Bleeding during menopause: Causes, Symptoms and Treatment

Hormonal failure occurring at menopause, often provoke bleeding of varying intensity. Heavy bleeding and clotted blood during menstruation may indicate not only on the hormonal imbalance, but also on the development of serious pathologies. That is why in case of regular bleeding of any intensity should consult a doctor and be screened. In addition, bleeding in menopause may indicate fibroids malignant process in the cervical and uterine body.

Menopause and bleeding

In many women, menopause is associated not only with old age, but also the constant swelling, pain in the heart of the joints, pressure and sweating. Contrary to popular belief, menopause is not a pathology, the appearance of which can be avoided. Indeed, menopause occurs parallel to the general aging of the body and sometimes significantly impairs the quality of life of women. Extinction of reproductive function also affects the intimate life.

It should be recognized that the climax - a multi-step complex process that involves a kind of transition from prosperity to their reproductive functions wilt. Literally from the Greek term "menopause" can be translated as a ladder. Phase menopause and mean stage or stages of menopause:

• premenopausal;
• menopause;
• postmenopausal women.

At the climax in the body occur many changes that are associated with the extinction of hormonal ovarian function. Only at first glance it seems that the change affects only the reproductive system. At menopause the ovaries gradually completed production of sex hormones. However, this affects the entire body, as sex steroids produced in the ovaries, regulate the operation of all organs and systems. Thus, the hormone deficiency leads to the need for the body to adapt to the new conditions of its functioning, which is about 10 years. That is why normal menopause lasts for many years.

Ovaries synthesize estrogens, progestins, and androgens. The most significant effect on the body have estrogen, which includes more than 30 species. They feature experts call one type of estrogen's ability to turn into the other.

Estrogens are produced by ovarian follicular apparatus. At birth, the female body contains about three million follicles with immature eggs that are laid in utero. A significant number of eggs are killed even before the onset of puberty. At ovulation, which occurs in the middle of each cycle, spent a small percentage of the follicles.

During each cycle, there is the development of multiple follicles under the influence of hormones of the first phase of the cycle. Thus, the follicles as a temporary hormone structure. Until the end of the ovary to ripen only one follicle, which contains the most viable egg.

By the end of its development at the end of the first phase of follicular envelope is broken, releasing the mature egg. Over the next two days conception may occur. Inner functional layer uterine also prepared for implantation of a fertilized egg, expanding the first phase under the influence of hormones cycle. In place sovulirovavshego follicle formed corpus luteum, produces progesterone.

In the absence of pregnancy before menstruation absorbed corpus luteum, and the uterine overgrown functional layer is torn away under the influence of hormones second phase of the cycle. Thus, start month. These changes were observed during each cycle.

Normally, a woman may be one or two anovulatory cycles annually.

By the onset of menopausal says about 10,000 follicles. Extinction of reproductive function lasting for several years before the final cessation of menstruation. However, the decrease in hormone synthesis, characteristic of early menopause is often unnoticed woman.

Premenopausal begins a sharp decline in the production of sex hormones. Experts say that menopause is caused genetically. Its appearance is due to the general aging of the organism, in particular hypothalamic structures. In this case, initially disturbed menstrual function. Trying to restore hormonal balance, there is a sharp increase in the level of FSH and LH. However, estrogen deficiency progresses.

The first signs of the come climax becomes a persistent change in menstrual function. Bleeding during menstruation can be both scarce and abundant, occur earlier or later. There is an increase of anovulatory cycles, which are single-phase. Acyclic bleeding may occur. Of course, the ability to conceive decreases dramatically. However, at this stage of pregnancy is possible, since there are menstruation and ovulation can occur spontaneously.

Gradually, there are signs pointing to the emergence of a variety of disorders of the internal organs. The body responds to estrogen deficiency disorders in the cardiovascular, nervous, endocrine system, musculoskeletal system, gastro-intestinal tract. There are hot flashes, excessive sweating, headache, tachycardia and heart pain, pressure drops, disturbed sleep. The woman notices mood variability, becomes irritable and whiny.

Menopause occurs in parallel with the last menstruation. This stage is set one year after the self-menstrual bleeding. During this period, any spotting and bleeding are excluded. Thus, menstrual function is completely terminated. This means that pregnancy becomes impossible.

In postmenopausal women, which covers the period after menopause to old age, estrogen production has vnezhelezistoe origin. It is known that a small part of the hormone is synthesized in muscle and adipose tissue, and adrenal glands. If the menopause are the main manifestations of urogenital disorders associated with atrophy of the mucous membranes of the vagina and the bladder, at this stage there are metabolic disorders. Significantly increases the risk of osteoporosis, Alzheimer's disease, heart attacks and strokes.

