Bloody issues

Bloody discharge - is not coincident with menstruation uterine bleeding pathological origin. Bloody uterine discharge as a pathological symptom is integrated into many gynecological ailments. Conventionally, they can be classified as related to pregnancy( and ectopic), provoked by dyshormonal processes or inflammatory diseases, as well as those associated with tumors of the appendages and / or uterus.

Extra-menstrual bleeding appears against the backdrop of extragenital pathology, for example, diseases of the blood and cardiovascular system.

It is extremely important to correctly differentiate any spotting and menstruation. Therefore, it is necessary to recall from the outset what the term "menstrual cycle" means, and how its "norm" is defined. As a rule, menstruation does not pass in all women equally, therefore, for a conditional "norm" a cycle is adopted, which is available to the majority, but not necessarily for everyone.

The menstrual cycle is the cyclically repeated hormonal and structural changes in the female body during the period between two menstruations. The first day of any menstrual cycle coincides with the first day of menstrual bleeding, moreover, the same day is the last day of the cycle of the previous one. The majority( 60%) of the menstrual cycle lasts 28 to 30 days, but considering the individual characteristics of the remaining 40% of women, these frames are extended to 21 - 35 days.

The duration of menstrual bleeding is also not the same for everyone, therefore, under the conditional "norm" is meant the interval from 3 to 7 days, when the greatest blood loss is not more than three days. To correctly measure the volume of lost blood, women are asked to calculate the number of daily hygiene pads replaced: physiological blood loss requires four( or less) pads a day.

Sometimes spotting after the end of the usual period of menstruation continues, or precedes it. Regardless of the amount, they are not considered menstruation and should be considered as a pathology, that is - bleeding.

Bloody discharge does not always imply the presence of a serious ailment. Some external negative factors( stress, fatigue, climate change, weight loss, infection) can temporarily distort the cyclic function of the ovaries and affect the character of the menstruation. Typically, if against the background of such provoking factors there were spotting outside the menstrual period, they are of a single nature and do not imply a lot of blood loss, and do not require significant drug intervention.

There are a lot of causes for bloody discharge, so the diagnosis includes an extensive list of studies. Each separate case of bloody discharge requires an individual diagnostic scheme.

Clinic of bloody discharge is very diverse, as defined by the etiology of bleeding. Plentiful spotting is often accompanied by severe anemia, deterioration of well-being. When inflammatory processes appear more lean, smearing bloody discharge, often combined with pelvic pain.

The only way to "cure" spotting is to stop them, and then conduct a complete examination to find the causes of bleeding. If you do not eliminate the bleeding-provoking factor, the spotting will reappear.

Causes of bloody discharge

Bloody discharge in different age periods have a number of specific signs, as well as causes and consequences.

Scant bloody discharge in newborns appears due to the so-called "sexual crisis" - the natural mechanisms of adaptation, when the born girl is released from the mother hormones. Discharge of bloody color in a small amount appear in the first week( often at the end) of extrauterine life, have a very meager and short( about 2 days) character. No treatment of the sexual crisis does not imply, since it is considered the norm and passes on its own.

Menstrual function is formed symmetrically with the development of the ovaries, and the period of the first menstrual period( menarche) is its culmination. In the first two years after the onset of menstruation, the hormonal activity of the ovaries is still imperfect, and therefore the monthly periods are not regular. Bloody discharge in this period is classified as juvenile bleeding. Sometimes they are the result of pathological pregnancy and / or childbirth. Juvenile bleeding occurs more often in perfectly healthy gynecological girls due to imperfect regulation of menstrual function from the pituitary and hypothalamus.

Unlike girls, in adult women, spotting has a wider range of causes. Among them, dyshormonal disorders are leading.

