Treatment of uterine bleeding

Normally, uterine bleeding occurs monthly in every woman of reproductive age. Blood discharge is also physiologically justified after childbirth and invasive gynecological procedures. However, if blood appears in girls before puberty, in women mid-cycle, or after menopause, it is considered abnormal uterine bleeding.

It can be caused by various reasons, from inflammatory diseases to tumors, and may require immediate hospitalization. Many women experience chronic uterine bleeding — perceiving it as menstruation, they do not seek gynecological care for a long time.

The symptoms of uterine bleeding may vary depending on its cause, the woman's age, the presence of other diseases, and individual characteristics.

Signs of a pathological process may include:

• frequent bleeding (menstrual cycle shorter than 24 days);

• prolonged bleeding (normally menstruation lasts from 3 to 7 days);

• bloody discharge in the middle of the cycle (may be spotting or heavy);

• irregular menstrual cycle;

• heavy discharge (if menstrual bleeding has become more intense than before);

• bleeding after intercourse (may be minor);

• appearance of blood in girls before menarche and in women postmenopause;

• abdominal pain and general deterioration of well-being.

In acute conditions, bleeding can be heavy and begin suddenly. Chronic bleeding is usually manifested by a prolonged menstruation duration, spotting in the middle of the cycle. Against this background, a woman may develop anemia, experience weakness, dizziness, and pale skin.

Uterine bleeding can be difficult to distinguish from regular menstruation. Because of this, many do not see a doctor in time. You should consult a specialist if:

• menstruation started significantly earlier than expected;

• discharge lasts more than 7 days (or even 7, if previously it lasted 3–4 days);

• after menstruation ends, there is continued brown spotting;

• blood flow is too intense (hygiene products need to be changed more than once every 2 hours or more than 4–5 pads or tampons per day);

• large clots are discharged;

• unusual abdominal pain occurs.

There can be many causes of abnormal blood loss. It can only be identified after a thorough examination. It is not possible to determine the cause based solely on symptoms.

The most common causes include:

• spontaneous abortion (miscarriage);

• hormonal imbalance;

• excess estrogen with a deficiency of progesterone (they regulate ovulation and menstruation);

• intake of hormonal drugs, emergency contraception;

• endocrine diseases;

• inflammation and infections of the reproductive organs;

• anovulation (a mature egg does not exit the follicle);

• endometrial hyperplasia (abnormal thickening of the uterine lining);

• endometriosis (growth of menstruating cells outside the uterus);

• polyps, cysts, tumors of the reproductive organs;

• trauma to the reproductive organs;

• thinning and atrophy of tissues during menopause;

• blood clotting disorders;

• autoimmune and other diseases.

Some specialists also identify such causes as severe stress, constant fatigue, climate change, strict diets, and malnutrition (in such cases, delays may also occur).

Uterine bleeding is classified according to several parameters.

By the woman's age:

• juvenile – in adolescent girls;

• reproductive – in women of reproductive age;

• climacteric – in women during menopause and postmenopause.

By the timing of appearance:

• acute – sudden, heavy bleeding requiring urgent medical attention;

• chronic – light or moderately heavy bleeding occurring at different times;

• intermenstrual – occurs mid-cycle.

Abnormal bleeding is also classified by causes. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) adopted a new classification system called PALM-COEIN. The abbreviations are based on the first letters of diagnoses within each group.

PALM includes mostly structural pathologies. These are:

• polyps;

• adenomyosis (invasion of the endometrium into the muscle layer of the uterus);

• leiomyomas (benign tumors);

• hyperplasia and malignant tumors.

COEIN includes 5 categories, mostly dysfunctional:

• coagulopathy – blood clotting disorder;

• ovulatory dysfunction;

• endometrial disorders;

• iatrogenic causes – resulting from diagnostic or therapeutic procedures;

• bleeding of unknown origin.

According to statistics from the Association of Gynecologists, the most common causes are leiomyomas and ovulation disorders.

Uterine bleeding is dangerous both in itself and due to its causes. With chronic blood loss, anemia may develop, and with acute, heavy loss — shock and other life-threatening consequences.

Abnormal bleeding can be a symptom of many diseases, including tumors. If not diagnosed in time, they can progress and cause even greater complications.

A comprehensive diagnosis is needed for uterine bleeding. The causes may be numerous and not limited to gynecological conditions. It is necessary to determine the true cause to select the correct treatment and prevent recurrence.

During the consultation, the gynecologist necessarily performs a pelvic examination. This confirms the bleeding and checks for superficial neoplasms that could have caused it. The doctor also asks about symptoms, possible pregnancy, existing diseases, etc.

Comprehensive diagnostics may include:

• ultrasound of the pelvic organs, thyroid, and adrenal glands;

• CT or MRI;

• colposcopy – examination of the cervix;

• endoscopic examination of the vagina and uterus;

• smear and scraping analysis;

• blood tests: complete, biochemical, hormones, glucose, and hidden infections.

Initially, the specialist assigns tests to confirm or rule out the most common causes of uterine bleeding. If they do not explain the condition, the gynecologist prescribes other examinations. The diagnostic program is always developed individually based on the patient’s symptoms, health status, age, and other factors.

The method of treatment depends on the nature of blood loss and its cause. In acute conditions, bleeding is first stopped and the woman’s condition stabilized. This is usually done surgically — through hysteroscopy. This is an endoscopic therapeutic and diagnostic procedure. An endoscope with an optical device is inserted into the uterine cavity through the vagina, transmitting an image to a monitor screen. It is magnified many times, allowing the doctor to identify the bleeding source, stop it, take tissue samples for analysis, and remove polyps or other neoplasms if necessary.

After acute bleeding is stopped, a thorough examination is conducted to determine its cause, which informs the treatment plan. If the bleeding is chronic, diagnostics are performed before treatment begins.

If the bleeding is associated with a cyst, polyp, tumor, or other structural condition, surgical intervention may be required. Mostly, minimally invasive hysteroscopic and laparoscopic operations are performed. They are low-trauma and involve a short recovery period.

For functional disorders (e.g., hormonal imbalance), medication therapy is used. The doctor may prescribe hormonal drugs, vascular-strengthening agents, iron supplements to treat anemia, and other medications as indicated. For inflammatory and infectious diseases, antibacterial, antiviral, or antifungal therapy is prescribed, as well as drugs to relieve painful symptoms.

If uterine bleeding develops against the background of endocrine, autoimmune, or other systemic diseases, the gynecologist may refer the patient to a specialized doctor.

In most cases, comprehensive treatment is carried out with various medications to eliminate the cause of bleeding and also the symptoms of the disease and its complications (anemia, etc.).

To reduce the risk of uterine bleeding and recurrence, you should carefully monitor your health.

Specialists recommend:

• undergo annual gynecological examinations and preventive checkups (twice a year if risk factors are present);

• consult a doctor at the first signs of gynecological diseases;

• avoid self-treatment;

• prevent hormonal imbalances (treat all endocrine diseases, do not take hormonal drugs, including contraceptives, without a prescription);

• follow all intimate hygiene recommendations;

• maintain a healthy diet;

• engage in physical activity;

• avoid excessive stress and overexertion;

• maintain a healthy weight.

The gynecologist may also suggest individual preventive measures, considering the woman’s health and risk factors.

You can book an appointment with an obstetrician-gynecologist at “Oxford Medical” in Kyiv by calling our contact center or messaging us via online chat.