Uterine Bleeding - How To Stop It? Causes, Types And Treatment Of Uterine Bleeding With Clots

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

How to stop uterine bleeding? Causes, types and treatment

Content:

• What is uterine bleeding?
• Why are uterine bleeding dangerous?
• Causes of uterine bleeding
• Types of pathological uterine bleeding
• Uterine bleeding with clots
• Uterine bleeding during pregnancy
• First aid for uterine bleeding
• Treatment of uterine bleeding

What is uterine bleeding?

Uterine bleeding is the discharge of blood from the uterus. Most often, it is a serious symptom of diseases of the female body. Any uterine bleeding should be diagnosed on time, and the woman should be provided with medical assistance. Ignoring such a symptom leads to serious consequences, up to and including death. It is important to know that normal uterine bleeding includes only menstruation, the duration of which is up to 5 days, with stable interruptions, 28 days long. All other bleeding is pathological and requires medical supervision.

According to statistics, uterine bleeding, which is of a pathological nature, in 25% of cases is associated with organic diseases of this organ or ovaries. The remaining 75% are bleeding associated with hormonal disorders and diseases of the genital area.

Menstruation (menstruation) is the only physiologically normal type of uterine bleeding. It usually lasts from three to five days, and the interval between periods (menstrual cycle) normally lasts from 21 to 35 days. Most often, the first couple of days of menstruation are not abundant, the next two are intensified and at the end they again become scarce; blood loss on these days should be no more than 80 ml. Otherwise, iron deficiency anemia develops.

In healthy women, periods are painless. In case of pain, weakness and dizziness, a woman should consult a doctor.

Menstruation usually begins at the age of 11-15 and lasts until the end of the reproductive period (menopause). During pregnancy and breastfeeding, menstruation is absent, but this is temporary.

It is important to remember that the early appearance of bloody discharge in girls (under 10 years old), as well as in women after menopause (45–55 years old), is an alarming sign of serious illness.

Sometimes spotting in the middle of the cycle (10-15 days after the end of menstruation) can become a variant of the norm. They are caused by hormonal fluctuations after ovulation: the walls of the uterine vessels become excessively permeable, so vaginal discharge may have blood impurities. Such discharge should not last more than two days. Sometimes the inflammatory process becomes the cause of bloody discharge, so a woman should definitely consult a gynecologist.

A variant of the norm is also implantation bleeding that occurs due to the introduction of the embryo into the uterine wall. This process takes place one week after conception.

Why are uterine bleeding dangerous?

Uterine bleeding has the ability to build up quickly, does not stop for a long time and is difficult to stop.

Therefore, depending on what type of bleeding a woman has, it can be dangerous with consequences such as:

• With moderate but regular blood loss, anemia of varying severity can develop. It begins if the volume of the released blood is 80 ml. Although in such conditions there is no direct threat to a woman's life, however, this process cannot be ignored.
• Large blood loss can be caused by heavy, simultaneous bleeding that is difficult to stop. Most often, surgery is required, with the replacement of lost blood and removal of the uterus.
• The danger of progression of the underlying disease. In this case, we are talking about small blood loss, which the woman does not pay attention to and does not go for medical help. At the same time, even a small amount of blood loss can eventually lead either to profuse bleeding, or to the fact that the disease that caused it will go into a neglected form.
• The danger of bleeding in pregnant women or in women in the postpartum period is that it can end in shock. The intensity and severity of this condition is due to the fact that the uterus is not able to fully contract and stop blood loss on its own.

Causes of uterine bleeding

There are many reasons that can cause uterine bleeding. In order to systematize them, one should understand that the induced blood loss can be a malfunction in organ systems, as well as disorders in the genital area.

Extragenital causes of uterine bleeding, that is, those caused by disorders in the work of non-sexual organs include:

• Some infectious diseases are: sepsis, typhoid fever, flu, measles.
• Diseases of the hematopoietic system are: hemophilia, hemorrhagic vasculitis, low levels of vitamin C and K, etc.
• Cirrhosis of the liver.
• Prolapse of the urethra.
• Disorders in the activity of the cardiovascular system, for example, hypertension, atherosclerosis, etc.
• Decreased functionality of the thyroid gland.

The causes of uterine bleeding are genital, in turn, may be associated with a woman carrying a child.