The normal menstrual cycle, despite the wide permissible parameters, always has two distinct phases. The first, follicular, is associated with the development of the oocyte. Upon reaching full maturity, it is in the follicle, which not only protects and nourishes it, but also secrete the hormone estrogen( estradiol) necessary for a full-fledged ripening process. When the egg becomes full, the follicle that protects it collapses. Since the release of the ovule beyond the follicle begins a short period of ovulation, which separates the first phase of the cycle from the second. It is conditionally considered that in most women the ovulatory period divides the cycle in half, that is, with a 28-day cycle, ovulation hypothetically occurs on the 14th day. However, in order to more accurately determine the boundaries of each phase of the cycle, laboratory studies are needed, since sometimes the ovulatory period can be shifted or absent.

The second, luteal, phase is associated with the appearance of a yellow body - formed from the follicle remnants of the temporary hormonal gland. The yellow body secretes the hormone progesterone throughout the second half of the cycle and is destroyed shortly before another menstruation.

Cyclic hormonal secretion of the ovaries provokes changes in the endometrium. The superficial( functional) epithelial layer in the uterus responds very sensitively to the amount of estrogens and progesterone, so its state in different phases of the cycle is ambiguous. After the next menstrual bleeding, when the superficial epithelium is completely rejected from the uterus, regeneration processes are started in the endometrium. Typically, after six days, the mucosa is fully restored. Thanks to estrogens in the first phase, the endometrium increases in volume, germinating with new glands and small vessels. Thus, the uterine cavity begins to prepare for a potential pregnancy. In the second phase, the progesterone of the yellow body provokes increased processes of uterine secretion, when the endometrium loosens even more and increases the number of glandular structures. If pregnancy does not occur, all changes in the uterine cavity should be eliminated, so the yellow body collapses, the concentration of progesterone falls, and the "unnecessary" overgrown functional layer begins to exfoliate and eventually completely evacuated during menstruation.

Bloody discharge outside menstruation can be caused by a malfunction of the ovaries, when they stop phonemic rhythmic hormonal secretion. The change in the amount of estrogens and progesterone, as well as their proportions, provoke bleeding, because the endometrium receives "wrong" commands and is rejected incorrectly.

Bloody discharge outside menstruation can provoke a dysfunction of the hypothalamic-pituitary structures that control the operation of the ovaries. In the follicular, the first phase, the pituitary gland secretes the follicle-stimulating hormone( FSH), through which the follicle reaches the required maturity.

The second phase is responsible for another pituitary hormone - luteinizing( LH).With his participation, the capsule of the ripened follicle becomes thinner, and then bursts to release the "adult" ovum.

If for any reason the pituitary gland functions incorrectly, the entire process of folliculogenesis and, accordingly, ovulation is violated, which leads to the appearance of bloody excretions unrelated to menstruation.

Sometimes spotting occurs against a background of unwell in the uterine cavity: inflammation, fibroids, endometrial hyperplasia, endometriosis. With the proper functioning of the ovaries, the endometrium reacts incorrectly to their "commands" and is partially rejected in time.

Bleeding due to trauma( labor, abortion) of the uterine wall is sometimes considered as a physiological. Pathological post-abortion or postpartum exuberant bloody discharge, beyond the permissible limits, can cause hemorrhagic shock.

Always worry spotting during pregnancy. In early terms, they can signal a miscarriage, a "frozen" pregnancy or a bubble drift, and in later terms - a pathology of the development or location of the placenta.

After 45 years, a woman enters the climacteric period, and spotting occurs due to the extinction of the ovarian function, when it gradually loses its cyclicity and becomes inadequate.

Bloody discharge in the middle of the cycle

Extra-menstrual bleeding has a number of manifestations, they vary in duration, volume of blood loss, the presence of concomitant negative symptoms( weakness, headache and pelvic pains and the like), as well as the appearance time.

Often, patients refer to a specialist with complaints of bleeding in the middle of the cycle. As a rule, in most( 80%) patients in the middle of the cycle, scarce bloody discharge appears, and only in a small part( 20%) do they acquire abundant character.

