Blood discharge in older women over 70. Uterine bleeding after menopause

Sometimes women turn to the gynecologist because of bleeding from the uterus. Such a deviation can occur at any age, both during pregnancy and without it. There may be several reasons for this pathology, and we'll talk about them.

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Types and causes of appearance

Blood discharges are of several types. This:

Nongenital or extragenital.
Genital, which are associated with pregnancy.
Genital, which are not related to pregnancy.
Dysfunctional uterine bleeding (DUB).

You should also know the following division of bleeding:

juvenile character. Occurs during puberty in girls. Strong mental overload, frequent illness, poor nutrition, and so on can contribute.
Profuse. Not accompanied by pain. Consequence of abortion or vaginal infection, side effect contraceptives, etc.
Acyclic. Occurs between periods. There is such bleeding with erosion, endometriosis, fibroids or cysts.
Hypotonic. The reason for its appearance is the low tone of the myometrium (after delivery or abortion).
Anovulatory. Develops in adolescence and in menopausal women. If nothing is done, then a malignant neoplasm may develop.

Non-genital bleeding

Occurs due to infection with certain diseases.

Diseases can cause bleeding in the form of:

measles;
typhus;
FLU;
sepsis;
cirrhosis of the liver;
hemophilia;
hemorrhagic vasculitis;
atherosclerosis.

Sometimes the cause lies in high blood pressure or improper functioning of the thyroid gland.

Genital bleeding (during pregnancy)

If women have bloody issues associated with the genitals, they are genital.

At the beginning of pregnancy, blood loss is due to:

ectopic pregnancy;
diseases gestational sac(cystic drift or the presence of a malignant neoplasm).

If the cervix bleeds during pregnancy at a later date, then this may be a sign of:

placental presentation;
the presence of scars on the uterus;
early placental abruption.

During delivery, bleeding is associated with:

low location of the placenta, its presentation or premature detachment;
uterine rupture;
violation of the integrity of the birth canal.

After delivery, this happens due to:

endometritis;
fibroids;
trauma during the birth process;
chorionepithelioma;
decreased uterine tone.

Genital (no pregnancy)

If the lady is not pregnant, then there may also be bleeding between periods. The reason lies in:

the presence of a tumor in the uterus, ovaries or fallopian tubes;
rupture of the ovary or cystic formation on it;
organ injury after sexual contact, etc.;
inflammation or infection of the organ (with cervicitis, endometritis, vaginitis, erosion, etc.).

Blood loss occurs with various dysfunctional disorders. More about this.

Dysfunctional uterine bleeding

If a woman has blood loss in the form of menstruation at the right time, while losing about 50-60 ml of blood, this is the norm. If there is prolonged bleeding after menstruation and there are more than 70 ml of them, this is a sign of dysfunction, that is, DMC.

If the bleeding is long and heavy, it is called menorrhagia. If it occurs between periods - metrorrhagia.

Often this dysfunction occurs in women after 30 years. Hormonal surges, improper functioning of the thyroid gland and adrenal glands, leads to disruption of ovulation.

It may also occur due to:

nervous tension, stressful situations;
overwork, both physical and mental;
harmful production;
difficult childbirth and abortion;
inflammatory processes occurring in the pelvic organs.

In the age category from 13 to 20 years, such deviations are also possible. This is the result of mental trauma, hard physical labor, lack of vitamins in the body, the presence of various pathologies, both chronic and acute.

Bleeding from the uterus in old age is associated with:

nervous tension;
diseases of a chronic nature;
hormonal changes.

Other reasons

Sometimes the cervix bleeds during examination, if the gynecologist was inaccurate and injured the organ. The same embarrassment can occur with rough sexual intercourse.

If a woman has any defects of the genital organs from birth, then blood loss is also possible, often with clots. In this case, you will have to be fully examined and resort to radical methods of treatment.

Bleeding in old age?

In older women, bloody discharge from the genital tract may be associated with:

diseases of the reproductive organs (pathologies of the ovaries, uterus, vagina);
improper metabolism;
liver dysfunction and endocrine system;
blood supply problems;
taking certain medications;
hormonal failure;
changes in the endometrial layer of the uterus.

Also, a common cause of blood loss in old age is the presence of tumors, inflammations and infections.

Symptoms and signs

The main sign of uterine bleeding is bloody discharge from the genital tract. With bleeding, but not menstruation, there are additional symptoms:

the volume of liquid is more than 80 ml (this can be understood if a woman changes her pads more often than once every two hours);
duration of blood loss for more than 6 days and more than once a month;
if the interval between periods is less than the 21st or more than 35 days;
bleeding of the cervix after sex;
blood on underwear is present in the postmenopausal period.

If a woman regularly loses a large amount of blood, she will develop anemia. You will feel dizzy, weak and your skin will become pale. If the erosion of the cervix bleeds, then you can not hesitate, as serious consequences are possible in the future.

First aid for uterine bleeding

When bleeding, the lady should be able to provide first aid to herself. Mass blood loss should not be allowed, as this can lead to loss of consciousness, anemia and other consequences.

You can not put anything hot on your stomach, take baths, soar your legs, eat foods containing vitamin C.

To improve your well-being you need:

take a horizontal position and put your feet on a hill;
put ice or a bottle of cold water on the abdomen;
constantly drink liquid.

When should you see a doctor?

If the bleeding does not stop within a week, clots and soreness are present. A woman needs to contact a specialist who examines her and prescribes the appropriate treatment. Self-medication in this case is inappropriate, since the patient does not know the cause of the pathology.

How to get rid of uterine bleeding?

What to do with bleeding? In such cases, you can not hesitate, you need to seek medical help. It is important to identify the cause of the pathology in a timely manner and begin its treatment.

