In the life of every woman of a certain age (from40 to 58 years, depending on the characteristics of her body) there comes a period during which hormonal reorganization of the reproductive system occurs. As a result of this restructuring in women, the childbearing function at first stops working, and later menstruation disappears. This difficult period is called the climax. Many of the fair sex feel themselves during periods of menopause is unimportant: they jerk pressure, torment constant tides, worsening mood. Another trouble that happens at this time is uterine bleeding. A large number of women are convinced that bleeding with menopause is a common thing and quite natural, not requiring sharpening of attention on it. However, in reality it is not so. Bleeding can occur during menopause for various reasons and often report by their appearance about any problems and dangers of the female body. Why do uterine bleeding occur during this period, what do they testify, and how should they be combated?

Causes and types of abnormal blood loss

These phenomena, which are pathological in nature,arise even in the first period of menopause - premenopause (before menopause) - and may appear after the termination of menstruation (in postmenopause). There are uterine bleeding for various reasons, depending on which you can identify 4 of their species.

Bleeding, indicating the diseases of the vagina, cervix, ovaries, the proliferation of the endometrium and myometrium.

Bleeding resulting fromhormonal imbalance in premenopausal (dysfunctional discharge of blood), and minor bleeding that results from endometrial atrophy during the postmenopausal period.

Bloody iatrogenous discharge caused by medication.

Extragenital pathology (bleeding arising from diseases of other body systems, for example, with liver cirrhosis, hypothyroidism, or with clotting disorders).

In addition to various reasons contributing to the emergence ofuterine bleeding, the loss of blood, depending on the intensity and duration, also come in several forms, for which special names are used. So, menorrhagia is the longest (more than 7 days) and the most abundant (more than 80 ml) bleeding that appear in women with menopause on a regular basis. But menometrorrhagia is usually called abundant or prolonged irregular blood loss. Polimenorrhea is considered a regular discharge of blood, the interval between which is less than 21 days. Metrorrhagia refers to frequent and irregular neobylnye bleeding. All these blood loss are manifested more often depending on the climatic period in which the woman is. For example, in the period of premenopausal menometromorrhage prevails among bleeding, and when the menopause has already come - metrorrhagia.

Normal and abnormal menstruation in premenopause

Already in the first climacteric period -premenopause - a woman should pay attention to the nature of menstruation and the duration of the cycle. At this time, the discharge can be of different intensity: from the most meager to the abundant. The duration of cycles also varies. Menstruation may be absent for 2-3 months, then again become regular. The reasons for such changes are a decrease in the frequency of ovulation and a fluctuation in the hormonal level. These causes contribute to the growth of the endometrial layer and affect the course of the menstrual cycle. These changes are considered by doctors to be normal phenomena of premenopause. There are, however, a number of signs, noticing that a woman should immediately turn to a gynecologist, since it is a matter of pathologies. What should be cause for concern?

Too copious menstrual bleeding, in which the sanitary napkin is required to be changed every hour or even more often.

Allocations with blood clots.

Bleeding that occurs immediately after intercourse.

Absence of menstruation for more than 3 months.

Bleeding or spotting that occurs between menstruation.

2-3 short menstrual cycles (less than 3 weeks).

2-3 menstruation, the length of which is 3 days longer than usual.

The presence of such signs can be caused by completely different causes, which should be considered in more detail.

Causes of abnormal bleeding during premenopause

Since abnormal bleeding is common inmainly middle-aged women in menopause, the first place is to put hormonal imbalance. Violation of the balance in sex hormones leads to the absence of ovulation, because of what the endometrium begins to expand and provokes the release of blood.

Polyps of the uterus can also cause bloodyirregular discharge. Polyps must necessarily be removed by resectoscopy, since it is during menopause that there is a risk of endometrial or cervical cancer. You do not need to start the tissue, but it's better to start treatment right away.

Myoma of the uterus. Symptoms of this benign tumor are menorrhagia, which arise from violations of the contractility of the uterine muscles. Myoma grows in premenopause and stops growing after the onset of menopause.

Another reason related to uterineendometrium, is endometrial hyperplasia, as a result of which the inner shell of the muscular genital organ expands and can reach a precancerous state - atypical hyperplasia.