In order to identify the allocation of blood outside menstruation, it is necessary to initially establish the nature of the menstrual cycle and the presence of ovulation including, as often the same causes provoke the appearance of bleeding in a different time period.

In the middle of the cycle, spotting can provoke quite innocuous causes. The most popular of these is cyclic hormonal contraception, the technique of which is based on the suppression of ovulation. In fact, when using oral contraceptives, an artificial ovarian dysfunction is created that does not allow a woman to conceive.

Lean spotting short-term bleeding appears in a small proportion of perfectly healthy women at the time of ovulation. They are usually associated with damage to the small vessels of the wall of the follicle.

Uterine bleeding in the middle of the pathological cycle also has a different degree of severity. So, with inflammatory changes in the endometrium, they are often scanty and monotonous, accompanied by pain, fever and deterioration of well-being, and if the mechanism of ovulation is disturbed, bleeding can be extremely intense.

With hormonal dysfunction, bleeding is called dysfunctional. At the source of their appearance are violations of rhythmic secretion of hormones by the ovaries due to changes in the functioning of the hypothalamic-pituitary system, when the brain gives "wrong" commands to the ovaries. On the nature of dysfunction, such bloody discharge is divided into:

- Single-phase, associated with anovulation. The follicle does not collapse, but continues to develop( persist), so there is no second phase of the cycle. Such violations lead to infertility.

- Two-phase, or ovulatory. They are based on both the insufficiency of the function of the yellow body and its excess. Also, ovulatory uterine bleeding provokes a malfunctioning ripening follicle.

Generally, severe hormonal dysfunction is monotonous when intermenstrual bleeding migrates from cycle to cycle.

Often, when talking about uterine bleeding, specialists use the term "hyperplasia", which characterizes the pathological process in the endometrium and is the cause of menstrual dysfunction. Hyperplasia of the endometrial tissue is an overgrowth( or proliferation) of the glandular structures, as a result of which the endometrium builds up the volume and, as a result, its rejection occurs incorrectly, therefore, intermenstrual bleeding is observed. Sometimes proliferative processes do not occur on the entire surface of the mucosa, but in a small area, when the proliferating tissue swells into the uterine cavity, such focal hyperplasia is called a polyp. The presence of polyps in the endometrium can be both asymptomatic and provoke bleeding with severe pain.

Clinic of any intermenstrual bloody discharge is very diverse and does not always agree with the severity of the process, so if out-of-the-menstrual bleeding appears of any nature, it is necessary to establish their cause.

Bloody discharge in early pregnancy

Bleedings of a different nature in pregnant women, unfortunately, are rare. It should be noted that pregnant women have no bloody discharge in the norm should not be. The exception is a very small( 3%) category of women who have minor spotting spots in the first few weeks. Overcoming the fallopian tubes, the fertilized ovum( zygote) enters the uterine cavity, where it finds the most "suitable" place for further development and is attached to it( implantation), this moment usually coincides with the date of expected menstruation and can sometimes provoke the appearance of a scanty bloody discharge thatIs a consequence of damage to small vessels. In all other cases, spotting during pregnancy relates to potentially dangerous situations.

Bleeding at pregnant women can appear on any term and have various clinical displays. Bleeding early( up to 12 weeks), the timing is often associated with the onset of spontaneous abortion. Natural miscarriages account for 10-20% of all authentically diagnosed pregnancies, with the majority( 80%) of them occurring precisely in the early stages.

Bloody discharge always accompanies the threat of premature termination of pregnancy, it can be insignificant, accompanied by drawing pains. As a rule, at this stage, miscarriage can be prevented. When the miscarriage begins, when the fetal egg has already peeled from the attachment site, the pain intensifies, acquiring a cramping character, and the bleeding becomes significant. Full abortion is considered after full-fledged evacuation of the fetus from the uterus. Bloody discharge while abundant, can contain blood clots.