If such a dysfunction arose in adolescence, then the doctor will prescribe medications that promote uterine contraction, as well as hemostatic drugs and those that strengthen blood vessels. It is also important to use vitamins, a course of herbal medicine. In some cases it is shown hormonal treatment. This will make it possible to adjust the menstrual cycle.

Women who are of reproductive age are prescribed hormonal drugs. If the cause is fibroma, the presence of a cyst or other formations, then it is possible radical treatment. If erosion of the cervix bleeds, then cauterization will help remove the bleeding.

How to stop bleeding in old age? Here, almost always, the reason lies in oncology, therefore, it is possible to get rid of the pathology only with the help of surgical intervention. The entire affected organ will have to be removed.

In order not to start the disease and cure it in a conservative way. You should promptly seek help from a specialist and do not self-medicate. Hemostatic agents will not relieve the underlying disease, but only temporarily eliminate the symptoms.

Prevention

To prevent this pathology, you should:

eat well and consume more vitamins;
less nervous;
have one partner;
timely treat all diseases associated with the sexual sphere;
do not have rash abortions;
regularly visit a gynecologist;
in the event of any abnormalities, immediately contact the hospital.

Output

Why does the cervix bleed and can an organ bleed without pathologies? Such questions are asked by women who have prolonged bleeding from the genital tract. There can be many answers. But it is important to know that the presence of blood on the linen between periods is not the norm. Bloody discharge remaining for more than a week should also be alarming. To prevent serious complications, you should consult a gynecologist in a timely manner.

What is this violation?

Uterine bleeding after menopause is defined as bleeding from the genital tract that occurs a year or more after menstruation has stopped. Bleeding may be the external hearth organs, the vagina, the cervix and the endometrium. The prognosis depends on the cause of the bleeding.

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If you are scheduled for scraping

Scraping is surgical procedure performed to form a normal menstrual cycle and determine the cause of the deviation from the norm.

Before the procedure

Before you are admitted to the hospital, your doctor will ask you about your symptoms and perform a physical and gynecological examination. You will have a swab taken for analysis and blood and urine tests.

The night before your procedure, you should shave with an antibacterial soap and take an enema to cleanse your intestines to prevent infection. In all likelihood, you will be asked not to eat or drink anything from the evening.

At the hospital, you will be given a mild tranquilizer before your operation and will have an IV ready in case you need to administer fluids or medications during the operation.

During the procedure

If they make you general anesthesia, you will wake up in the recovery room in about an hour, and the nurse will check your condition. If you are given local anesthesia, you will be awake during the procedure.

You will be helped to lie on your back on the operating table with your legs tucked into the belt loops.

The doctor will conduct an examination. If he finds polyps, he will remove them by taking tissue samples from the cervix and from the uterus. These tissues will be examined to determine the cause of the bleeding. Then the doctor will do a curettage of the endometrium, after expanding the cervix.

If you develop cramping pains, nausea, dizziness, breathe deeply and try to relax. It is unlikely that you will feel bad. But if you feel bad, tell the doctor and he will give you medicine.

After the procedure

When the anesthetic wears off, you will experience cramping pains similar to those you experience during menstruation. They are usually weak, but can be strong. Your lower back may ache for 1-2 days.

During the period that you have a dirty discharge (several days or more), use only sanitary napkins.

Resume your normal activities, but ask your doctor if you can exercise more.

Refrain from sexual intercourse until complete recovery occurs - approximately 2 weeks.

Tell your doctor if you experience menstrual-like vaginal bleeding and a fever. See a doctor if you experience persistent pelvic pain, an increased heart rate, and a foul-smelling vaginal discharge.

See your doctor regularly.

What are the causes of bleeding?

Causes of uterine bleeding after menopause can be:

estrogen replacement therapy (if a woman receives too much estrogen or if the doses of estrogen are low, but the endometrium is very sensitive);

release of too much estrogen; in some women, even slight fluctuations in estrogen levels can cause bleeding;

atrophy of the endometrium due to low estrogen;

atrophic colpitis; usually occurs as a result of trauma during intercourse with low estrogen levels;

aging; blood vessels become weak, degenerative changes occur in tissues, resistance to infections decreases;

endometrial and cervical cancer (usually occurs after 60 years);

adenomatous hyperplasia and atypical adenomatous hyperplasia.

What are the symptoms of uterine bleeding after menopause?

The main symptom is vaginal bleeding, and the duration and blood loss can vary greatly. Other symptoms depend on the cause of the bleeding. So, excess estrogen can lead to the production of excess cervical mucus; estrogen deficiency can cause wrinkling of the vaginal mucosa.

How is uterine bleeding diagnosed after menopause?

The doctor performs a physical examination (including the pelvic organs), examines the medical history and prescribes standard laboratory tests (complete blood count). A cytological examination of tissue samples of the cervix and cervical canal is carried out. Endometrial biopsy and curettage can detect endometrial disease.

It is necessary to carry out differential diagnosis. Thus, an increased content of estrogen suggests an ovarian tumor. Before determining the content of estrogen, a woman should stop taking estrogen and not use ointments and creams containing estrogen.

How is uterine bleeding treated?

The need for emergency treatment to stop large blood loss is rare (only in the last stage of cancer). Treatment may include curettage, after which the bleeding stops. The choice of treatment depends on the cause of the bleeding. With estrogen deficiency, the use of ointments and suppositories with estrogen usually gives a good effect, because they are quickly absorbed. For recurring bleeding from the endometrium, a hysterectomy is indicated, since such bleeding may be symptoms of endometrial cancer.

Menopause is a natural period in the life of every woman. It is considered the end of the reproductive age, when she loses the ability to conceive and give birth to a child.

For some women, this farewell is very unpleasant. They feel negative changes in the body, fall into depression. Others do not pay attention to this, trying to quickly cross the line of menopause.

