Vaginal bleeding is normal during menstruation and for some time after birth. Irregular intermenstrual bleeding, as well as extremely heavy bleeding during menstruation - a problem faced by many women.

Abnormal vaginal bleeding

Abnormal vaginal bleeding are any who are not menstruating. Their general medical name - metrorrhagia, vaginal bleeding or dysfunctional.

Excessively heavy menstrual bleeding is also not the norm; their official name - menorrhagia. Consult your doctor should be the appearance of any vaginal bleeding that seem atypical. If very heavy bleeding accompanied by symptoms such as dizziness, severe pain in the abdomen Acute abdominal pain   or fever, seek immediate medical help.

Causes

• Pregnancy. Ectopic pregnancy, miscarriage and some other complications of pregnancy can cause vaginal bleeding. If you are pregnant and you have started bleeding, contact your doctor immediately.
• Menopause. Women mature during perimenopause from time to time may occur dysfunctional vaginal bleeding.
• Benign tumors and cancer. Harmless polyps, ovarian cysts Ovarian cysts - normal or dangerous?   and fibroids can cause abnormal vaginal bleeding. In much rarer cases, their causes are cancer of the vagina, cervix, uterus or ovaries.
• Taking certain medications. Some medications, such as anticoagulants, can impair blood clotting and lead to vaginal bleeding.
• Injury. Sometimes the cause of vaginal bleeding are injuries sustained during sexual intercourse, but also because of the problems with the IUD.

Other causes of bleeding may be polycystic ovary syndrome, a dramatic reduction in weight and extremely intense exercise, do not meet the level of training of women.

Diagnostics

During a visit to the doctor women suffering from abnormal vaginal bleeding, should be as detailed as possible to talk about your symptoms: when they started bleeding, if they are accompanied by abdominal pain or other symptoms, and so on. The doctor may ask the patient about when she was the last normal menstrual cycle (not too heavy and / or dysfunctional bleeding), how often it has to change tampons How to use sanitary pad - basic precautions   and gaskets during bleeding, if she could get pregnant in the last few months, whether she had before pregnancy, and how they ended, whether a woman is sexually active, and enjoys any contraception. In addition, the doctor needs to know about any medications that the patient takes, and that if she uses alcohol or taking drugs.

Then, a gynecological examination. The walls of the vagina and cervix inspected to detect any abnormalities that have the potential to cause vaginal bleeding. There are cases when the vagina remained swabs (or fragments thereof), and other foreign objects that can become a cause of bleeding and. Typically, during the examination the doctor takes a sample of cervical mucus for analysis of diseases, sexually transmitted diseases. In addition, during the diagnosis may be used:

• Pregnancy test;
• Blood tests to detect such disorders as anemia, low red blood cells or platelets;
• Analysis on thyroid hormones Thyroid hormones: mechanism of action and physiological effects ;
• Ultrasound examination of the abdominal and pelvic area;
• Endometrial biopsy - a sample of tissue sampling the inner lining of the uterine wall.

Treatment

If the diagnostic process was identified a specific cause of vaginal bleeding, such as thyroid dysfunction, infections, sexually transmitted infections, cervical polyps, and so on, the doctor will prescribe treatment for a particular disease. If as a result of bleeding the patient developed anemia, a violation must also be treated.

During a particularly heavy vaginal bleeding may be recommended bed rest. Thus patients should not take aspirin and other drugs that can thin the blood.

If the cause of bleeding began hormonal disorders, it can be recommended combined oral contraceptives. Sometimes it may be preferable to the levonorgestrel intrauterine devices - they constantly emit a small amount of the hormone, and can significantly reduce the amount of menstrual flow. Medroxyprogesterone and norethisterone - two forms of synthetic progestogen, which is also used to treat excessively heavy menstrual bleeding.

It may also be used preparations containing tranexamic acid - they do not contain any hormones, and some women are safer.

Nonsteroidal anti-inflammatory drugs, nonprescription (eg, ibuprofen) is also often used to treat abnormal vaginal bleeding.