During pregnancy, the following causes of bleeding from the uterus are distinguished:

• Ectopic pregnancy.
• Pathology of the ovum.
• The presence of a scar on the uterus.
• Placenta previa, its low location or early detachment.
• Various processes of destruction of uterine tissues.
• Rupture of the uterus during labor.
• Injuries to the birth canal (vagina or vulva).
• Infringement or delay of the departed placenta.
• Enometritis.
• Trophablastic disease.
• Myoma of the uterus.
• Cesarean section.
• Chorionepitheloma.

Genital bleeding can occur in a woman who is not carrying a child. Their causes include:

• Dyscirculatory bleeding, which, in turn, can be climateric, reproductive and juvenile.
• Tumors of the ovaries or uterus that are both benign and malignant, such as fibroids.
• Adenomyosis, characterized by the introduction of the uterine mucosa into its wall.
• Rupture of the cyst or rupture of the ovary itself.
• Any injury to the uterus.
• Diseases of an inflammatory nature, these include cervicitis, vaginitis, endometritis, erosion, endocervicosis.
• Damage to the external genital organs.
• Taking pre-oral contraceptives.
• Sexual abuse.

Uterine bleeding with menopause

It is a mistake to believe that a woman does not have discharge during menopause. However, even during the premenopausal period, she needs to pay attention to their nature and number. Sometimes menstruation may be absent for several months, and sometimes it will be regular. This is due to the fact that ovulation has a different frequency, as well as fluctuations in hormone levels. Such changes are considered the norm and should not cause anxiety in a woman.

To alert her and become a reason for contacting a doctor, the following should:

• Heavy bleeding, which hygiene products cannot cope with.
• Discharge accompanying clots.
• Bleeding that occurs between periods.
• The duration of the bleeding is more than three days than usual.

You can not leave such uterine bleeding during menopause, because they can indicate hormonal imbalance, uterine polyps or myoma, endocrine disorders, ovarian tumors and other serious diseases.

Find out more: Menopause and hot flashes in women, treatment methods

Uterine bleeding with hormonal imbalance

Uterine bleeding can occur in a woman with a hormonal imbalance in the body. This problem is relevant for the fairer sex at any age. This happens when the amount of hormones is violated or when their ratio changes.

Hormonal disruption can be caused by a number of reasons:

• Violations occur due to the fact that the brain does not properly regulate their production, for example, with pathologies of the pituitary gland.
• Sometimes bleeding opens due to the pathology of the gonads. This can occur due to inflammatory processes in the ovaries, with tumors, cysts.
• Chronic fatigue syndrome, especially when exacerbated by fasting and wasting, can also cause bleeding.
• Severe hormonal disorders occur during puberty of a girl, during pregnancy and after childbirth, after abortion.
• Sometimes a hereditary predisposition and taking certain hormonal pills can affect.
• Prolonged bleeding can develop against the background of medical abortion, which has recently been gaining momentum.

Treatment of bleeding caused by hormonal disruptions requires an individual approach. It will depend on the cause that caused the bloody discharge from the uterus.

Uterine bleeding after cesarean

After a caesarean section, the woman should be under medical supervision. Most often, bleeding lasts a little longer than after a natural birth. This is due to the fact that a scar forms on the uterus, which makes it difficult to contract. Normally, bleeding stops completely after a couple of months. If it continues, then the woman needs to inform the doctor about this problem.

The cause of pathological bleeding after the operation is most often hemostasis. Therefore, to eliminate this problem, doctors must carefully but thoroughly scrape the walls of the uterus. If the bleeding cannot be stopped, its extirpation is required.

If the bleeding is hypotonic, then it is not always possible to stop it, since it occurs after the uterus begins to contract. Profuse blood loss can lead to hypotonic shock. It is necessary to replenish blood supplies by transfusion and manual examination of the uterus in order to detect possible remnants of the placenta, to determine the contractile function of the uterus and to establish the existing rupture.

A critical measure that doctors take to keep a woman alive is the removal of the uterus. This method is used if bleeding after cesarean section cannot be stopped by other means (electrical stimulation of the uterus, vascular ligation, administration of uterotonics).