It is impossible not to notice the changes if uterine bleeding occurs in the premenopausal period and after menopause. They may indicate pathologies in the body, especially the presence of formations. Tumors are both benign and malignant.

When there's nothing to worry about

When menopause occurs, bleeding is not always abnormal.

Its appearance should not be alerted when:

manifestations of premenopause;
artificially prolonged premenopause;
taking oral contraceptives and installing a uterine spiral to exclude the possibility of pregnancy in premenopause and menopause.

It is worth remembering that in the presence of menstruation, a woman can become pregnant. Therefore, protection during this period is mandatory. Bleeding may indicate the wrong choice of contraceptive method. It is important to visit a doctor to replace the method with a more suitable one.

The onset of menopause is noted after the age of 40 years. The sudden disappearance of menstruation should not be.

During this period, several stages of development are observed:

Premenopause is observed for two to five years. At this time, menstruation persists, but they have an irregular, mild character. Changes are associated with hormonal imbalance, disruption of the endocrine system.
During menopause, menstruation stops. If they are absent for a year, then their final disappearance is noted. Some women who are trying to delay menopause take progesterone. It allows you to return menstruation, which becomes painless and mild.
In the absence of menstruation during the year, postmenopause occurs. During this period, any bleeding is considered pathological. Particularly dangerous are discharge with clots. Changes are no longer caused by hormonal disorders. Sometimes they indicate malignant tumors. It is important to visit a doctor who will note possible reasons and treatment of uterine bleeding in menopause.

It is worth remembering that during menopause may appear various diseases accompanied by uterine bleeding. To identify them, it is important for a woman to regularly visit a gynecologist and treat pathologies.

Classification

Bleeding from the uterine cavity in old age can be of various types:

In diseases of the organs of the female reproductive system, among which the uterus, ovaries, and vagina are distinguished, organic bleeding appears. They can also be associated with metabolic disorders, endocrine system, liver and blood supply.
Iatrogenic bleeding is associated with taking medications with hormones in the composition, anticoagulants and other medicines. They also appear when installing an intrauterine device.
Dysfunctional uterine bleeding in the premenopausal period is caused by a violation of the cycle due to hormonal imbalance.

Bleeding of a dysfunctional nature can have a different duration. They are considered abnormal when they are abundant (more than 80 ml), elongated (longer than a week), and a cycle of less than 21 days or more than 40 days. Normally, the cycle should be from 21 to 35 days, monthly for 3-7 days with blood loss up to 80 ml.

Depending on the nature of the violations, bleeding of a dysfunctional type can be divided into several types:

regular long periods of abundant (more than 80 ml) nature for more than a week are called hypermenorrhea or menorrhagia;
with a weak expression of intermenstrual discharge, metrorrhagia is diagnosed;
irregular bleeding from the uterus that lasts more than a week is considered menometrorrhagia;
regular bleeding at intervals greater than 21 days is polymenorrhea.

In menopause, bleeding disorders (duration and profusion) may be associated with the state of blood vessels or blood clotting. Doctors also note among the common causes of changes in the endometrial layer of the uterus.

Why uterine bleeding can occur with menopause

Uterine bleeding during menopause may indicate hormonal changes that are associated with aging. Also, abnormal disorders can be the result of pathologies, taking contraceptives, and other medications.

Women can notice the first changes already at the age of 35. Early menstruation, a significant interval between births, and the cessation of lactation by artificial means lead to the appearance of bleeding in this period.

Affect the onset of menopause and dysfunctional bleeding and heredity. In addition, among the common causes, infectious and inflammatory processes in the organs of the reproductive system, tumors of a benign and malignant nature are distinguished.

As a result of a sharp increase in the level of estrogen in the body, the endometrium can uncharacteristically grow and thicken. In a normal state, after a mature egg leaves the follicle, a decrease in hormone levels should occur. During this period, progesterone rises, which prevents estrogen from increasing.

After that, the woman can become pregnant. Then the embryo is attached to the mucous membrane of the uterus. If fertilization does not occur. then the endometrium is rejected and comes out in the form of menstruation.

Climax is due to hormonal failure. Therefore, premenopause is characterized by heavy and prolonged menstruation. If menstruation is absent for six months, then a woman may detect bloody discharge. they have a plentiful or scanty expression and varying duration.

Myoma

Myoma is a benign formation that appears in the uterine cavity in the muscle layers. This is due to a violation of the structure of tissues and the absence of normal contraction of the uterus.

Before the onset of menopause, women often suffer from fibroids. As a result of the tumor, the nature of menstrual flow changes: their abundance and duration increase (up to 10 days).

Due to the regular occurrence of bleeding, menorrhagia is considered. The tumor may increase in size until the end of the menopause period. Subsequently, its growth stops.

polyps

Benign tumors in the uterine cavity are polyps. They are considered the result of the growth of individual parts of the endometrium.

A polyp is a growth made up of endometrial cells. Education stands on a leg, with which it is attached to the wall of the uterus. It is permeated with blood vessels, which, if injured, can bleed. The discharge is usually spotty and irregular.

Polyps may be found singly or in clusters. They are considered dangerous, as they can degenerate into malignant tumors.

Adenomyosis or endometriosis

If the endometrium grows into the uterine walls or neighboring organs, then adenomyosis or endometriosis is diagnosed.

It may cover:

ovaries;
fallopian tubes;
vagina;
intestines.

With the development of the process, the degeneration of tissues into malignant ones may occur. In this case, endometriosis is accompanied by bleeding between periods and severe pain.

malignant tumor

Cancers sometimes do not have any expression. Therefore, women do not diagnose them in a timely manner.

It is important to remember that even mild bloody discharge can signal the presence of a malignant tumor. Sometimes bleeding is profuse or spotting. Cancer is especially common in postmenopausal women.