Endocrine disorders due toa syndrome of polycystic ovaries. As a result, menstruation can be very rare or completely absent, as there is no ovulation. When later menstruation nevertheless appear, they are abundant in nature and are explained by the proliferation of the endometrium.

Violation of the processes of blood coagulability. This phenomenon leads to irregular bleeding.

Pregnancy. Even during premenopause pregnancy occurs, and bleeding is associated with the threat of miscarriage, placenta previa or fetal placement in the fallopian tube or ovary (ectopic pregnancy).

Various contraceptives. If taking hormonal oral contraceptives is accompanied by breaks, irregular bleeding and spotting between menstruation can occur. The non-hormonal intrauterine device (IUD) can increase the volume of the menstrual fluid, and the hormone-containing IUD can reduce blood loss.

Hypothyroidism (deficiency) or hyperthyroidism (an overabundance of thyroid hormones). These diseases are accompanied in the first case by heavy bleeding, in the second - a prolonged absence of menstruation.

About the causes of bleeding during the postmenopause

During the postmenopause, the menstrual cycle ofof women ceases. In normal bleeding, similar to menstruation (painless, lasting only 3-4 days) can occur when taking medications that contain hormones progesterone and estrogens. The remaining cases of blood discharge testify to diseases. These can be submucosal fibroids, endometrial polyps, cervicitis, ovarian tumors and atrophic vaginitis. More serious diseases can be oncological problems, for example, cervical cancer. From 5 to 10% of women in the statistics during this period suffer from endometrial cancer. When bloody discharge, not associated with taking hormonal tablets, women during the period of postmenopause must necessarily appear to the gynecologist.

Methods of diagnosing diseases in uterine bleeding

Because bleeding in women can besymptoms of different diseases, it is not so easy to determine their causes. Diagnosis includes a whole range of activities and analyzes. Everything begins at a reception with a gynecologist who, during the examination, can assess the intensity and nature of the discharge, determine whether they are uterine, or bleed very different organs. A gynecologist is able to identify one of the four types of bleeding described above. Further, to determine the nature of uterine bleeding in menopause, women should undergo clinical and laboratory examinations. The complex of surveys includes such actions as:

• collection of anamnesis from the attending physician and analysis of the nature of the menograms (drawing of bloody discharge schedules);
• detection of the level of the hormone β-hCG;
• biochemical and clinical blood tests;
• research of the system of blood circulation;
• transvaginal ultrasound;
• MRI of pelvic organs;
• hormonal studies;
• A smear on oncocytology from the cervix;
• endometrial biopsy and hysteroscopy.

Diagnostic curettageendometrium and its morphological studies. As a result of such studies, doctors can establish an accurate diagnosis in a fairly short time and immediately tackle the treatment of the detected diseases.

How are women's bleeding treated during the menopause?

After the diagnosis is established, the doctor prescribes treatment. If the causes of uterine bleeding are dysfunctional, that is, the hormonal balance is violated, then the main method of treatment is the intake of hormonal drugs that contain analogues of female hormones of the genital. This method is called hormone replacement therapy. It should be remembered that the use of drugs should be strictly according to the scheme prescribed by the doctor, otherwise as a result of improper intake of hormones, uterine bleeding may occur again. Sometimes, to prevent excessive discharge, hemostatic drugs are prescribed. To make up blood loss, doctors prescribe infusion therapy as a cure. If suddenly a woman during the menopause suffered profuse blood loss, she can provoke severe anemia or hemorrhagic shock. In this case, urgent medical care is required, which can be provided only in the hospital. If the pathology is intrauterine, for example, endometrial hyperplasia, then hysteroscopy and ablation - scraping of the uterine cavity. In other serious cases, too, surgical intervention is required. If the polyp bleeds, then an endoscopic operation is performed - resectoscopy. With her help, the polyp is removed through the cervix. If several myomas are found, they can remove the uterus by performing a hysterectomy. If the disease is cancerous, the woman continues treatment already with an oncologist. In this case, in addition to surgical operations, radiotherapy and chemotherapy are included in the treatment regimen. Every woman who entered the menopause period should carefully monitor the health of her reproductive and genitourinary system. Once every 6 months, you need to undergo an examination with a gynecologist, and with the above symptoms, immediately consult a doctor. Only timely assistance will facilitate rapid treatment and the final disposal of severe ailments, because there are no preventive measures to prevent uterine bleeding.

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