bleeding;
• frozen fruit. The death of the fertilized egg is accompanied by small spotting clots.

During pregnancy, brown or bloody discharge must be diagnosed and studied. Postpartum bleeding should be heavy. It can last 6-8 weeks.

What kind of discharge should there be after childbirth:

1. the first 2-3 days. The amount of fluid released is 400 ml per day. Color – scarlet, bloody with mucus, clots;
2. after 1 week. Bloody, spotting and brown discharge;
3. in 5-6 weeks. There is a normalization of the secreted fluid and the formation of mucus.

Disorders associated with the appearance of pus, unpleasant odor or pain, or fever should be studied.

Causes of spotting after sex

In case of regular bleeding or spotting small clots after sexual intercourse, which are accompanied by pain in the lower abdomen, in the perineum and lower back, urgent help from a gynecologist is required.

The causes of bleeding after sex can be serious gynecological problems:

1. vaginitis In women of reproductive age. Caused by bacteria and microorganisms such as chlamydia, Haemophilus influenzae, staphylococcus;
   cervicitis. Inflammation of the uterine canal;
2. cervical erosion. Focal lesions of the mucous walls of the organ;
3. ovarian damage or cysts;
4. ovulation. The release of the egg from the follicle into the fallopian tube for subsequent fertilization;
5. fungal infections.

In rare cases, damage to the blood vessels and walls of the vagina is caused by a lack of lubrication or the use of orgasm stimulants, such as dildos.

Discharge after abortion

Surgical termination of pregnancy involves removing the fertilized egg by curettage or performing a mini-abortion, vacuum aspiration, in the early stages. After a surgical abortion, bleeding continues for up to 10 days. Changes from bright scarlet color to brown daub. With vacuum removal – about 3-5 days.

If bleeding does not stop after an abortion, the following consequences are possible:

• polyp. Benign neoplasm on the cervix and on the surface of the uterus;
• endometriosis. Changes in the structure of the inner layer of the uterine wall, its excessive growth outside the organ;
• staphylococcus, streptococcus. Bacterial infection of the genital organs.

Additional examination, testing, taking samples and prescribing treatment are mandatory.

Discharge after cauterization of erosion

Ulcerative lesions of the mucous membrane of the cervix are a common gynecological disease that resembles a small wound.

Cervical erosion is determined by examination by a gynecologist or by characteristic signs such as bloody discharge:

1. after sexual intercourse;
2. between menstruation.

The reasons for its appearance may be congenital pathologies, hormonal disorders, sexually transmitted infections, consequences of surgery, and failure to comply with the rules of intimate hygiene.

Depending on the course and damage to the uterus, treatment is prescribed:

1. cauterization. There may be some slight bleeding after the operation for about 2-3 weeks. After healing, the scab disappears and there is not too much bleeding. Recovery time is from 1 to 3 weeks;
2. freezing or cryodestruction. It is carried out using liquid nitrogen on the lesions. After freezing the erosion, patients continue to have copious amounts of bloody discharge for about a month.
3. laser therapy. There may be slight bleeding 7-10 days after the procedure.

The treatment method is selected depending on the woman’s age and gynecological diseases she has, and the degree of tissue damage by erosion.

How long does it last and what is the discharge after a miscarriage?

Spontaneous abortion often occurs in the early stages of pregnancy, 5-6 weeks, or in the last trimester. Detachment of the fertilized egg and placenta begins, the cervix opens, the fetus comes out, and the vessels are damaged.

As a result, uterine bleeding begins:

1. 7 days in the early stages;
2. 1-2 days after the procedure, curettage and curettage.

Obligatory observation in the hospital after the procedure and examination by a gynecologist. For treatment, hemostatic drugs and antibiotics are prescribed, and the cause of spontaneous abortion is studied.

Discharge from an intrauterine device

There is no need to worry if spotting or spotting appears after insertion of the intrauterine device. They usually continue for about 5 days and will be observed between periods for about another six months.

Acute or nagging pain in the lower abdomen and an increase in the volume of blood discharge is a disorder. In this case, an examination and consultation with a doctor is urgently required.

Why is there heavy bleeding with blood after the installation of the IUD?