Some patients require surgery - for example, if the cause of bleeding is uterine fibroids or other growths.

Painful menstruation (or algomenoreya) is both a medical and social problem. This is due to the emergence of complex neuro and behavioral manifestations of pain in the background. The pathological condition can develop in women of different age groups, with a significant influence individual pain threshold.

The difference between the various forms of algomenoree

This painful condition during menstruation is experiencing a large number of women. Depending on the nature of lesions can be divided into two clinical variants:

• Primary (or functional) algomenoreya
• secondary

If the cause of algomenoree are anatomical changes of the uterus, pathological processes in the pelvic organs, the focus should be on the secondary nature of the disease. Menstruation occurs with sharp cramping pain in gynecological diseases, such as uterine fibroids with submucosal location of nodes in endometriosis Endometriosis - a serious problem with serious consequences , Varicose veins of the pelvis and uterine malformations. In primary algomenoree functional changes often occur among adolescent girls in the period after the formation of menstrual function, when the cycle becomes ovulatory. This happens within the first year after menarche. This is most clearly manifested pain in girls who are emotionally unstable, tearfulness, labile with asthenic body type. In this regard, it should be emphasized that respect for the alternation of work and rest, physical exercises Myths about exercise: do not believe Contributing to the harmonious development, the development of preventive measures are algomenoree adolescents.

These substances have a stimulating effect on the contractility of the uterus, which leads to the pain during menstruation. When prescribing which are inhibitors of prostaglandin synthesis, there is a pronounced clinical benefit in the form of reduced pain (analgesic properties). It is recommended to start taking this group of medications for several days before the onset of menstruation and continue for the period of the menstrual period. To avoid possible adverse effects on the digestive tract, the drugs can be assigned in the form of suppositories for rectal administration.

The reaction of women on the ability of the uterus to contract during the next menstrual period depends on the pain threshold. To a large extent it depends on the individual threshold synthesis of endogenous substances. If a woman would try to shift attention to another activity (eg, intellectual work), then there is a strong motivation and willpower can be reduced severity of pain or even completely suppress a twinge.

The required volume of diagnostic measures

To establish the cause of painful menstruation can only be based on a careful history, the complaints of the patient and after the results of the survey. To establish the presence of the distinctive features of the two types of ultrasound scanning algomenoree it helps because it allows very accurately detect the presence of various intrauterine pathology, which can cause pain. If a woman's menstrual cycle is regular, this type of survey should be encouraged to take place in the first phase. Greater diagnostic capabilities have endoscopic methods (hysteroscopy, laparoscopy). In some cases, they may be the only methods that detect rare form of disease, for example, small forms of endometriosis clinically occurring with severe painful menstrual periods, or varices.

We must also consider the possibility of using endoscopic techniques for therapeutic purposes. Hysteroscopy as well as laparoscopy, are both diagnostic and therapeutic procedures, permit a therapeutic manipulation in detecting pathology in the uterus or from the pelvic organs. One of the reasons algomenoree are anomalies of genital organs, so the frequency of detection depends on the introduction into practice of endoscopic methods.

The first diagnosis of primary algomenoree Algomenoreya - with age and can not pass   It can be based on characteristics:

• asthenic body type
• the young age of the patient
• the appearance of painful menstruation one year after the establishment of menstrual function
• availability vegetovascular manifestations

An essential aspect in the diagnosis should be no anatomical changes or pathological processes in the pelvic cavity of the uterus. This is confirmed by gynecological examination and instrumental methods of diagnosis.

Hormonal examination can be an important addition to the complex survey. It is proved that the painful menstruation develops in the presence of ovulation, so after the results of hormonal possible to conclude the presence or absence of possible violations. It is important to further select hormonal therapy. One option is to assign the treatment of contraceptives. They help block ovulation Ovulation - How to determine as accurately as possible? That causes the development of therapeutic effect. Dose has a value of components in the tablets, shown most gestagenic contraceptives active component. To properly determine the choice of product, you need to pick it up, taking into account the survey results in hormonal levels.

Marina Solovyov