Update: October 2018 In the life of every woman sooner or later
menopause occurs, which is characterized by
extinction of the hormonal activity of the reproductive system and
involution of its organs. This process is quite natural and
is natural. Many women often have uterine
menopause bleeding which is a serious problem and
require medical care. Than similar bleedings
dangerous and what to do – try to answer this
Climax or menopausal period is called a long and
multi-stage process occurring in the female body, in
the time of which the functions of the reproductive system are gradually fading,
decreases, and then stops the production of estrogen. It is this
period gradually disappear menstruation, and the body
adapts to existence in new conditions. Average
menopause begins at the age of 45 to 55 years.
Climax is divided into several periods (conditionally):
The first signs of menopause appear (the most common –
hot flashes), which indicates the beginning of hormonal changes and extinction
ovarian function. Menses becomes confused and at times
Begins on the date of the last menstrual period and lasts a year (number
experts consider the correct 1.5 – 2 years).
The countdown is from the last menstruation and this period lasts.
the rest of your life.
Separately, it should be said about perimenopause, which unites
premenopause and menopause.
There are physiological menopause, which develops in force.
natural causes and artificial caused by medical
factors (taking certain medications, chemotherapy or
radiation, removal of the ovaries). Also distinguish premature
menopause when the ovaries cease to function early
the nature of time, up to 40 years. Premature menopause is also called
premature ovarian exhaustion.
The mechanism of development of menopause
The appearance of menopausal symptoms due to estrogenic
insufficiency that develops on the background of progressive
reduce ovarian function (their ovarian and hormonal
From about 35 years of age in the ovaries begin
involutive processes due to their hardening
inner layer. In the stroma (inner layer) of the ovaries increases
the amount of connective tissue, follicles begin to dissolve
or undergo protein dystrophy. Due to these processes
the ovaries begin to shrink and shrink.
The logical stage is the reduction of the formation of ovaries.
sex hormones (estrogen and progesterone). In the initial stages
lack of estrogen is compensated by their formation from
testosterone in the subcutaneous layer and skin.
Simultaneously with a decrease in the number of normal follicles occur
changes in ovarian response to pituitary hormones (FSH and LH), which
regulate the reproductive system. In childbearing age FSH
and LH stimulate the work of the ovaries, their production of genital gomons,
the onset of ovulation and menstruation. By reducing the response of the ovaries
on the levels of FSH and LH by the type of feedback decreases their
production in the pituitary gland.
As a result, the overwhelming number of cycles occur without
ovulation and their duration may vary. With this monthly
distinguished by irregularity and scarcity. On the background of long
delayed menstruation and menopausal bleeding occurs.
What is climacteric bleeding and its types
Uterine bleeding during menopause is called sudden
excretion of blood from the genital tract of a premenopausal woman,
menopausal or postmenopausal periods. If bloody
excretions, regardless of their volume, are observed in the postmenapusal
period, then talk about bleeding after menopause, although it is not
quite correct definition. Climacteric bleeding
are the most common cause of women entering the 45 – 55 year old
age in a gynecological hospital. Usually,
menopausal bleeding occurs on the background of concomitant
gynecological pathology (myoma, endometriosis, polyposis
Signs that should alert the woman “aged”:
- abundant monthly, requiring frequent (hourly) shift
- bleeding with lots of clots;
- postcoital bleeding;
- intermenstrual “daub” or bleeding;
- monthly missing 3 or more months;
- the presence of short (less than 21 days) menstrual cycles (more
- the presence of more than three menstruation with a duration of 3 days
longer than usual.
By the time of occurrence of climacteric bleeding is divided
- premenopausal bleeding;
- menopausal bleeding;
- postmenopausal bleeding.
By the amount of blood lost, duration and regularity
кровотечения при климаксе делятся on:
- menorrhagia – abundant and regular spotting in
- metrorrhagia – abundant acyclic bloody discharge;
- menometrorrhagia – heavy monthly plus acyclic
- polymenorrhea – copious menstruation, repeated regularly and
at short intervals (less than 3 weeks).
Depending on the cause of menopausal bleeding
- caused by gynecological pathology
- arising on the background of extragenital pathology.
Possible causes of bleeding with menopause
premenopausal period include:
- Hormonal imbalance
Due to inhibition of ovarian function and rare maturation
menstruation ovules become irregular. AT
result for the period of absence of monthly endometrium significantly
grows, which leads to significant bloody
- Uterine myoma
Myomatous nodes not only increase the area of the uterus, but
respectively, and the endometrium, but also violate the contractile function
uterus. These factors cause the appearance
- Endometrial polyposis
Endometrial polyps also significantly increase its area,
in addition, the presence of polyps suggests a hormonal imbalance.
The spotting becomes not only plentiful, but also
- Endometrial hyperplasia
Excessive proliferation of the inner layer of the uterus, as
accompanied by profuse blood secretions.
- ATнутриматочная спираль
Ношение ATМС провоцирует увеличение кровяных выделений
(excessive uterine contraction).
- Oral contraceptives
When taken regularly, the amount of blood lost during
menstruation is significantly reduced, but in case of a break or
discontinuation may cause bleeding.