It is difficult to accurately indicate when the climax comes at a particular woman. Modern gynecology refers to the age of 45-51 years as the most likely age of onset of menopausal changes. This does not mean that menopause does not normally occur sooner or later.

In small number of women menopausal changes begin as forty, and after 55 years. This may be due to a genetic predisposition, the influence of living and working conditions. For example, early menopause is typical for women from the mountainous regions, as well as representatives for smokers. Late menopause often occurs in women with benign hormone-producing tumors in history, such as uterine myoma.

Thus, menopause can be either physiological or pathological. In the presence of comorbidities menopause postponed. If the womb is put a smaller number of follicles to forty years there has been an early depletion of ovarian syndrome. Menstrual bleeding, as well as reproductive function are completed on the background of the functioning of a young body, which causes a serious hormonal imbalance and heavy adaptation. If the individual follicles remain, menopause occurs easier. There may be periodic menstrual bleeding and spontaneous ovulation. When the form of total follicles are absent, causing severe course of menopause.

Late menopause in most cases is a cause for concern. By late onset of menopause are often disguised malignant tumors with hormone-character.

Drug-induced menopause is temporary and is created artificially and is used for medicinal purposes in women of reproductive cycle. Surgical menopause develops after removal of the uterus and ovaries. After removing only the uterus or one ovary menopause does not occur immediately. Possible periodic bleeding. Radiation climax develops after exposure. Fertility can be restored partially.

Nevertheless cancers and various disease can develop at menopause. Often of serious violations indicate bleeding, which normally does not occur after the cessation of the menstrual function. That is why after menopause there is a need for regular surveys, especially in the presence of bleeding.

Uterine bleeding in menopause period implies the presence of uterine bleeding precipitates of varying intensity. These uterine bleeding may occur against the background of fading menstrual function, and after its completion.

Uterine bleeding are differentiated by the following indicators:

• duration;
• periodicity;
• blood volume;
• presence of clots.

Uterine bleeding in menopause can have various origins:

• dysfunctional;
• organic.

To determine the causes of the climacteric uterine bleeding in various diagnostic methods may be used, for example, a gynecological examination, ultrasound, WFD scraping histological analysis. Selecting further treatment strategy depends on the cause of menorrhagia.

Uterine bleeding may be marked in any phase of menopause: pre-menopausal, menopausal and postmenopausal women. Gynecologists emphasize that uterine bleeding is the most common cause of hospitalization in women aged 45 to 55 years, which coincides with the menopause. In general, the causes of uterine bleeding depends on the particular stage of menopause.

In 25% of cases cause uterine bleeding is related fibroids. Uterine bleeding often occurs due to endometriosis, as noted in 20% of cases. Endometrial polyps leads to uterine bleeding in 10% of cases.

When uterine bleeding regardless of the length, size and intensity precipitates requires medical supervision. This is due to the fact that uterine bleeding can occur as a background hormonal dysfunctions, and because of benign and malignant tumors.

Classification

Several distinct types of uterine bleeding, which are differentiated according to various criteria. In particular, distinguish uterine bleeding occurring at different periods of menopause:

• premenopausal;
• menopausal;
• postmenopausal.

Depending on the volume of blood released, duration and frequency of bleeding following variants:

• menorrhagia, implying cyclical uterine bleeding abundant nature in pre-menopausal women;
• metrorrhagia, meaning acyclic uterine bleeding;
• menometrorrhagia related to heavy menstruation, which are combined with the acyclic nature of bleeding;
• polimenoreya deemed uterine bleeding occurring regularly at short intervals.

In premenopausal uterine bleeding often refer to menometrorrhagias. After the cessation of menstruation, ie, menopausal and postmenopausal women, uterine bleeding metrorrhagia imply.

Depending on the causes of the pathology, the following types of uterine bleeding in menopause:

• dysfunctional;
• iatrogenic.

Iatrogenic uterine bleeding associated with both diseases of the reproductive system, and extragenital pathologies.

Causes

There are many reasons that can cause uterine bleeding. Identifying the causes which leads to uterine bleeding, it is necessary to select the appropriate treatment strategy.

hormonal dysfunction

This is the most common cause uterine bleeding in pre-menopausal women, which is the first phase of menopause. Dysfunctional uterine bleeding associated with involutional disorders arising in the hypothalamic-pituitary-ovarian regulation. Due to violations of cyclic gonadotropin secretion violations occur in the maturation of follicles, as well as notes luteal insufficiency and deficiency of the corpus luteum.

Hyperplastic processes and polyposis

Against the background of progesterone deficiency and hyperestrogenia proliferation phase can be prolonged, and the secretion - to decline. Uterine bleeding may occur resulting in endometrial hyperplasia.

