Discharge with blood in the first week after menstruation: causes, classification, treatment

When is brown leucorrhoea normal?

The so-called brown spot is not always a sign of a problem in the body. Discharges that come from the genitals are not pathological if they appear:

• began (up to 2 days) before menstruation;
• after the end of menstruation (up to 3 days).

The reason for the appearance of brown leucorrhoea in the middle of the cycle may be hormonal changes in the body:

• When taking contraceptives
  . Leucorrhoea occurs during the first months (sometimes up to six months) after starting to take medications. They are not accompanied by additional symptoms and then disappear.
• After using medications
  emergency contraception (Postinor, Escapelle, etc.).

• During adolescence.
  The regularity of menstruation is established within 2 years from the onset of menarche (first menstruation). Therefore, the appearance of a scant bloody smear in the middle of the cycle is a variant of the norm during puberty.
• During menopause
  . Irregular cycles and spotting are common during menopause (from six months to a year after the cessation of menstruation).

Hormonal imbalances and the appearance of brown discharge can be caused by endocrine diseases.

Another non-pathological cause of brown spotting in the middle of the cycle is internal microtraumas that occur:

• During ovulation
  . After maturation, the egg ruptures the follicle and leaves the ovary into the fallopian tube.
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  The rupture may be accompanied by the release of a small amount of blood, which, when oxidized, acquires a brown tint (from light chocolate to dark brown or black).

• After first coitus
  . Brown and even bloody discharge is a consequence of the destruction of the hymen. Sometimes spotting leucorrhoea appears after the first few sexual intercourses.

• After rough vaginal sex
  . If a woman is insufficiently aroused and there is no (or poor secretion of) lubrication in the vagina, microtraumas occur, accompanied by small bloody leucorrhoea.

Leucorrhoea that begins after sex, with an unpleasant odor, itching or pain, may be a symptom of sexually transmitted diseases.

Uterine bleeding

Uterine cancer

Cervical cancer

5558 January 27

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Uterine bleeding: causes of occurrence, what diseases it occurs with, diagnosis and treatment methods.

Definition

Every woman and girl can experience abnormal uterine bleeding. They are a signal of dysfunction of the reproductive, endocrine or nervous systems. This condition usually occurs suddenly, so it is necessary to clearly understand what to do if abnormal uterine bleeding develops.

The uterus is an organ of the female reproductive system, consisting of three layers: internal (endometrium), middle muscular (myometrium) and external (perimetry), which is adipose tissue surrounding the outside of the uterus.

The uterus, like other organs of the female reproductive system, undergoes significant changes during the menstrual cycle, which, in turn, is associated with the maturation of eggs in the ovaries.

The germ cells (cells that are the precursors of the egg) laid down during the intrauterine development of the female fetus are activated and enter into the process of further development every month, but not all at once, but in a strictly defined quantity (about 20–30 cells), while fully maturing only one cell. It leaves the ovary, enters the fallopian tube, through which it gradually moves towards the uterus. If the egg has been successfully fertilized by a sperm, then a zygote is formed - the first cell of the future embryo, which begins to divide and, reaching the uterine cavity, is fixed (implanted) on the surface of the endometrium. If fertilization does not occur, then the egg does not remain in the uterine cavity and is subsequently excreted along with normal menstrual flow. In the process of implantation, the most important role is played by the epithelium lining the uterine cavity from the inside - the endometrium. From the beginning of the menstrual cycle, it grows, thickens and reaches its maximum thickness at the time of ovulation. Next, the endometrium is loosened, which is necessary for successful implantation. If implantation does not occur, then before the start of a new menstruation, endometrial rejection begins, which is preceded by spasm of the uterine arteries. It is the spasm of the uterine arteries that causes the development of pain during the premenstrual period. Next, the arteries relax and become fragile, which leads to the development of bleeding under the endometrium with its further rejection.

Thus, it is the rejected endometrium that is the main component of the discharge from the uterine cavity during uterine bleeding.
Types of Uterine Bleeding
All uterine bleeding can be divided into normal menstrual bleeding and abnormal uterine bleeding. Normal menstrual bleeding is characterized by frequency of occurrence, a certain duration of the menstruation itself (on average from 3 to 7 days) and a small loss of blood (usually about 40-60 ml).

Bleeding that differs in its characteristics from those listed above is considered abnormal in women who have reached reproductive age.

These bleedings are excessive in duration (more than 7 days), volume of blood loss (more than 80 ml), and frequency (including intermenstrual bleeding).

Separately, abnormal bleeding of the pubertal, perimenopausal and postmenopausal periods is distinguished, which is associated with the peculiarities of the functioning of the reproductive and neuroendocrine systems during these age periods.