- Pathology of the thyroid gland
Thyroid hormones in a certain amount affect
menstrual cycle. As with their lack (hypothyroidism), and with
their excess (hyperthyroidism) appear uterine bleeding.
- Scleropolystic ovary
Pathology is accompanied by long, up to 6 months, delays
menstruation that leads to the development of endometrial hyperplasia and how
consequence, uterine bleeding.
- Taking anticoagulants or bleeding disorders
Both lead to the “dilution” of the blood and provoke
возникновение маточных bleeding.
The following can provoke heavy bleeding
- heavy physical exertion;
- rise in blood pressure;
- acute infectious disease;
- sexual intercourse
ATозможно, это беременность?
And although with age (45+) the chances of getting pregnant are sharply reduced,
all occurrence of pregnancy is possible. Usually, при
In the absence of menstruation more than three cycles, women stop
use precautions that can end
unexpected pregnancy. Late pregnancy is often
proceeds with a pathology (ectopic or threat of interruption) that
accompanied by bloody discharge, often abundant.
AT постменопаузе кровянистые выделения любой интенсивности должны
absent. The only factor explaining the appearance
bleeding and considered normal is holding
hormone replacement therapy (estrogen plus progesterone). ATсе
other cases of bleeding and bleeding
- uterine fibroids (although with the cessation of menstrual fibroids, as
- endometrial polyposis and hyperplasia;
- atrophic colpitis.
But postmenopausal bleeding should first
suggest the presence of malignant tumors:
- cervical cancer;
- ovarian cancer;
- endometrial cancer.
Abundant blood flow during menopause is unlikely to remain
unnoticed by a woman. Usually, такие выделения имеют большие
сгустки, что связано со свертыванием крови в полости uterus.
Often, heavy bleeding occurs suddenly, in the midst of a complete
health and take a woman by surprise. Often provoking factor
the occurrence of bleeding is sexual intercourse, that is, discharge
appear immediately or some time after coitus. it
due to the formed hematometer (accumulation of blood in the uterus) –
during orgasm, the uterus begins to contract, which contributes
release of blood from its cavity.
ATозможно появление тянущих или ноющих болей внизу живота и в
lumbar region during bleeding, sometimes disturbing
colic pains. ATозникновение болей, как правило, говорит о
presence of concomitant gynecological pathology (submucous
myoma node, uterine fibroids, etc.). But more often uterine
the bleeding does not give the woman considerable physical
AT случае опухоли матки или придатков могут беспокоить проблемы с
urination and defecation (compression of the bladder and direct
The overall clinical picture during menopause has its
distinctive features. Monthly become irregular,
may disappear for 2 or more months, and then resume.
Their intensity also changes, they can become either scarce,
or excessively abundant. If there is no accompanying
gynecological pathology, then similar phenomena are considered
The reason for the speedy treatment of a gynecologist is the appearance
bleeding in the period between periods – as menstruation,
prolonged menstruation, their disappearance for 3 months or more,
appearance often (shorter than 21 days) or bleeding after coitus.
Diagnostics климактерического кровотечения начинается с осмотра
a gynecologist who assesses its intensity and sets
the nature of blood discharge from the genital tract (from the uterus or
vagina or cervix). Based on the inspection data, the doctor
determines the type of bleeding (dysfunctional and other).
Further diagnostics include instrumental and
laboratory research methods:
- biochemical and general blood tests (allow to clarify the degree of
anemia and identify irregularities in the work of other organs);
- coagulogram (estimated coagulation ability
- determination of chorionic gonadotropin (exclude
- determination of hormonal levels (estradiol and progesterone, LH and
FSH, thyroid hormones and tumor markers);
- Ultrasound transvaginal sensor (exclude the pathology of the uterus and
- Doppler sonography (to evaluate the blood flow in the uterine arteries);
- hysteroscopy followed by scraping;
- separate diagnostic curettage of the cervical canal and
- histological examination of the materials obtained.
According to the testimony, MRI and
hysterosalpingography that help diagnose
submucous myoma nodes and endometrial polyps.
If menopausal bleeding occurs, the woman should
Seek immediate medical attention, and in case of excessive blood
discharge and signs of post-hemorrhagic anemia
(weakness, loss of consciousness, dizziness) cause emergency
help. Treatment любого кровотечения в период прем- или
postmenopause is only done in the hospital and starts with
separate curettage that wears not only diagnostic, but
and therapeutic. After curettage is assigned
drug therapy. In order to further stop bleeding
- uterotonics (reducing agents) – oxytocin,
- Hemostatic agents (tranexam, aminocaproic
Acid, sodium ethamylate, intramuscularly and intravenously);
- intravenous infusion of saline solutions (physiological,
glucose solution and others) to restore the volume
- blood transfusion (according to indications) – introduction of erythrocyte mass,
- prescription of iron-containing drugs (restoration
After stopping blood secretions, hormone replacement is prescribed.
therapy (for a long time). Treatment гормонами подбирается индивидуально и
depends on the age of the woman, concomitant gynecological and
extragenital pathology. Reception recommended after 55
anti-estrogen drugs (danazol, gestrinone). In the presence of fibroids
uterus possible appointment:
- Gonadotroping-releasing agonist factors:
- diferiline or triptorelin – taking from 3 days of menstruation for
half a year;
- gozerillin or buserelin – not less than 6 months;
- zoladex injections from 1 to 5 days of menstruation.