Bloody discharge in the early stages is sometimes caused by the so-called "frozen" pregnancy, when, due to a whole complex of pathological causes, the fetus stops prematurely and dies. Uterus tries to expel the deceased fetus, and therefore there are spotting. Along with them, the patients have a feeling that all the signs( morning sickness, nausea, vomiting, etc.) that were present before have disappeared. Also, there is a bad state of health, fever, dizziness. In fact, the interruption of frozen pregnancy clinically resembles the stage of spontaneous abortion, but differs from that by the impossibility of a full evacuation of the fetus from the uterine cavity.

It should not be forgotten that pregnancy is not always localized in the uterus. Ectopic pregnancy can also provoke spotting. Diagnosing ectopic pregnancy is not easy. As a rule, with a small delay, women themselves conduct express diagnostics. However, the positive test result is both in the case of uterine and ectopic fetal location, because when testing in the urine, only the presence of a "pregnancy hormone"( HCG) is determined without specifying the localization of the latter.

Thus, any spotting in pregnant women deserves special attention and additional diagnostic measures.

Bloody discharge before the monthly

Mucocutaneous spotting on the eve of the expected monthly is not uncommon. Often, the next normal menstruation starts with minor bloody discharge, which after a day( less than two) becomes abundant and turns into the usual menstrual bleeding. Since the day before the monthly blood goes out very little, premenstrual secretions often resemble pink mucus, as the blood is mixed with cervical mucus and vaginal discharge.

Minor blood separation on the eve of menstruation is sometimes associated with excessive physical exertion, stress, hypothermia and other external temporary effects. As a rule, such discharges are of a one-time nature and are not considered as a pathology.

Pathological bloody premenstrual secretions appear at least one week before the onset of menstruation. Sometimes they stop shortly before the menstruation, and sometimes continue until they begin. The reasons for such selections are several, the most popular are:

- Hormonal Contraception. When a woman starts to take tablet contraceptives, the ovaries need time to adapt to hormonal effects from the outside, so not only the menstrual cycle itself changes, but also its characteristics. As a rule, no later than three cycles later, the monthly cycles stabilize. A similar situation occurs after the use of oral contraceptives is completed, when bloody discharge on the eve of menstruation is associated with the period of adaptation of the hormonal system.

- Hormonal dysfunction. It is considered the most common cause of menstrual disorders. Since the menstrual cycle is the result of consistent functional and structural changes in the hypothalamic-pituitary and ovarian system, dysfunctional bleeding is provoked by disruption of any link in this chain.

- Inflammatory infectious process. If the infection affects the ovaries, it provokes a change in the cyclic secretion of hormones. In inflammatory processes with localization in the endometrium, the ovaries work properly, but the uterine epithelium affected by infection loosens, bleeds slightly and therefore provokes smearing mucous or mucocutaneous bleeding.

- Endometriosis. Complex hormonal-dependent pathology with a variegated clinic. Due to certain pathological causes of endometrioid tissue falls outside its normal location, that is, the uterine cavity, but continues to function according to its purpose - growing and tearing away in a cyclic rhythm. It can be said that the endometriotic foci( heterotopia) "menstruate" outside the uterus.

Localization of endometrioid heterotopies can be different - they are found in the uterus and its appendages, bladder, vagina and pelvic cavity, intestines and peritoneum. This sometimes turns this ailment not only into a gynecological problem.

The endometriosis clinic does not have a classical set of symptoms, in some situations pathology does not appear at all. However, if there are symptoms of the disease, menstrual dysfunction, pain and infertility are often present among them. If on the eve of menstruation there are scarce brown discharge, and subsequent menstruation is painful and more abundant, the presence of endometriosis should be excluded.

- Myoma. Located in the uterine cavity myomatous nodes can disrupt the process of normal contraction of the uterine musculature, therefore provoke extra-menstrual uterine bleeding and / or profuse menstruation.