In violation of the production of hormones in the body, ovarian dysfunction can be observed. It is associated with inflammatory processes and endocrine pathologies.

This disease is especially common in premenopausal women. A woman can distinguish it by randomly occurring menstrual bleeding of varying intensity.

Other reasons

There are other causes of bleeding in older women:

Causes of bleeding	How does it affect the body
The use of contraceptives	When taking oral contraceptives, irregular bleeding may occur between periods. If a woman has an intrauterine device installed, then her periods may become more abundant. With a hormonal IUD, there is an impoverishment of secretions.
Pathologies of the organs of the endocrine system	With insufficiency (hypothyroidism) and redundancy (hyperthyroidism) of hormones thyroid gland profuse discharge of a bloody nature or a prolonged absence of menstruation are observed.
Pathologies of the blood coagulation system	In violation of coagulability, the result is the irregularity of menstruation
The onset of pregnancy	Even during the premenopausal period, a woman is fertile. Bleeding may be associated with threatened miscarriage, ectopic fetal development, and placenta previa
Polycystic ovaries	With polycystic ovary syndrome, endocrine disorders and the absence of a mature egg are observed. In this case, menstruation may be absent or rarely observed. When bleeding occurs, they differ in abundance and duration due to the increased growth of the endometrial layer of the uterus.

Symptoms

The duration of the menstrual cycle and the abundance of menstruation change already in premenopause. At this time, periods may be absent for several months, and then suddenly begin.

The abundance of secretions also changes. They either become scarce or become too plentiful. These signs are considered normal for a woman who has entered premenopause.

If a woman notes an increased abundance of discharge, in which pads are changed every hour, bleeding can be suspected. Menstruation, accompanied by the release of clots, should also alert.

Bloody discharge between periods or after intimacy is considered pathological.

You should be concerned about:

long periods;
absence of menstruation for several months;
the onset of menstrual bleeding earlier than 21 days after the previous one.

The condition of a woman in this period may also change. It depends on the severity of anemia, additional pathologies (hypertension, liver failure, thyroid disease, malignant tumors).

Diagnostic measures

To detect pathologies in the uterine cavity, a woman needs to undergo a diagnostic examination.

It consists of:

ultrasound examination of the pelvic organs;
biochemical analysis blood to detect pathologies of the liver, pancreas;
studies of the hormonal state of the body, provided by the thyroid gland;
determining the level of sex hormones;
hysteroscopy, as a result of which a piece of tissue of the uterine mucosa is taken for analysis;

How to stop

To stop bleeding, gynecologists often carry out curettage of the mucous membrane of the uterus and cervical canal. During the procedure, you can not only restore the functioning of the endometrium, but also find out the causes of bleeding. After surgery, further treatment tactics are determined if the discharge does not stop.

Panhysterectomy is required if a woman has adenocarcinoma or atypical endometrial hyperplasia. If the mucosa is covered with fibroids, fibroids and adenomas, a hysterectomy or supravaginal removal of the uterus is performed.

If the changes are not dangerous, conservative treatment is carried out:

To exclude the possibility of recurrence of bleeding, hormonal tablets with gestagens in the composition are prescribed. They atrophy the glandular epithelium and stroma of the endometrium. Also, drugs alleviate other symptoms of this period.
With uterine bleeding, antiestrogenic agents Danazol and Gestrinone can be prescribed. They not only affect the endometrium, but also reduce fibroids, mastopathy.
After 50 years, patients are prescribed androgens.

Hemostatic drugs for uterine bleeding with menopause are additional medicines. It is also possible to correct the weight and condition of patients with metabolic disorders. It is carried out by an endocrinologist, a diabetologist and a cardiologist.

If uterine bleeding continues even after treatment, this may indicate:

nodes (myomatous and submucosal);
polyps;
endometriosis;
formations on the ovaries.

In this case, additional examination and therapy will be required.

First aid in old age

Treatment of uterine bleeding in the elderly is based on the causes of its occurrence. With dysfunctional secretions, hormonal agents are prescribed. They include analogues of female sexually active substances - estrogen and progesterone. Hormones regulate the menstrual cycle during perimenopause and prevent menometrorrhagia.

Organic bleeding is treated in the course of eliminating the underlying pathology. Often not without the help of a surgeon. Oncological tumors are removed promptly and supplemented with radiation therapy, chemotherapy.

Consequences

Bleeding from the uterine cavity can lead to various complications. One of the dangerous is posthemorrhagic anemia or hemorrhagic shock. This happens when there is a lot of bleeding.

Also, infection of the body often occurs in an ascending way. As a result, secondary complications develop in the form of purulent myometritis or the formation of pus on myomatous nodes.

If the fibroid is not detected in a timely manner, then the woman feels a strong pain syndrome in the abdomen and bloody discharge. Symptoms are due to the rejection of the fibromatous node and its exit into the uterine cavity. The complication is dangerous and requires surgical removal.

Bleeding, which is atypical, should alert a woman in any period of menopause. It is important to immediately contact a gynecologist to prevent the development of complications.

Uterine bleeding (in medical terminology, menometrorrhagia) means abnormal blood discharge from the uterus, not associated with menstruation and physiological discharge after childbirth.

Uterine bleeding in an elderly woman aged 80 may indicate the development of some serious pathology. Timely appeal for qualified help will allow to stop abnormal hemorrhage in time and avoid further development of the disease.

Similar pathological changes in the female body appear in older women during menopause and menopause. At this stage of life, a woman is obliged to be attentive to her health, and immediately respond to any changes. It should be noted that only a gynecologist should stop uterine bleeding, treating the problem at home can lead to irreparable consequences.