Hyperplasia may be focal and diffuse. Pumping in focal endometrial polyps growth occurs, which may relate to the different histological types. The most dangerous adenomatous polyps, including signs of atypia.

endometriosis

Development of the disease usually occurs in the reproductive cycle. Endometriosis cell spread implies inner layer of the uterus endometrium beyond their subsequent germination in different tissues. Endometriosis lesions are formed which are also affected by sex hormones, as well as elements of the endometrium. Thus, in a first cycle phase is observed proliferation of endometriotic lesions and in the second - their rejection followed by bleeding and the development of inflammatory processes.

With the onset of menopause pathology in most cases, it regresses. However, sometimes due to hormonal imbalance may occur intensive proliferation of endometriotic foci.

Myoma

Quite often in women in pre-menopausal detected fibroids, which is a benign tumor formation in the uterine cavity. As endometriosis, myoma is considered one of the most mysterious of pathologies, as its causes are not known for certain. It is assumed that the cause of fibroids can be hormonal imbalances. It determined that the fibroid is not a threat, in terms of oncology. However, fibroids can cause compression of the internal organs, the stomach volume growth.

Some species of fibroids, such as submucous, even at early stages of development causing severe symptoms. One such symptom is uterine bleeding

malignant tumor

Cancer of the uterus and the cervix is ​​a common cause of uterine bleeding in women during menopause. Malignant tumor endometrial hyperplasia develops in the background and can be latent for a long time to progress. Predispose to malignant transformation uterine polyps, particularly adenomatous type. Cervical cancer is a consequence of HPV.

Uterine bleeding It can be observed in patients receiving hormonal preparations extragenital diseases, such as hypothyroidism. In premenopausal women with uterine bleeding should be excluded ectopic pregnancy and miscarriage.

symptoms

The first changes in the menstrual flow observed in premenopausal women. Monthly characterized by irregular, may not be available 2-3 months. discharge intensity is also changing. Menstruation can be both scarce and abundant. In the absence of other symptoms such changes are the norm of premenopausal.

The reason for concern is the monthly, by volume resembling uterine bleeding. For example, if the gasket should be replaced every hour. Alarming signal are also spotting or clotted red blood. Acyclic or contact spotting are also not normal.

You should also pay attention to the following points:

• says long-term nature of monthly;
• menstruation resumed after a break of a few months;
• between periods does not pass three weeks.

Symptoms uterine bleeding during menopause depend on concomitant pathologies and severity of anemia.

Diagnostics

Abundant spotting, particularly acyclic nature may indicate various pathologies. That is why the presence of this pathology woman recommended a thorough examination.

1. Gynecological examination in which the doctor examines the history of women and analyzes its complaint.
2. In the absence of bleeding doctor produces a smear on the fence onkotsitologiyu.
3. Pelvic ultrasound eliminates uterine pathology, ovaries and other pelvic organs. Through ultrasound can confirm or deny the pregnancy.
4. Laboratory diagnosis includes blood tests, coagulation, determine the level of tumor markers, sex steroid and thyroid hormones, the study of liver function tests and lipid profile.
5. In terms of the value of research is to provide the WFD, which is carried out directly using hysteroscopy. Histological examination of the inner layer of the uterus scraping allows you to determine the cause of bleeding and their species, exclude more serious pathology.

For detection of fibroids and polyps can be used diagnostic methods such as MRI and hysterosalpingography.

Treatment

In the treatment of diseases commonly used separate diagnostic curettage. This procedure is both a diagnostic tool and treatment. After the scraping on the hyperplasia and polyposis spotting stops. Tactics treatment further depends on histology results.

When detecting endometrial cancer or atypical hyperplasia recommended pangisterektomiya. Supravaginal amputation of the uterus or hysterectomy is shown in the following cases:

• Multiple fibroids;
• adenomyosis in nodular form;
• combination of fibroids and adenomyosis.

In benign processes non-hormonal nature appointed conservative treatment:

• progestins, which contribute to atrophic changes in the endometrial stroma and glandular epithelium, soften the symptoms of menopause;
• drugs with antiestrogenic action, reduce symptoms of mastitis and contribute to reducing myomas;
• androgens after 50 years.

Hormonal treatments are often contraindicated. In particular, treatment by hormonal agents are not recommended for the following pathologies:

• thromboembolism;
• varicose veins;
• hepatitis and in chronic cholecystitis;
• hypertension.

As an auxiliary hemostatic treatment is also used and antianemic agents. Medication and Special Diet correction is performed for obesity, hypertension, hypothyroidism.

Relapses pathology indicate undiagnosed disease. It should be remembered that in 10% of cases the cause of uterine bleeding is uterine cancer. That is why women in menopause should see your doctor regularly for the purpose of passing examinations.