Types of pathological uterine bleeding

Gynecologists divide uterine bleeding into many types. But there are those that are most common:

• Juvenile bleeding. Are characteristic of the onset of puberty in a girl. They can be triggered by a number of factors, for example, frequent illnesses, increased physical activity, inappropriate nutrition, etc. Depending on the amount of blood lost, such bleeding can lead to anemia of varying severity.
• Profuse uterine bleeding should be talked about if it is not accompanied by pain. In this case, the amount of fluid lost may vary. There are many reasons, it can be a past abortion, and vaginal infections, and taking hormone-containing drugs, etc.
• Acyclic bleeding is characterized by the fact that it appears in the intervals between menstrual cycles. It can be caused by myoma, cyst, endometriosis and other pathologies. If acyclic bleeding is observed regularly, then a doctor's consultation is necessary. Although this view is not always a symptom of any pathology.
• Anovulatory bleeding is typical for women who have entered the period of menopause and for adolescents undergoing puberty. It is caused by the fact that the maturation of follicles and the production of progesterone are disrupted, in the absence of ovulation. This species is dangerous because, without treatment, it can provoke the development of malignant tumors.
• Dysfunctional uterine bleeding occurs when the ovaries are dysfunctional. A distinctive feature is that it occurs after menstruation has been absent for a long time, and blood loss with it is profuse.
• Hypotonic bleeding occurs due to a low tone of the myometrium, after an abortion, etc., most often appears after childbirth.

Dysfunctional uterine bleeding

Dysfunctional uterine bleeding includes those that are associated with a disruption in the production of sex hormones produced by the endocrine glands. They can manifest themselves at almost any age, both during puberty and during menopause, and in the reproductive period of a woman's life. This pathology is widespread.

This type of bleeding is expressed by the fact that the period of menstruation is lengthened, and the amount of lost fluid increases. Without treatment, it always leads to the development of anemia. The main feature is a prolonged absence of menstruation, sometimes up to six months, and then the onset of bleeding, which has varying strength.

Dysfunctional bleeding can be ovulatory (bothering women of reproductive age) and anovulatory (more common in adolescents and premenopausal women). Cycle disturbances in this case are expressed in abundant and irregular periods, with long (more than 35 days) and short-term (less than 21 days) intervals, in the absence of menstruation for more than six months.

The tactics of treatment depend on the age of the patient and on the presence of concomitant pathology. It can be both medicinal and surgical. However, in adolescence, surgery is resorted to only in emergency cases. Conservative therapy consists of taking hormones. If left untreated, dysfunctional uterine bleeding can lead to infertility, miscarriages, chronic anemias, endometrial cancer, shock and even death.

Atonic uterine bleeding

Atonic bleeding is characterized by the fact that it forms when the uterus becomes unable to contract. The lack of contractility in obstetric practice is called the Kuveler's uterus. A characteristic feature of atonic bleeding is zero tone and a similar response to the administration of uterotonics.

When it is not possible to stop the bleeding with the help of specialized drugs, a thick suture is applied to the posterior lip of the cervix, and clamps are additionally applied to clamp the uterine artery.

If these methods turned out to be ineffective, and it was not possible to stop the blood loss, then they are considered as preparation for the operation to remove the uterus. Mass blood loss is considered to be from 1200 ml. Before completely removing the uterus, attempts are made to ligate blood vessels using the Tsitsishvili method, electrical stimulation (this method is becoming less popular, and doctors are gradually abandoning it), acupuncture. It is important to continually replenish lost blood supplies.

Hypotonic uterine bleeding

This type is characterized by the fact that the tone of the myometrium decreases. Such bleeding occurs with a delay in the uterine cavity of the ovum, with the separation of the placenta, after its release. The reason lies in the hypotension of the uterus after childbirth, when contractions occur rarely and are spontaneous. The critical degree of this condition is referred to as atony, when contractions are completely absent.

The tasks facing doctors in the first place are:

• The earliest possible stop of bleeding.
• Replenishment of the BCC deficit.
• Avoid blood loss of more than 1200 ml.
• Tracking blood pressure and preventing it from falling to a critical level.

Treatment is aimed at restoring the motor function of the uterus as soon as possible. If there are remnants of the ovum, then it must be removed either by hand or with a curette. When hypotonic bleeding occurs after childbirth, it is necessary to squeeze out the placenta as soon as possible, if it does not work, then it is removed manually. Most often, it is the removal of the placenta that helps restore the motor function of the uterus. If necessary, gently massage her on her fist.

The administration of pituitrin or oxytocin is indicated as medicines. In some cases, it is effective to apply a bladder containing ice to the abdomen or irritate the uterus with ether. For this purpose, a moistened tampon is inserted into the posterior fornix of the vagina. If hypotension does not respond to the indicated therapy, then measures are taken that are characteristic of uterine atony.

Acyclic uterine bleeding

Acyclic uterine bleeding is called metrorrhagia. It is not associated with the normal menstrual cycle, characterized by the complete absence of any periodicity.