Physiological features of the menstrual cycle

The menstrual cycle is a complex mechanism, where there is a direct and inverse relationship between levels of regulation. For a simpler understanding, this mechanism can be compared to a five-story building, where each floor interacts with the floor below and above. None of these floors is able to function independently.

Table number 1. The interaction of the "floors" of the menstrual cycle.

"Floor" mechanism	Interaction
	This is the main executive body, influenced by all higher levels of regulation. Accordingly, uterine bleeding is the main symptom, meaning the development of a particular pathology. Treatment in this case depends on establishing the cause of bleeding, symptomatic therapy does not represent a problem.
	These are endocrine glands that produce a huge number of such sex hormones: estrogen; progesterone; androgen. The ovaries, like the uterus, are subject to the influence of other levels of regulation that are localized above.
	The pituitary gland is responsible for the production of the following hormones: FGS (follicle stimulating hormone). This hormone is responsible for the mechanism of maturation of the follicle in the ovaries. LH (luteinizing). The peak of production of this hormone provokes ovulation, which means the release of the egg from the ovaries.
	The hypothalamus produces antagonists (liberins and statins), which in turn suppress the production of pituitary hormones. In the system of the menstrual cycle, an important role is played by the cyclical flow of hormones into the bloodstream. According to medical observations, the hormones of the hypothalamus should enter the bloodstream with a regularity of 1 hour.
	This is the central nervous system. Thus, it turns out that any stressful influence sends signals to the cerebral cortex, from where they then go to all the other “floors” of the cycle regulation, which gives a strong effect on the cycle itself. This explains the numerous causes of uterine bleeding caused by stressful situations in women.

Note. Uterine bleeding is one of the most common signs with which a woman goes to the doctor. Such a symptom can appear both in very young representatives of the weaker sex, and in women who have been in menopause for more than 20 years.

Reasons for such dangerous symptom there can be many, so treatment is aimed at establishing the root cause, and then at eliminating the symptom itself.

Sometimes in women during menopause, bleeding is not a serious reason to sound the alarm, as minor changes in reproductive function can contribute to it. Such bleeding is easily amenable to conservative therapy and completely disappears in a short time.

But, sometimes, bleeding during menopause is severe and means the development of complex diseases, including malignant neoplasms. The establishment of predisposing factors, the age and physiological characteristics of a woman will help to understand the cause of the appearance of physiological blood discharge.

Classification of uterine bleeding

Abnormal bleeding is classified by doctors according to many criteria.

These include:

cause;
frequency;
abundance;
period of menstruation.

The origins are as follows:

uterine;
ovarian;
iatrogenic;
dysfunctional.

At the same time, dysfunctional uterine bleeding (DUB) is divided according to the nature of cyclic disturbances.

Table number 2. Classification of dysfunctional uterine bleeding:

Type	Description
Anovulatory	This type of bleeding from the uterus is also called single-phase DUB. Appear as a result of short-term atresia or persistence (long-term survival) of the follicles.
promenorrhea	The cyclicity of menstruation is not broken, but their duration is 7 or more days.
ovulatory	It is also called a two-phase DMK. This type of bleeding often occurs in women of reproductive age. These include hypo- and hyperfunction of the corpus luteum.
metrorrhagia	With this type, the disorder of the cycle is noted, which does not have a certain interval between blood loss. They have nothing to do with menstruation.
Polymenorrhea	Uterine blood loss occurs at least once every 20 days.

Blood loss from the uterus can be diagnosed in women of any age, while they have their own characteristics of the course.

Based on these criteria, there are:

Juvenile bleeding. It occurs in girls under the age of 18.
Reproductive. Appear in women aged 18 years and before the onset of menopause.
Peri- and post-menopause. During this period, as a rule, dysfunctional MC appear, which is caused by a disorder of the hypothalamic-pituitary-ovarian axis.

Attention. The risk of bleeding in older women is due to the risk of developing malignant tumors. After all, during menopause monthly cycle completely stops, and the appearance of blood discharge in frequent cases indicates the development of some serious pathology.

Etiology of uterine bleeding

The appearance of spotting in older women almost always means danger, as it is often a sign of the development of cancer. When a problem occurs, you should immediately sound the alarm, frivolity can lead to the most unpredictable consequences.

Abnormal bleeding from the uterus can be called any physiological bleeding that appears regardless of the regularity of the menstrual cycle.

Abnormal gynecologists include discharge:

if their duration is 7 or more days;
the volume of blood loss is more than 80 ml per day;
the time period between bleeding is less than 21 days (menstrual cycle).

For a complete and accurate diagnosis of an anomaly, doctors take into account such indicators as frequency, regularity or irregularity of occurrence, volume of blood loss, duration, relationship with reproductive age and hormonal levels.

Causes of blood loss can be conditionally divided into 2 groups:

associated with reproductive diseases.
associated with systemic disorders.

As for bleeding associated with systemic disorders, in this case, provocative factors are:

blood diseases with thrombocytopenia;
blood clotting disorders;
vascular pathologies;
numerous infectious diseases.

Reproductive diseases that cause bleeding from the uterus are varied. These can be inflammatory, atrophic and hypertrophic changes in the uterus itself and genital organs. Hormonal imbalance also often causes bleeding.

The pathological condition in older women is caused by such diseases:

uterine fibroids (leiomyoma, fibromyoma);
polyps;
endometriosis;
ovulatory dysfunction;
iatrogenic MK;
endometrial cancer;
a spiral standing in the uterus for a long time;
diseases of the cervix;
tumor formations;
ovarian dysfunction;
endometrial hyperplasia.

Attention. The main difference between bleeding from the uterus in women in old age is the risk of developing oncology.

During menopause, a woman should no longer have any bleeding from the uterus, as all reproductive processes stop. During this period, all processes of the menstrual cycle stop.