- Antagonists of gonadotropic hormones:
- Norethisterone – from 5th day of monthly for 5 – 10 mg orally
ежедневно в течение half a year;
- medroxyprogesterone – a scheme similar to that of admission
- установка ATМС «Мирена» — внутриматочный контрацептив с
- Norkolut or primolyut – from 16 (in some cases, from 5) days to
Norkolut / primolyut also assigned to women aged 45 to
55 years according to the recommended scheme.
Further treatment with combined oral
contraceptives (logest, tri-regol) or hormonal
anti-menopausal drugs (livial, cliogest, klimonorm,
femoston and others).
Surgical intervention for menopausal bleeding
(complete or partial removal of the uterus) is carried out in the case of:
- adenocarcinoma (cancer) of the uterus;
- atypical endometrial hyperplasia;
- multiple uterine fibroids of considerable size;
- submucous uterine fibroids;
- сочетания миомы и эндометриоза uterus.
What if menopausal bleeding happens at home and
how to stop it? AT первую очередь женщине необходимо
calm down, do not panic and pull yourself together. If blood
the allocation is very abundant – you should call an ambulance, in case
moderate excretions is necessary to hold a number of activities:
- go to bed with a cushion under the lumbar region or
pillow to facilitate blood flow and normalize blood circulation in
- apply a cold water bubble or ice to the underbelly
(be sure to wrap in a diaper) – the duration of finding cold
the abdomen is 15 minutes with 5-minute breaks, and the total
about 2 hours;
- consume large amounts of sweet liquid (tea, decoction
hips, fruit drinks) in order to restore water balance.
It is strictly forbidden:
- warm or hot baths;
- performance of any, especially heavy, physical exercise and
- sexual intercourse;
- taking a horizontal position with the rise of the lower
limbs – this posture retains blood in the uterine cavity and
contributes to the formation of hematometers.
Treatment народными средства при климактерических кровотечениях
it is completely allowed, but it should be carried out only with the permission
doctor and as an addition to the main therapy. Of commonly used
plants that have hemostatic properties,
- Stinging nettle
To prepare the decoction should be 4 tablespoons of dried leaves
pour a glass of water and simmer for 10 minutes
minutes Broth strain and take a tablespoon 4 – 5 times a
Ripe viburnum berries should be chopped and mixed with a small
the amount of sugar. Dilute the mass with boiled water 1: 1. Take
one tablespoon three times a day (an irreplaceable source
vitamin C, which has a hemostatic effect).
Pour 2 teaspoons of dry grass with a glass of boiled water and infuse
In one hour. Infusion strain and take a quarter cup
четырежды в day.
- Shepherd’s purse
A tablespoon of dry raw materials pour a glass of boiling water and infuse
In one hour. Strain the infusion and drink a tablespoon 4 times a
day before meals.
- Orange peels
Peel from 5 to 6 oranges, rinse and pour a half liter
boiling water, leave for an hour, strain and drink 4 tablespoons
ложек от 3 до 5 раз в day.
Freshly squeezed beet juice to take a third cup three times a
ATопрос – ответ
ATопрос: Какие последствия могут быть после
AT первую очередь – это развитие острой и хронической
post-hemorrhagic anemia (weakness, lethargy, decreased
disability, fainting). Also regularly repeated
bleeding can trigger endometrial hyperplasia,
and, worst of all, endometrial cancer (in 5–10% of cases).
ATопрос: Мне 48 лет и у меня нет месячных уже 4
of the month. Before this cycle was confused. I wait for the next menstruation or
This question is difficult to answer. ATозможно, что у вас последняя
menstruation really was the last and more menstruation is not
will be. But it is possible and return monthly. For a more accurate answer and
endometrial thickness evaluation (prevention of uterine bleeding)
You should have an ultrasound transvaginal probe. With
the doctor may recommend a significant thickness of the endometrium
performing curettage to eliminate pathology
mucous membrane of the uterus and prevent possible bleeding.
ATопрос: Мне 45 лет, цикл был регулярный, но
месячных нет вот уже 3 of the month. I just went on an ultrasound
pelvic and I revealed pregnancy 3 weeks. What to do?
I think the answer is obvious – abortion. Because
the period is small, it is quite possible to conduct a mini-abortion or
abortion in the medicamental way.
ATопрос: У меня небольшая миома матки, около 7
weeks. But I already got to the hospital three times with bleeding, where
I was scraped. What do I need to do next?
If the histology results are “good,” continue the treatment.
hormones that you probably assigned a doctor and comply
recommendations (limit weight lifting, do not visit the bath / sauna,
do not take hot baths). ATопрос об удалении матки в вашем случае
should be decided by the attending physician (for example, not treatable
chronic post-hemorrhagic anemia).