• incorrect procedure. Damage to blood vessels, puncture of the uterus;
• gynecological diseases;
• oral contraceptives;
• ectopic pregnancy;
• uterine bleeding.

It is impossible to determine the cause on your own. Even during an examination, the gynecologist will not be able to identify the source of bleeding.

It is necessary to undergo a full diagnosis and conduct a series of appropriate tests. Perhaps the body does not accept the material from which the spiral is made, and it is rejected.

Discharge during menopause

The period that begins in the life of any mature woman and is characterized by the end of her reproductive function is called menopause. This process is gradual and can last from 1 year or more.

Menstrual discharge becomes small and can occur once every 2-4 months until it disappears completely.

If frequent heavy bleeding appears during or after menopause, you need to look for the cause:

The lack of production of female hormones and protective lubricants leads to genital infections and inflammatory processes in women during menopause.

Be sure to see a gynecologist during this period and take hormonal medications.

Bleeding from the genitals can occur in both men and women, but the causes of these processes are different. Minor bleeding does not threaten the life and health of the patient, but should be the reason for a visit to the doctor. If the blood loss is significant, then emergency assistance is needed to stabilize the situation, replace blood loss, eliminate the cause of bleeding and further treatment.

Normal vaginal and uterine bleeding

In some cases, bleeding from the genitals is considered normal, physiological, and is not a cause for concern. Such bleeding includes:

Pathological bleeding from the genitals

Pathological uterine bleeding occurs as a result of improper functioning of the body. In this case, bleeding from the genital organs is caused not only by malfunctions of the reproductive system, but also by other organs. For example, uterine bleeding can be triggered by infectious diseases, blood diseases, liver problems, and high blood pressure.

Other bleeding is caused by reasons directly related to disturbances in the functioning of the genital organs. Such bleeding can primarily be caused by diseases of the uterus - endometritis, fibroids, endometriosis, benign and non-benign tumors, cervicitis, adenomyosis.

Bleeding with endometritis. Endometritis is called inflammation of the inner layer of the uterus, which occurs due to infection. Streptococci, staphylococci, gonococci, E. coli and other bacteria directly lead to the disease. They can enter as a result of abortions, gynecological manipulations, non-compliance with personal hygiene rules, and promiscuous sex life. The main symptom of endometritis is bleeding between menstrual cycles. In this case, along with the blood, mucopurulent discharge characteristic of endometritis may come out. With the acute onset of the disease, the patient may feel pain in the lower abdomen and fever, but chronic, sluggish endometritis does not produce such symptoms.

The disease is diagnosed based on the patient’s complaints and a previous history of the disease. During a gynecological examination, the uterus is swollen and painful. To identify the cause of endometritis, diagnostic curettage is performed and sent for histological analysis. Additionally, ultrasound diagnostics and hysteroscopy are performed.

Bleeding due to uterine fibroids arise due to a decrease in uterine tone, a violation of its contractile abilities and the appearance of additional venous plexuses. They can appear both in the middle of the cycle and during menstruation, lengthening it by a couple of days. The blood released due to fibroids is dark in color, thick, and does not contain any impurities of pus. When myomatous nodes grow under the mucous membrane of the uterus, mucous with an unpleasant odor is added to the bloody discharge.

The diagnosis is established based on concomitant factors (lack of childbirth, long-term contraception, irregular sex life, previous inflammatory diseases of the uterus, etc.) and gynecological examination. During the examination, doctors note that the uterus has a lumpy structure, is denser to the touch, and is slightly increased in size. Upon palpation, myomatous nodes can be seen. Additionally, an ultrasound examination is performed to determine the type of fibroid, the degree of its growth into the uterine layers, and the presence of associated complications, both for the uterus and for other organs.

Bleeding with endometriosis. Studies in different countries show that about eighty percent of patients suffer from bleeding with endometriosis. Endometriosis of the uterus occurs due to improper hormonal regulation of the natural process of endometrial shedding when pregnancy does not occur. An increase in estrogen levels and prolonged ovulation contribute to the proliferation of the endometrium, and sometimes to the hematogenous drift of endometrial cells into the fallopian tubes and the muscular layer of the uterus.