In this case, pregnancy is impossible, since the endometrial mucosa of the uterus becomes thin, the ovaries become smaller, sex hormones are not produced, and the process of follicle formation stops. But not always menopause becomes a lull for the female body, spotting in old age makes you worry and seek help from doctors, because MK always means a pathological condition.

Important. Even the smallest discharge, having droplets of blood, is considered a pathology.

Myoma

IN muscle layer uterus (myometrium) a benign tumor appears - this is a fibroid. Among all the requests of patients over the age of 50, fibroids are diagnosed in 80%.

At reproductive age, fibroids may not make themselves felt by any signs, and with the cessation of the menstrual cycle, a woman discovers the appearance of spotting.

On growth benign tumor sex hormones are affected, therefore, with the onset of menopause and the cessation of the production of these hormones, fibroids stop developing. If there is further growth of the tumor, soreness and frequent bleeding, this may indicate the development of a malignant tumor.

Attention. Patients with large fibroids during menopause are encouraged to undergo treatment based on surgical removal neoplasms. Sometimes a decision is made to remove the uterus completely, depending on the size of the fibroids.

The reasons for the development of fibroids are as follows:

frequent stress;
abortions;
heredity;
infertility;
diabetes;
excess weight.

polyps

A polyp is a kind of convex thickening with a glandular or fibrous structure. Formed in a specific area of the penis. The formation of polyps is accompanied by bleeding from the uterus.

If a woman is of reproductive age, she takes this bleeding for a normal menstrual cycle, however, it has a longer duration (7 or more days). At the same time, polyps cause severe pain, especially disturbing during intercourse.

In such situations, the doctor prescribes a cardinal treatment based on the surgical removal of neoplasms.

Diagnosis of polyps allows ultrasound examination. Therefore, a woman during menopause should visit a gynecologist at least 2 times a year and undergo a complete diagnosis.

endometriosis

Endometriosis is a disease accompanied by the growth of endocrine cells of the uterus outside the walls.

Table number 3. Types of endometriosis:

With endometriosis of any type, a woman feels:

soreness in the pelvic peritoneum;
difficulty with bowel movements;
difficulty emptying the bladder;
irregular uterine bleeding.

Further development of the pathological process carries the risk of tissue degeneration into malignant tumors.

Ovulatory dysfunction

Ovulatory dysfunction is associated with hormonal disorders and a violation of the corpus luteum. In such situations, a complex and serious process of hormonal failure is noted, they are directly associated with the thyroid gland and the gopothalamo-pituitary system.

The reasons may be:

excessive physical activity;
sudden weight loss;
stressful situations.

Iatrogenic MK

Iatrogenic uterine bleeding occurs against the background of taking medications and instrumental interventions.

Common causes of iatrogenic MK:

taking oral contraceptives;
taking antiplatelet agents and anticoagulants;
taking certain types of antibacterial drugs;
exposure to glucocorticosteroids.

Diagnosing iatrogenic MK is quite difficult; even a highly qualified gynecologist is not always able to do this.

Tumor formations

One of the most common causes of MC in older women is the appearance of a tumor in the ovaries and the growth of a cyst. If a tumor is found in a woman during menopause, it is almost always a danger to her life.

Important. According to medical statistics, in elderly women, a tumor of the serous cystadenoma type is most often diagnosed. In second place in development is papillary serous cystadenoma. A step below appears endometrioma and dermoid cyst.

The treatment method is selected by the attending physician based on the nature of the tumor and the course of the pathological process. To determine these indicators, the patient undergoes a number of diagnostic measures.

If a woman has frequent bleeding, the doctor determines the need for surgical cleaning of the uterus. If the results of the biopsy showed a malignant nature of the formation, then after removal of the tumor, chemotherapy is mandatory.

Attention. The sooner it is diagnosed malignant tumor the higher the chances of recovery.

Ovarian dysfunction

Ovarian dysfunction is the most common problem in premenopausal women. At this time, the production of sex hormones stops in the body, against which inflammatory processes and endocrine diseases may appear.

The problem is accompanied by irregular MK, which have different intensities.

Diseases of the cervix

Not all abnormal bleeding from the uterus is caused by pathological processes in the uterus and ovaries, often cervical diseases become the cause of MK.

Oncological diseases of the cervix provokes the papilloma virus. To determine the presence of a pathological agent allows blood tests for HPV and ultrasound examination.

Attention. Unfortunately, it is not always possible to completely get rid of an oncological disease, however, if you start treatment in the early stages of the development of the disease, you can slow down the process of its progression.

Other reasons

In addition to the reasons described in our article, uterine bleeding can be triggered by the influence of other factors.

Table number 4. Other causes of uterine bleeding in older women:

Cause	Effect on the female body
	With hypothyroidism and hyperthyroidism (deficiency and excess of thyroid hormones), a woman may experience irregular abundant blood discharge, or the opposite phenomenon is noted - the absence of menstruation (if the woman is still in her reproductive age).
	Taking oral contraceptives can cause irregular bleeding from the uterus. In the presence of an intrauterine device, the discharge may be more abundant and more painful.
	Even during menopause, a woman has a small chance of getting pregnant. Uterine bleeding in this case means: the threat of miscarriage; ectopic pregnancy; placenta previa.
	In the presence of blood clotting disorders, irregular menstrual cycles are observed.
	Polycystic ovary causes endocrine disorders and the inability to release a mature egg. In such situations, a woman either has no bleeding from the uterus at all, or they are rather scarce and rare. If bleeding nevertheless opens, then they differ in their duration, profusion and soreness, this condition is facilitated by the growth of the endometrium of the uterus.

Any bleeding from the uterus, of varying intensity and volume, should not be ignored by women who are in the menopause period. All of them are dangerous, because the cause of their appearance is always some kind of pathological process in the body.