Possible causes of abnormal uterine bleeding

Identification of the causes of abnormal uterine bleeding formed the basis of the PALM-COEIN classification, widespread throughout the world (many domestic gynecologists also use this classification, indicating this abbreviation in the diagnosis). In accordance with it, the causes of uterine bleeding are divided into organic (structural, accessible to visualization and detection by ultrasound, MRI, etc.) diseases of the female reproductive system and functional, caused by impaired functioning of the reproductive system in the absence of visible changes, as well as those arising from -for disorders of the endocrine system, blood coagulation system, etc.

What diseases cause abnormal uterine bleeding

What diseases are hidden under the abbreviation PALM-COEIN?

• Polyp (polyp) – the presence of polyps, i.e. formations, often benign;

• Adenomyosis (adenomyosis) is a type of endometriosis in which the endometrium grows deep into the wall of the uterus;
• Leiomyoma (leiomyoma, or myoma) is a benign tumor that develops from myometrial tissue;
• Malignancy (malignancy) – malignant (oncological) processes developing from uterine tissue;
• Hyperplasia (hyperplasia) – excessive growth of the endometrium;
• Coagulopathy (coagulopathy) – disorders of the blood coagulation system (for example, hemophilia, von Willebrand disease, etc.), manifested by a tendency to bleeding of various locations (not only uterine bleeding, but also nasal, post-injection, etc.);
• Ovulatory dysfunction (ovulatory dysfunction) – disruption of the functioning of the ovaries, leading to certain changes in the process of egg maturation;
• Endometrial (endometrial dysfunction) – disruption of the functioning of the endometrium in the absence of its visible changes;
• Iatrogenic (iatrogenic cause) – uterine bleeding as a complication in the process of treating a particular disease;
• Not yet classified (not yet classified cause) - other rare or unknown causes of uterine bleeding.

Which doctors should I contact if abnormal uterine bleeding occurs?
Emergency treatment of abnormal uterine bleeding is carried out by an obstetrician-gynecologist. After the bleeding has stopped, the gynecologist continues to care for such a patient, often together with an endocrinologist and mammologist. If abnormalities in the blood coagulation system are detected, the patient is sent for a mandatory consultation with a hematologist (a doctor specializing in blood diseases).

Diagnosis and examination of abnormal uterine bleeding

Diagnosis of the cause of abnormal uterine bleeding begins with a detailed interview of the patient in order to identify risk factors for a particular disease and clarify the circumstances of the development of bleeding. The dates of the last normal menstruation must be specified, and pregnancy is excluded (in the laboratory) using a blood test for hCG (human chorionic gonadotropin).

Discharge from a healthy woman

Normal indicators of the health of the female reproductive system are full discharge from the vagina and uterus. Every qualified gynecologist can explain why they go and visit regularly during an appointment. The mucous membranes of internal organs have their own protective microflora, which provokes the excretion of transparent mucus. Causes of natural discharge:

• microorganisms and epithelial cells of the vagina and uterus;
• vaginal lubrication. Observed after sexual intercourse;

• protective function of the cervical canal.

There is another type - periodic bleeding menstrual flow. Traditionally, bleeding occurs differently for everyone and has an individual character. The daily amount is from 5-6 grams to 15-18 grams of liquid. The duration does not exceed 8 - 9 days. The rest of the menstrual cycle has a creamy or denser consistency of the composition.

The norm for the appearance of brown spotting impurities in vaginal discharge is the period before or after the expected menstruation. The duration should not exceed 2-3 days. Sometimes you can observe these signs during the period of ovulation.

Discharge after sex

Normally, after intimate relations, the discharge should be mucous, without any foreign odor. Blood after sex, a feeling of discomfort and pain should be a reason to contact a gynecologist, especially if they appear repeatedly. Unpleasant symptoms can be physiological in nature (if it is the beginning of menstruation, first sexual intercourse, insufficient vaginal moisture), and in this case the woman’s condition can be easily corrected in accordance with the doctor’s recommendations.

In emergency cases, urgent hospitalization is necessary, but more often you can visit a doctor as planned, after which the specialist will prescribe treatment based on the identified pathology.

However, the reason may also be the development of gynecological pathology (inflammation, cancerous tumors, benign neoplasms, cervical erosion), which needs to be diagnosed (examination by a doctor, pelvic ultrasound, smears for flora and oncocytology) and timely treatment.

It is important to pay attention not only to the presence of blood during intimate contact, but also to other warning signs, so that you know what to do if there is blood during sex - relax or urgently consult a doctor for consultation and treatment. To clarify the reasons, the woman is prescribed several types of examination:

• examination on a gynecological chair;
• colposcopy to determine the condition of the cervix;
• performing an analysis of vaginal smears to exclude sexually transmitted diseases;
• pipel biopsy;
• Ultrasound to determine the condition of the endometrium;

• hysteroscopy (for regularly recurring bleeding).

If you suspect a precancerous condition of the tissues of the cervix, endometrium, or external genitalia, consultation with an oncologist is required.

Treatment and reasons for choosing a therapy method

Treatment depends only on the underlying cause of the bleeding. Once identified, drug therapy (dysfunctional causes) or surgical intervention (malignant formations) may be required.