This condition can occur suddenly and be associated with a woman's pregnancy, with an incomplete abortion, with placenta previa, with the development of an ectopic pregnancy, delayed part of the placenta, etc.

Acyclic bleeding, if a woman is not carrying a child, can be observed in pathologies such as uterine fibroids, benign tumors. If the tumor is malignant, then metrorrhagia is observed at the stage of its decay.

It is not possible to describe the degree of intensity of blood loss, since the discharge can be smearing, abundant, with and without admixtures of blood clots.

It is important to pay close attention to acyclic bleeding for women in menopause, both at the initial stage and several years later, after the cessation of constant menstruation. In no case should they be perceived as renewed ovulation. Metrorrhagias in this period require careful study, since they are often signs of a malignant process, for example, sarcomas.

Breakthrough uterine bleeding

Breakthrough uterine bleeding develops against a background of hormonal disorders. They are characterized by an imbalance between estrogen and progesterone. Sometimes bleeding of this type occurs against the background of a woman taking oral contraceptives. In this case, breakthrough bleeding is an adaptation response to the drug. If, after taking the prescribed medication, bleeding occurs that does not correspond to the menstrual cycle, then you should consult with your doctor about adjusting the dose or changing the remedy.

Breakthrough bleeding can also be observed when the uterine wall is damaged by the spiral. This cannot be ignored, the spiral must be removed immediately.

Most often, blood loss in breakthrough bleeding is insignificant, however, a visit to the doctor should not be postponed.

Anovulatory uterine bleeding

These bleeding occurs in the interval between menstruation, their causes are varied, including they may be a manifestation of a disease. Most often, anovulatory bleeding is prolonged in time, lasts more than 10 days, and is acyclic in nature. Women suffer such blood loss either during the extinction of the reproductive function, or during its formation.

This bleeding is also called single-phase, during its opening, the corpus luteum is not formed, the development of the follicle occurs with disturbances, there is no ovulation.

This bleeding can be hyperestrogenic when the follicle matures but does not rupture and hypoestrogenic when several follicles mature but do not fully mature.

Rarely, anovular uterine bleeding occurs during a woman's reproductive life. Such phenomena are associated with disturbances in the work of the hypophosotropic zone, after the stress, poisoning, infections.

Among adolescents, according to statistics, this type of bleeding occurs quite often. Such violations account for up to 12% of all gynecological diseases. In this case, the decisive factor can be inappropriate nutrition, mental trauma, physiological overload.

Dyscirculatory uterine bleeding

The occurrence of discirculatory uterine bleeding is caused by dysfunction of the ovaries. Sometimes external factors such as past viral infections, stress, etc. are the impetus. Blood loss is not great, it is observed after menstruation has been absent for a long time.

Uterine bleeding with clots

Often, women observe the presence of clots in uterine bleeding. Most often, doctors explain their appearance by the fact that the uterus, during intrauterine development, has undergone certain anomalies. Therefore, the blood stagnates in its cavity, forming clots.

Most often, menstruation causes more pronounced discomfort in such women, especially when they occur with an increased hormonal background. Sometimes it is such a congenital anomaly that can cause increased bleeding and the presence of numerous clots in the discharge.

In addition to the fact that abnormalities are congenital, they can be acquired during life. Such phenomena are associated with the professional characteristics of a woman and with the abuse of bad habits. Often, during menstruation with blood clots, women experience severe cutting pains. In order to exclude the presence of a pathological process, it is important to seek advice from a gynecologist.

Sometimes hormonal abnormalities can also lead to the formation of clots. To clarify the reason, you need to pass a number of tests, including for thyroid hormones and adrenal hormones, to investigate the level of progesterone and estrogen.

The presence of clots, severe pain in the lower abdomen, profuse blood loss during menstruation, acyclic mini-bleeding - all this most often indicates endometriosis. Such a diagnosis is established after a thorough diagnosis and requires appropriate treatment.

Sometimes the cause can be poor blood clotting and some complications after childbirth.

Learn more: Heavy and heavy bleeding during menstruation, with clots, what to do?

Uterine bleeding during pregnancy

The most common causes of uterine bleeding during pregnancy are miscarriage, uterine disease, ectopic pregnancy and damage to the placenta.