Clinical picture of uterine bleeding

In women, with the onset of 50 years, a period of menopause begins, however, for each woman this period begins in different ways. Menopause is characterized by irregular menstrual cycles, and then there is a lull.

Sudden bleeding makes you worry and consult a doctor, because it always means the development of a particular pathology. To recognize abnormal uterine bleeding, one should observe their nature and the state of the body during this period.

Symptoms of menometrorrhagia include:

profusion of blood secretions, or, conversely, their scarcity;
the presence of blood clots;
the duration of menstruation is more than 7 days;
low blood pressure;
dizziness;
general weakness;
pallor of the skin;
the appearance of discharge after intimacy.

When abnormal bleeding occurs, a woman has a high abundance of discharge. It happens that in 1 hour a tampon or pad is filled to capacity. At the same time, weakness and dizziness indicate a pathological condition.

Attention. If all the signs of menometrorrhagia are present, in addition, pain in the lower abdomen is added, however, there is no bleeding, then this complicates the situation, since internal uterine bleeding may open. The patient urgently needs medical attention.

Diagnostics

To determine the cause of bleeding, the doctor prescribes instrumental diagnostic methods and laboratory tests, and before starting diagnostic measures, he must carefully collect the patient's history and examine her genitals.

The most widespread and informative methods of instrumental diagnostics are:

transvaginal ultrasound;
positron emission tomography;
saline infusion sonohysterography;
biopsy of the inner mucous layer of the uterus;
hysteroscopy;
colposcopy.

As laboratory methods diagnostics, detailed information about the state of health of the patient is given by:

complete blood count with platelets;
analysis of thyroid hormones and sex hormones;
blood clotting test;
tumor markers;
pregnancy test.

After a complete examination, the doctor establishes a diagnosis and prescribes the appropriate treatment.

Treatment of MK in older women

The tactics of treating uterine bleeding depends on the cause that caused the unpleasant symptom. As a rule, in old age, bleeding is serious; in some situations, only surgical intervention can correct the situation.

Table number 5. The tactics of treating uterine bleeding in elderly women, depending on the cause that provoked the pathological condition:

Pathology	Treatment tactics
Identification of the pathology of the endometrium of the uterus or polyps, with alertness to oncological diseases.	Among all the methods of treatment, one of the most common in such situations is surgical curettage of the uterine cavity and cervical canal. After the procedure, the biomaterial is subject to histological examination, in order to confirm or refute the oncological disease. After cleaning, the patient is prescribed hemostatic drugs and astrogens.
Myoma	When diagnosing fibroids, the doctor prescribes hysteroresectoscopy with the removal of the fibroid node. If the formation is so extensive, the need to remove the entire uterus along with the appendages is determined.
"Forgotten" spiral	Many women, due to their frivolity, can simply forget about the spiral set 5 years ago, or consider that its presence cannot negatively affect their health. After 5 years, any uterine spiral is subject to extraction. After the operation, it is necessary to verify the integrity of the walls of the organ with the help of ultrasound. As a restorative therapy, anti-inflammatory drugs are prescribed.
Low hemoglobin concentration	Low hemoglobin is often a consequence of the development of many pathological conditions, one of the first is fibroids. In addition, with a deficiency of a substance in a person, there is a deterioration in well-being, weakness and dizziness. Depending on the degree of hemoglobin concentration, the doctor prescribes medications gland. It can be injections or tablets.

Attention. Medical observations prove that in women who are in menopause, in 70% of all cases of treatment with a symptom of MK, endometrial cancer is diagnosed.

Timely diagnosis of abnormal uterine bleeding allows you to learn in time about the development of the oncological process and stop further deterioration of the condition. In addition, surgical scraping of the biomaterial allows you to verify the nature of the tumor: benign or malignant.

Consequences

A frivolous attitude to uterine blood loss can lead to the most unpredictable and dangerous consequences, up to and including death.

The most dangerous are:

posthemorrhagic anemia;
hemorrhagic shock.

Such complications give heavy bleeding. Often complications are infection by an ascending method, as a result, secondary complications appear in the form of purulent myometritis.

When fibroids are neglected, a woman develops severe pain in the lower abdomen, accompanied by profuse blood loss. This situation requires immediate surgical intervention.

Important. Atypical bleeding from the uterus in any situation requires medical care. Self-medication can aggravate the situation and lead to severe and irreparable consequences.

Summing up, we note that the information given in our editorial office is informative, and starting diagnosis and treatment on your own is dangerous for a woman's life. Only high-quality professional help will stop or eliminate the pathological processes developing in the reproductive organ.

The video in this article will brief information on the development, course and consequences of uterine bleeding in elderly women.

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A significant percentage of bleeding in menopause depends on diseases of the female genital organs. Here, neoplasms, benign and malignant, as well as inflammatory processes, should be put in the first place.

Of the neoplasms, uterine fibroids are the most common. According to A. I. Petchenko and V. V. Slonitsky, who studied the features of the course of uterine bleeding at the age of 46 to 57 years in women suffering from uterine fibroids, women with uterine myoma menstruate longer - menopause occurs in them 5-10 years later than in healthy women. Histological studies of uterine scrapings predominantly showed mucosal atrophy with congestion in the endometrium, and only in some cases cystic endometrial hyperplasia and polyposis were observed. According to. authors, menopausal uterine bleeding in the presence of uterine fibroids is largely associated with a disorder of the function of the central nervous system and with the phenomena of general angioedema. Reduced contractility of the uterus, stretched by knots, as well as often an enlarged surface of a hypertrophically or atrophically altered mucosa, cause bleeding in uterine fibromyoma. A. A. Lebedev and colleagues also believe that the pathogenesis of uterine bleeding in uterine fibroids is similar to the pathogenesis of functional uterine bleeding. In both cases, a significant role is played by the reduced reactivity of the vascular tone and the failure of the liver function.