The classic symptom of endometriosis is prolonged menstruation and bleeding in the middle of the cycle. The severity of bleeding is individual in each case, but all cases are characterized by the duration of this process. As a rule, there is no pain during bleeding.

If bleeding due to endometriosis is too long, this can cause iron deficiency anemia, which causes signs of weakness, drowsiness, general malaise, and decreased performance.

Bleeding from uterine tumors are not a specific sign of this disease, therefore it is not correct to diagnose tumors only on the basis of this sign. However, with cancerous formations in the uterus, symptoms of tumor germination and its disintegration appear later. Bleeding is accompanied by pain in the lower abdomen, pain after sexual intercourse, weight loss, and various types of vaginal discharge.

The bleeding itself from tumors varies in strength and duration. Blood can be present as streaks in mucous secretions, or it can be released for a long time and in large volumes. Diagnosis of the disease is carried out by a thorough examination of the genital organs and taking a biopsy.

Bleeding with cervicitis occurs due to both trauma to the inflamed cervix during sexual intercourse, and spontaneously during exacerbation of the inflammatory process. Most often, women notice such bleeding after intercourse; they are small in volume, contain mucus, or themselves appear as bloody streaks in the mucus. The discharge also contains pus coming out of the cervical canal. The disease is diagnosed based on the patient’s complaints and a gynecological examination, which clearly shows the inflammatory process in the cervix. Additionally, a colposcopy is performed and a smear from the cervical canal is taken.

Bleeding with adenomyosis caused by a disruption of the normal formation of tissues in the body. In particular, with adenomyosis, the endometrium begins to grow into the myometrium, which causes bleeding. Typically, bleeding occurs in the middle of the cycle, the volume of blood released is insignificant. Patients complain of pain in the lower abdomen, pelvic pain, and a feeling of internal pressure. Diagnosis is made based on ultrasound examination and careful history taking.

The nature of bloody discharge as a sign of disease

Despite the fact that spotting is already a clear symptom of dysfunction of the genital organs in a woman, they can be different in nature. Depending on the nature of the discharge, we can assume what disease caused the bleeding.

1. Abundant bright red discharge without any admixture of pus indicates high blood pressure, endometriosis;
2. Thick, dark-colored bloody discharge indicates uterine fibroids, polyps, and neoplasms in the uterine cavity;
3. Minor bleeding mixed with pus suggests cervicitis, endometritis;
4. Minor discharge without any admixture of pus may indicate adenomyosis, the initial stage of tumor germination.

It is important to remember that the above is a pure clinic of diseases, which is quite rare. Most often, other symptoms may be added to the discharge, confusing the doctor, so when assessing the discharge in a patient, you should not rely on classic manifestations, but always take into account what complications and concomitant diseases can blur the clinical picture of true pathology. Sometimes this is difficult to do even for doctors, not to mention patients, so women do not need to become hysterical and suspect that they have late-stage cancer with dark discharge. It is possible that in this case, a rupture of the venous vessels occurred during the growth of fibroids, which is not a malignant neoplasm and can be successfully treated with hormonal drugs and may not require surgical intervention provided that the growth of the tumor is stopped.

Causes of bleeding during pregnancy

The onset of pregnancy significantly changes the functioning of a woman’s body. Now it has new functions, but also new threats - sudden bleeding. Discharge of blood from the genital organs during pregnancy most often occurs in the first or third trimester, which is associated with the greatest changes in a woman’s body - preparation for bearing a child and preparation for childbirth. Bleeding at any of these stages can pose a threat to pregnancy.

In the first trimester of pregnancy bleeding can be caused by:

• threat of miscarriage if before pregnancy the woman had genital tract infections, chronic and acute inflammatory diseases of the uterus. Such bleeding can also occur due to taking certain medications, too much physical activity, or injury to the lower abdomen;
• a complete miscarriage, when the embryo is no longer capable of further development and is separated from the uterine cavity;
• incomplete miscarriage, when the embryo has died, but, nevertheless, is still in the uterine cavity. Its further expulsion is inevitable, therefore such a pregnancy is not preserved, but the uterine cavity is curetted;
• a frozen pregnancy, as a result of which the fetus does not develop, but the mother’s body is still able to provide for its vital functions. After the fetus freezes, the female body receives a signal about it as a foreign body, and after some time it is spontaneously expelled from the uterine cavity. In some cases, doctors may insist on using abortion medications or curettage of the uterine cavity;
• ectopic pregnancy - the attachment of the fetus not in the uterine cavity leads to further problems, for example, rupture of the fallopian tubes may occur and severe bleeding from the genitals may occur. In this case, both the fallopian tube and the fertilized egg are removed; provided the second tube is healthy, pregnancy is possible in the future;
• hydatidiform mole. Hydatidiform mole is the fertilization of a defective egg, as a result of which an embryo as such is not formed. However, chorionic villi grow in the form of bubbles, and the woman’s body reacts to this with symptoms of pregnancy - vomiting, nausea, and malaise. With a hydatidiform mole, heavy bleeding can occur at any time.

If bleeding in the early stages is more dangerous for the fetus than for the woman, then later periods endanger both the life of the fetus and the life of the mother. They may occur in the following cases:

• Placenta previa causes painless bleeding in seventy percent of women with this diagnosis, and twenty percent of expectant mothers feel cramping pain in the lower abdomen. In another ten percent, the blood does not come out freely, but pours into the uterine cavity between its wall and the placenta;
• placental abruption is a very rare occurrence, but the most severe for the fetus and mother. In this case, dark red blood comes out with clots, the uterus is in good shape, and the lower abdomen hurts as if it were contractions. In this case, the issue of emergency caesarean section is resolved;
• An even more rare situation is bleeding from the umbilical cord or vessels located in the fetal membrane. A clear indicator of this pathology is an increase and then a slowdown in the fetal heartbeat, which indicates blood loss. In each case, the doctor makes an individual decision to continue the pregnancy.

Bleeding after childbirth

During the postpartum period, bleeding from the genitals is normal. They continue abundantly for another two hours after the baby is born, and then gradually decrease and take the form of menstruation. The duration of such bleeding varies, but no more than a month after the birth of the child. The discharge at first is bright red in color, and after ten days the blood is only mixed with the mucous discharge. After some time, clear mucus will be released from the vagina, and then the discharge will stop.

Pathological bleeding may occur if:

• after childbirth, there are remains of the placenta in the uterine cavity (division anomalies, additional lobule);
• there are disturbances in uterine contraction as a result of the birth of a large fetus, polyhydramnios, excess weight of the woman in labor, and prolonged labor;
• injuries were diagnosed during the passage of the child through the birth canal (uterine ruptures, vaginal ruptures);
• the blood clotting process is disrupted.

After giving birth, for two hours, the woman is in the postpartum ward, where doctors monitor her. When the bleeding stops, the young mother and baby are transferred to a regular ward until discharge from the hospital. However, in difficult cases, bleeding can occur even with an apparently favorable end of labor. The reasons for such late bleeding are as follows:

• placental polyp (remnants of the placenta that have not been removed);
• development of endometritis;
• pathologies in the blood clotting chain;
• disturbances in uterine contractions.

If there is a sudden onset of bleeding and a rapid increase in the volume of blood released, it is necessary to urgently call an ambulance and take the woman to a medical facility. Further actions are determined depending on the cause of the bleeding. If it can be stopped, the patient is left under supervision for some time, and sometimes it becomes necessary to remove the uterus.

Bleeding after menopause

Menopause occurs in women at different ages; most often, menopausal manifestations make themselves felt after forty-five years. Normally, if there are no diseases of the genital organs, then menstruation stops by itself, becoming less and less in duration and less in volume. By some time they disappear completely.

However, during this period, a woman should be attentive to her health, since there is a certain risk of bleeding. Reasons why bleeding occurs after menopause:

• atrophic vaginitis associated with estrogen deficiency. When the level of this hormone in the blood decreases, changes in the vaginal mucosa occur, making it more susceptible to infections and erosions. Discharge with atrophic vaginitis is scanty, brownish, as if at the end of the cycle;
• Tumors (benign and malignant) can also cause bleeding. The average age of patients with this diagnosis is over 60 years, and half of them experienced bleeding from the genital organs due to malignant neoplasms;
• changes in the endometrium, the appearance of vascular fragility, blood stagnation in the pelvic organs.