If unusual bleeding without an accompanying pain, fever and other negative symptoms appeared before menstruation, and subsequent menstruation has passed as usual, it is necessary to pay attention to subsequent menstruation. If in the future the menstrual cycle has not become the same, it is worth turning to a specialist.

Bloody discharge after monthly

The appearance of bloody discharge both before and after menstruation can initiate the same causes. They sometimes become a source of intermenstrual bleeding.

Among the causes that cause postmenstrual bloody causes inflammation and dyshormonal processes, endometriosis, excessive proliferation of glandular structures( hyperplasia) of the endometrium, myoma( especially submucous localization) of the uterus and others are more often leading.

The reason for bloody discharge at the time of occurrence is more often impossible to establish.

For normal menstrual bleeding, there are three periods:

- the appearance of first minor( smearing) secretions, which then become more intense;

- "abundant" days, when the volume of lost blood is maximal;

- monthly proceeds in the form of insignificant discharges, which gradually decrease quantitatively and disappear at all.

Pathological spotting after the menstruation is considered:

- if they do not end in normal time, but continue as a lean dark smearing discharge;

- if "abundant" days do not end at the usual time, but continue without signs of a decrease in blood loss;

- if at the end of the month they suddenly start again.

In healthy women, there may also be episodes of a change in the usual rhythm of menstruation. As a rule, such failures are of a single nature. If the spotting after the end of the menstrual period is repeated again, they probably have a pathological cause.

Bloody discharge after sexual intercourse

The separation of blood from the vagina after sexual contact is not a rare symptom. In order to interpret this attribute, it is necessary to take into account when and in what quantity such allocations have appeared. It should be noted that the overwhelming number of reasons are not classified as dangerous.

The most common cause of spotting after intima is mechanical damage to mucous membranes. Intimate intimacy on the eve of menstruation can provoke the appearance of a slight bloody discharge, as the mucous membranes become more friable, vulnerable and easily injured when coitus. Such discharges are very slight and short-lived.

The likelihood of microtraumas of mucous membranes and subsequent bloody discharge during sexual contact is increased if there is infectious inflammation in the vagina, including specific etiology. Infection penetrates into the deep layers of the vaginal epithelium, changes the condition of cells and small vessels, after which the mucosa is easily damaged. Also postcoital blood separation can appear against the background of the existing inflammation of the cervix( cervicitis).As a rule, the presence of infection, in addition to contact bloody leucorrhoea, is accompanied by other unpleasant symptoms: purulent vaginal discharge( sometimes with an unpleasant smell), discomfort, dysuria, moderate soreness. Often, an admixture of blood in the vaginal secretions with a pronounced inflammatory process appears outside of sexual contacts.

Often after proximity, blood in the secretions appears due to pseudo-erosion( ectopia) on the cervix. The cervix, like the vaginal cavity, is covered with a multilayer epithelium, the cells of which are flat. This structure helps the mucous to withstand both infectious and traumatic effects. The cervical canal, by virtue of other functions, is lined with cells of cylindrical form arranged in one layer. When pseudo-erosion on the cervix of the uterus, a delimited region is formed, covered not by a multi-layered flat, but by a single-layered cylindrical epithelium. Blood vessels in this zone are located close to the surface, so they are relatively easily traumatized and bleed at sexual intimacy.

Another cause of blood after intima is cervical polyps. Located on a long base( "leg"), they can protrude beyond the cervical cavity and be injured during coition.

Single cases of having a small amount of blood after the end of sexual intercourse are not considered pathology. However, if they are repeated on a regular basis, accompanied by pain or become abundant, they should not be left without attention.

Bloody discharge after childbirth

Even the most "light" births are a serious traumatic factor for the tissues of the uterus and the birth canal, therefore, always accompanied by bleeding.