A miscarriage is accompanied by severe cramping pains in the lower abdomen, bleeding is intense, the color of the blood is from bright scarlet to dark. With an ectopic pregnancy, bleeding is accompanied by a deterioration in the general condition, malaise, nausea, vomiting, sweating and fainting. The blood is dark in color, usually clotted.

Damage to the blood vessels of the cervix during pregnancy can occur during intercourse or gynecological examination. This bleeding is usually not profuse or prolonged.

If the placenta is damaged or previa, uterine bleeding may occur in the second or third trimester. The bleeding is usually severe. It poses a serious threat to the life and health of the expectant mother and her child.

It should be remembered that uterine bleeding in pregnant women is very dangerous, so a woman must definitely call a medical team that will provide her with urgent help.

First aid for uterine bleeding

First aid for uterine bleeding is to call an ambulance as soon as possible. This is especially true in the case when a woman is carrying a child, her blood loss is profuse, her condition worsens sharply. In this case, every minute counts. If it is not possible to call a medical team, then it is necessary to deliver the woman to the hospital on their own.

Any uterine bleeding is a serious threat to life and health, so the reaction must be appropriate.

In case of dysfunctional bleeding, it is strictly forbidden to apply a hot or warm heating pad to the abdomen, douche with any formulations, take a bath, and use drugs that promote uterine contraction.

Independently, at home until the ambulance arrives, a woman can be helped as follows:

• The woman must be put to bed, preferably on her back, and her legs must be placed on some kind of elevation. To do this, you can put a pillow or blanket roller. Thus, it will be possible to preserve the patient's consciousness, especially if the blood loss is impressive.
• Something cold must be applied to the stomach. If you don't have a heating pad at hand, you can wrap the ice in a regular cloth. You can replace the ice with an ordinary bottle filled with cold water. Cold exposure time - up to 15 minutes, then a break of 5 minutes. This will help to achieve vasoconstriction, which means a little to reduce bleeding.
• The woman needs to be watered. Since it is not possible to put a dropper at home, it is necessary to offer the patient an abundant drink. Plain water and sweet tea will do. This will contribute to the loss of fluid along with blood, glucose will provide nutrition to the nerve cells of the brain.

Taking medication should be treated with extreme caution, especially if a woman is carrying a child. Before taking them, it is imperative to consult a doctor, but sometimes it happens that such an opportunity is absent. Therefore, it is necessary to know the names of the haemostatic agents and their minimum dosage. These include Vikasol (taken 3 times a day, at a dosage of 0.015 g), ascorbic acid (maximum daily dose of 1 g), Dicinon (taken 4 times a day, at a dosage of 0.25), calcium gluconate (1 tablet up to 4 times per day). It is important to remember before use that all medications have side effects.

How to stop uterine bleeding?

When an ambulance team arrives at the scene, its actions will be as follows:

• A bubble containing ice is placed on the woman's stomach.
• If the bleeding is profuse, then the woman should be brought to the car on a stretcher.
• Hospitalization of the patient with the transfer directly to a specialist.
• The introduction of a solution of magnesium sulfate, with a threat or beginning of miscarriage. Or if a spontaneous abortion occurs, the woman is injected intravenously with calcium chloride and ascorbic acid diluted with glucose. Etamzilat may be injected.

Doctors in the hospital use hormonal drugs to stop bleeding, in the event that a woman has not yet given birth, she has no suspicion of a tumor. Hormonal drugs include Jeannine Regulon, etc. On the first day they give an increased dose (up to 6 tablets), in the following days one tablet less, bringing to 1 piece. Sometimes progestogens are used, but it can be used only in the absence of severe anemia.

Hemostatic agents, for example, Dicinon, Vikasol, Ascorutin, Aminocaproic acid, can also be used.

Sometimes surgical interventions are used, such as curettage of the uterus (an effective method for stopping blood loss), cryodestruction (a method without contraindications), laser removal of the endometrium (used in those women who do not plan to have children anymore).

Find out more: Haemostatic agents for uterine bleeding

Treatment of uterine bleeding

Treatment of uterine bleeding largely depends on its causes and the patient's age.

Adolescents are most often prescribed drugs that reduce the uterus, drugs that stop blood and strengthen the walls of blood vessels. It is also recommended to take vitamins, herbal medicine, less often - hormonal drugs that regulate the menstrual cycle. Women of reproductive age are prescribed hormonal drugs, sometimes surgical operations are performed (for fibroids, endometriosis of the uterus, etc.) appendages.

In treatment, it is most important to diagnose the causes of bleeding in time, so sick women should immediately seek medical help.

The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.