According to the observations of A. A. Lebedev and colleagues, all patients suffering from fibroids, according to the histological picture, in comparison with the data on the excretion of sex hormones, can be divided into three groups: a) patients with asymptomatic uterine fibroids with a normal menstrual cycle; there are no pathological changes in the histological picture of the endometrium and ovaries; b) patients also with a normal menstrual cycle, but with a predominance of the follicular phase (hyperpolymenorrhea); in the histological picture of the endometrium, the majority (in 94%) show glandular hyperplasia, sometimes atrophy, in the ovaries (in 72%) there is a cystic expansion of the follicles and corpus luteum; c) patients with "anovulatory" cycle (hemorrhagic metropathy); histologically, there are glandular hyperplasia (57%), endometrial atrophy (10%), in the ovaries - cystic expansion of the follicles, foci of hemorrhages, vascular sclerosis; no yellow spots.

According to our data, climacteric bleeding is especially often combined with the so-called uterine fibromatosis - an enlarged, dense uterus, which is due to the development of scar connective tissue and sclerotic changes in the muscles of the uterine body.

The cause of uterine bleeding during the transitional years of a woman is often ovarian tumors - benign, hormonally active. The latter, exerting a hormonal effect on the uterine mucosa, cause bleeding. These tumors include granulosa cell blastomas and thecablastomas; by producing estrogenic hormone, they cause excessive endometrial hyperplasia, uterine bleeding and necrosis.

Finberg (R. Fiettberg) described 6 women aged 60-75 years who had sudden bleeding during menopause. Histological examination of the ovaries of these patients revealed granulosa-thecacellular tumors in 6 cases, and a thecamatous tumor in one. In all cases, there was hyperplasia of the uterine mucosa with mitoses.

Menopausal bleeding is often associated with inflammatory diseases genital organs, mainly with inflammatory tumors of the appendages and with various abnormal positions (displacements) of the uterus. In the latter case, fixed retrodeviations, as well as omission and prolapse of the uterus, have a particularly great influence. With incorrect positions of the uterus, bleeding can be caused both by venous stasis (in the presence of a pelvic plethora) due to the bending of the uterine ligaments with the vessels passing through them, and (which happens especially often) by the resulting insufficiency of the muscles of the uterus. When the uterus prolapses, the source of bleeding can be ulcers such as bedsores that develop on the surface of the vaginal part of the uterus.

During menopause, sclerotic changes are of no small importance in the occurrence of uterine bleeding, which are characterized by excessive development of connective tissue, the almost complete disappearance of muscle tissue and pronounced changes in the vessels (phenomena of atheromatosis and endarteritis). According to Yashke, Pankov (R. Jaschke, O. Pankow), S. S. Kholmogorov, etc., a decrease in the muscle layer and sclerosis of the vessels, summing up, can cause profuse uterine bleeding.

Malignant neoplasms (cancer and sarcoma) are one of the frequent causes of uterine bleeding in the transitional years of a woman. Statistical data of the world literature characterizing the frequency and causes of bleeding in menopause and menopause in women, collected by Gecke and Garbut (Garbut), are presented in table 9 (in percent).

The "other" group includes endometriosis, traumatic and other injuries.

Table 9 shows that in both periods of transition years, women in the first place are cancers of the genital organs; glandular hyperplasia is the cause of more than a quarter of all bleeding; polyps and erosion account for approximately 1/5 of all bleeding. Fibroids and ovarian tumors also play a significant role in causing bleeding. menopause. The same should be said about inflammatory diseases.

These data on menopausal bleeding show how different the etiology and pathogenesis of uterine bleeding during menopause and menopause. The presence of a large number of causes that cause uterine bleeding of this period dictate the need for a thorough and comprehensive examination of women suffering from this pathology. In addition to two-handed research, inspection with mirrors, cytological examination smears of contents from the vagina and from the uterine cavity (aspiration), diagnostic curettage or biopsy followed by a histological examination of the scraping and, in addition to hormonal studies, a study of the state of the blood, liver, cardiovascular and other systems is shown. Differential Diagnosis uterine bleeding of the transitional period of a woman has great importance to select the right individualized treatment.

The basic principles of the doctor's tactics for menopausal bleeding will be as follows:

1. In the presence of bleeding, it is first necessary to exclude a malignant neoplasm, based on data histological examination scraping of the uterine mucosa. Curettage of the uterus during menopausal bleeding is not only a diagnostic, but also a therapeutic measure that has a hemostatic effect. This is explained by the fact that after the removal of the hyperplastic bleeding necrotic mucous membrane, the uterus begins to contract vigorously. If, after curettage, bleeding soon (after 2-3 months) resumes, this, with appropriate clinical picture and in the presence of certain studies, indicates its functional character. If, during menopause or menopause, the bleeding that stopped after curettage reappears after 1-2 years or later, then curettage must be repeated, since in such cases, the cause of bleeding may be an incipient neoplasm.

It is much more difficult to diagnose cancer of the body of the uterus by the cytological picture of a smear than cervical cancer. This is due to the fact that the polymorphism of cells and their nuclei, which is one of the main criteria in cytodiagnosis, is much less pronounced in cancer of the uterine body [Papanicolaou (G. Papanicolau), V. A. Mandelstam, etc.].

2. In the complex pathogenesis of menopausal bleeding, it is necessary to take into account age-related disturbances in the activity of the higher parts of the central nervous system, mainly the hypothalamus and pituitary gland, as well as dysfunction of the endocrine glands and other systems of the female body, and it is wrong to see the main cause of bleeding only in functional disorders of the ovaries and uterine mucosa .

3. Rational Therapy menopausal bleeding should be a set of measures aimed at regulating the menstrual cycle.