For full development the fetus needs adequate nutrition, breathing and metabolism, for this the placenta is formed in the uterus. It connects to the uterus through a placental platform, which literally fuses with the endometrium. With the fetus the placenta is reported via the umbilical cord. The placenta also secretes the hormone progesterone to prevent premature termination of pregnancy.

Functional mucosa lining the uterine cavity as it develops in the fetus is transformed into a decidual membrane. It lays the uterus from the inside and like a bladder surrounds the fruit, performing additional functions of protection, nutrition and metabolism.

During the delivery, thanks to rhythmic contractions of the uterine musculature, the uterus leaves the placenta together with the fetus. Naturally, separating from the uterine wall, the placenta provokes bleeding from the exposed vessels, and after its separation, the wound surface remains.

In the first hours after delivery, spotting can be associated with trauma in the birth canal, which is eliminated by suturing.

After birth, bloody discharge is observed completely in all those who gave birth. They contain liquid and thrombosed( with clots) blood, scraps of decidual tissue, destroyed muscular structures and mucus. Physiological postpartum spotting is called lochia. They continue until the end of the regeneration of the uterine tissues. As the mucous layer is restored, the quantity of lochias, as well as their color, change. Completely lochia disappear after 3-6 weeks.

Immediately after childbirth, the lochias are bright, red. Then their number and color change, and after ten days they become like lean pink mucus. Loechia brown means complete restoration of the integrity of the vessels of the endometrium. During the six weeks after delivery, 500 to 1500 ml of lop-liver are evacuated from the uterine cavity.

Pathological lochiaes become if:

- their number does not decrease as far as the time of delivery is concerned, but increases;

- they do not change their color and remain rich red;

- they contain pus or a lot of blood clots;

- they are accompanied by pain and / or fever.

Bloody discharge after childbirth is not always associated only with the lochia. Postnatal bleeding can be caused by a violation of the contractile activity of the uterine musculature, when the muscular wall is not able to contract properly. Such conditions include hypotension and atony of the uterus. With hypotension, the muscular apparatus of the uterus shrinks, but not enough, and with atony there is complete paralysis of the uterine muscles.

Massive bleeding after childbirth provokes the remaining plaquents in the uterus. They interfere with the uterus to contract, so there are abundant spotting.

Sometimes spotting after delivery is mistaken for women's menstruation. Meanwhile, for the restoration of menstrual function after childbirth, the body needs time for which all changes that occurred during pregnancy are eliminated, and in the ovaries begins the cyclic hormonal secretion. As a rule, it takes one and a half or two months. The time of the first postpartum menstruation depends on breastfeeding. In nursing, because of the increased content of the hormone prolactin, the monthly may not be the entire lactation period.

Postmenopausal bloody discharge

Postmenopause is the final menopause period from menopause( last menstruation) to 65 to 69 years.

With the concept of menopause, patients have a lot of misconceptions, so once again recall what is meant by this concept. The climacteric period is not something pathological, it's just a certain long stage in the life of every woman, when the hormonal function of the ovaries naturally ends gradually. As a rule, it lasts not less than eight years and, according to the ongoing structural and functional changes, is divided into several consecutive stages:

- Premenopause. Time of appearance of the first symptoms of menopause. Ends with the last menstruation.

- Menopause. The last menstrual bleeding. Since in the climax menstruation is losing its habitual rhythm, reliable menopause is considered a persistent absence of menstruation for a year and a half.

- Postmenopause. Closes the climacteric period.

Bloody discharge during menopause and premenopausal menopause is not always associated with severe pathology, but in women who have entered the postmenopausal period, they are always a cause for concern.

Post-menopausal bleeding is more often associated with hyperplastic processes in the endometrium, including those with atypia. Often, the cause of bleeding are polyps, submucous myomatous nodes or ovarian tumors.

In older women, bleeding can be provoked not only by benign pathologies, but also by cancer.

In post-menopause, there is no clear correlation between the nature of bleeding and the severity of the causes that caused it. Therefore, any spotting requires careful diagnosis.