Menstrual bleeding

Menstrual bleeding accompanies every representative of the fair sex during childbearing age. Thus, the female body prepares to receive a fertilized egg. During the first two weeks of the cycle, a woman’s body actively produces estrogen, which is responsible for the growth of the endometrium and the growth of follicles. At the moment of ovulation, the egg leaves the follicles and moves through the fallopian tubes, descending into the uterine cavity. It is here that she most often encounters sperm.

The fertilized egg tries to sink into the enlarged endometrium. If fertilization does not occur and the egg does not attach to the walls of the uterus, then it is excreted from the body in the blood. During menstruation, bleeding reaches approximately 80 ml, but this figure is individual and may vary. Along with the blood, the slightly overgrown inner layer of the uterus, which was preparing to receive the embryo, is also excreted. Endometrial detachment and spotting may be accompanied by pain, especially in the first days of menstruation.

This process is designed by nature in such a way that every month the uterus is renewed as much as possible to ensure the vital activity and safety of the new embryo.

What to do if there is heavy bleeding

If uterine bleeding has no apparent cause and is not associated with menstruation, then if the amount of hemorrhage is insignificant, you can try to stop it yourself. To do this, you need to lie down in bed, put a pillow or cushion under your feet, and cold on your lower abdomen. After stopping the bleeding, a visit to the doctor is required to find out the cause of the hemorrhage. The doctor may prescribe vitamins, iron supplements, and hormonal contraceptives.

Man Woman Arms Belly Back Skin Legs Chest Pelvic area Neck Head Miscellaneous Pain in the rectum and anus Pain in the groin Testicles hurt Pain in the penis Painful menstruation Painful to urinate Tumor in the groin Tumor in the testicle Blood in the urine Blood in the stool Bleeding from the vagina

Bleeding from the vagina

In healthy women aged 13 to 50 years (or so), bleeding is not something to worry about. You expect it - regularly, every month. If you don't menstruate, it's not normal.

But vaginal bleeding, which are either too strong, too small, or at the wrong timing can pose a problem. The different options depend on your age (especially if you are before or after menopause), whether you are taking birth control pills, whether you are physically active, and your health.

If you have abnormal vaginal bleeding, it may be related to something else in the reproductive system and is the result of infection, hormonal changes and sometimes cancer. The risk of malignant growth increases with age. The likelihood of infection largely depends on your sex life. Hormone levels fluctuate in response to signals from the brain, ovaries, thyroid and adrenal glands. But make sure that the blood you see is actually from the vagina and not in the urine or stool.

Where can blood come from in the vagina?

Let's start with an overview of the different places in the female reproductive system where vaginal bleeding.

The labia at the entrance to the vagina can be damaged, most often during violent sexual intercourse. Sometimes, however, upon careful examination you will see a small polyp there, or a small ulcer, or a wart, or even varicose veins - any of these can bleed.

When the hymen is torn, expect the same; moderate bleeding.

The vagina itself can become inflamed, infected, or undergo cancerous growth, all of which will cause bleeding.

Foreign objects inserted into the vagina, usually during masturbation, can cause bleeding. (The amazing variety of such items indicates imagination rather than caution.)

After menopause, when the level of estrogen hormones drops sharply, the vaginal walls become dry, less lubricated during intercourse, and this causes pain and bleeding.

Moving higher up the vagina, we reach the cervix, the entrance to the uterus. It may bleed due to infection (which is quite common in this area), if it is injured by deep intercourse or after the insertion of an intrauterine contraceptive device.

Polyps and malignant tumors the cervix will also cause bleeding. (Women should have regular pap smears to detect such tumors in their earliest stages, when they are treatable).

Bleeding from the uterus often occur with pathological pregnancy, cancer, polyps or fibroids, and abortion (spontaneous or induced). Foreign objects can also make their way here from the vagina. Fluctuating hormone levels, birth control pills, stopping or starting estrogen replacement can all cause uterine bleeding.

In women before menopause, the ovaries release an egg every month, which then travels into the fallopian tubes, where it meets sperm. The fertilized egg then travels down to the uterus where it implants. If it remains in the tube without entering the uterus, the result is an ectopic pregnancy. The egg has no future at this location and eventually causes the fallopian tube to rupture, accompanied by severe pain and bleeding. This is quite serious. More often, bleeding occurs when the fallopian tubes become infected and inflamed due to a sexually transmitted disease.

Malignant growth, infections or ovarian cysts can cause vaginal bleeding. They are also caused by decreased function of the thyroid gland, or a poorly functioning pituitary gland, or other disorders of the endocrine glands.

Trying to understand why you are abnormal vaginal bleeding, always remember that non-gynecological factors may play a role here - blood thinners, medications, clotting disorders: all will leave you vulnerable to abnormal bleeding not only from the vagina, but from any organ in the body.

Vaginal bleeding in menopausal women has many causes. Let's assume that you have either just entered menopause or have been in this state for a long time. You've almost forgotten what menstruation is when you suddenly see blood leaking from your vagina, or find it on your underwear. What could it be? Statistically, there is good evidence that the blood is the result of cervical or uterine cancer. Indeed, most cases of uterine cancer occur in menopausal women. The likelihood of such a tumor is greater when you bleed lightly rather than heavily and when you have never given birth. The tumor could, of course, be a benign polyp, but without a biopsy you won't be able to tell for sure.

Here's another scenario.

You recently turned 50 years old, and your periods have become so irregular that you are unable to accurately predict them. Moreover, you have started to experience hot flashes, cold sweats and painless vaginal bleeding. It is very likely that you have simply entered the end of your period. The bleeding will stop over the next few months. But, if there is a high statistical probability of cancer, you should double check everything with your gynecologist.

If along with bleeding you feel pain in the lower abdomen, cancer is possible, but fibroids are almost as likely. These large, benign tumors in the wall of the uterus are a very common cause of bleeding in women before menopause and are one of the main reasons for uterine amputation.

In pre-menopausal women, vaginal bleeding may simply reflect a variation of the normal 28-day menstrual cycle. This cycle can shorten to 24 or 25 days and lengthen to 30 or even 32 days. The bleeding period itself usually lasts from 3 to 7 days, and most women use four or five sanitary wipes per day. If a tampon is sufficient for your bleeding, it is probably normal in amount.

What does abnormal vaginal bleeding mean then?

Excessive bleeding during periods, even if they occur regularly every 28 days. Common causes are fibroids (more common in menopausal women, but by no means limited to this age) or an underactive thyroid (women with an overactive thyroid will have light monthly bleeding).

Vaginal bleeding between periods is not normal, but sometimes it’s difficult to figure it out if your cycles are very irregular.

Here are some additional signs to help you figure out what happened.

If you are taking birth control pills, expect unpredictable bleeding.

The presence of clots in menstrual blood indicates heavy bleeding in the uterus.

If your periods have always been normal and you suddenly start bleeding profusely, you may have been pregnant without knowing it—and you have suffered a spontaneous miscarriage.

“Blood spots” on underwear between menstruation may be due to cervical or uterine cancer or with a polyp.

If you are bleeding and have pain in your lower abdomen, you probably have a pelvic infection (especially if the pain comes on gradually and is accompanied by fever and vaginal discharge).

If you are an alcoholic and/or you have serious liver disease, there is too much estrogen in your body and this will cause vaginal bleeding.

Regardless of your own diagnosis, see your gynecologist when you are bleeding. While you wait for your appointment, consider a few additional items that you can bring to your doctor's attention.

Is your skin dry and rough? Do you feel tired and sleepy? If so, abnormal bleeding may be due to an underactive thyroid gland.

Have you ever had a fever that comes and goes? It often happens that when you visit a doctor you do not have a temperature. So tell your doctor about it. A fever usually means an infection.

If you have small bleeds under the skin or bleed easily in other parts of the body, the condition may be a general clotting disorder, and vaginal bleeding is only one manifestation.

After talking with you and a thorough external examination, the doctor can make any appointment - from a pregnancy test to a cervical smear, ultrasound examination or tomogram.

But by making all the observations described above, you will greatly simplify the process of making a diagnosis and shorten it.