A woman should always choose the most appropriate treatment, including taking into account her age or her desire to have children. This allows you to increase patient adherence to therapy, as well as achieve maximum success.

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Causes of bleeding

When bleeding appears in the middle of the cycle without pain or itching, and the discharge does not smell unpleasant, the symptom is almost always provoked by physiological factors:

1. Ovulation
   . The release of a mature egg is accompanied by a change in hormonal levels due to increased estrogen synthesis. On the 13th day of the cycle, spotting, if there are no gynecological diseases, is almost always caused by ovulation.

2. Current pregnancy
   . At the time of implantation of the fertilized egg into the uterus, there is often a little bleeding from the vagina. Bloody discharge in the middle of the cycle without pain can occur any day after menstruation, but more often it occurs on the 15th day of the cycle if there was unprotected intimate contact before that.

3. Microdamage to the vagina
   . Active sex, accompanied by damage to the mucous membrane. Reasons: inappropriate or large size of the partner's organ. One-time minor bleeding in the middle of the cycle after sex is not dangerous. If the situation repeats and the peeing is not associated with coitus, then you should look for another reason.

4. Taking oral contraceptives
   . On the 16th day of the cycle, bleeding often occurs when hormonal contraceptives are taken.

5. Precursors of menstruation
   . Bloody discharge that appears on the 18th day of the cycle can signal that menstruation will begin soon.

The causes of bleeding in the middle of the cycle, even if there are no other signs of deterioration in health, are not always physiological in nature. If blood is released for several days or bleeding appears regularly, you need to undergo an examination and find out the cause.

Discharge associated with pregnancy

Brownish leucorrhoea in the middle of the cycle may indicate the beginning or end of pregnancy (miscarriage). Why is this happening?

When a fertilized egg attaches to the uterus, the endometrial vessels may be slightly damaged. The released blood stains the mucus. Sometimes mild spasms may occur.

Heavy discharge, which is accompanied by severe pain, nausea and cycle disruption, can be a symptom of an ectopic pregnancy.

If the fertilized egg detaches from the endometrium (due to the non-viability of the fetus or the presence of scars and adhesions in the uterus), a miscarriage occurs, which is accompanied by slight bleeding (duration - up to 48-72 hours).

When to worry: signs of illness

Mid-cycle spotting, the causes of which are not related to normal physiological secretions, may be a sign of a gynecological disease. You should pay special attention to your health if leucorrhoea is accompanied by the following symptoms:

• unpleasant odor or heavy discharge;
• pain or cramping in the lower abdomen (moderate to severe);
• itching and burning;

• painful sexual intercourse;
• general intoxication (fever, weakness);
• long period of discharge (from several days);
• the appearance of blood clots;
• regular discharge (appears over several cycles).

Many serious gynecological diseases (cancer, polyps, fibroids, etc.) can be asymptomatic in the early stages, so delay in diagnosis and treatment is deadly

Brown spotting as a symptom of the disease

Brown leucorrhoea can be one of the symptoms of gynecological diseases. Often the appearance of spotting is caused by damage as a result of injury or infection of the mucous membrane of the reproductive organs.

The consequences of these diseases are very serious: from infertility to disability and death.

Therefore, it is necessary to carry out diagnosis as early as possible.

Hemorrhage in ICD-10

The content of the article

To systematize all human pathologies, the International Classification of Diseases, 10th edition (ICD-10) was developed. The code for bleeding in ICD-10 depends on the type of discharge:

• Code 93.0 – Postcoital or contact bleeding .
  Bloody discharge that appears after sexual intercourse or medical interventions.
• Code 93.8 – Other specified abnormal bleeding from the uterus and vagina.
  Bloody discharge that occurs against the background of a gynecological disease - fibroids, polyps, endometriosis, oncology, etc.
• Code 93.9 – Abnormal uterine and vaginal bleeding, unspecified.
  The cause of blood discharge from the vagina or uterus has not been established.
• Code 62.5 – Bleeding from the anus and rectum.
  Anal bleeding that develops as a result of injury or inflammation of the rectum. Pathology can also occur with hemorrhoids, tumors and other proctological problems.

By establishing the pathology code according to the ICD, it is easier for the doctor to develop effective treatment and avoid dangerous health consequences.

What is the danger?

There are cases when it is simply necessary to seek help from a specialist after detecting brown discharge, since spotting is a clear sign of abnormalities. For example, bleeding after sex is the first sign of diseases of the reproductive system. However, if the spotting is not accompanied by additional symptoms, for example, an increase in body temperature, then discharge after sexual intercourse may indicate the approach of menstrual bleeding.

The strength of the discharge also matters.

So, with an ectopic pregnancy, the discharge of blood can be very copious. It is worth noting that this condition is extremely dangerous for women. Dark brown spotting is most often referred to as metrorrhagia and intermenstrual bleeding.

This phenomenon is typical for women at any age and can appear as a symptom of pathology or be an individual feature of the body. If there is spotting in the middle of the cycle, the doctor may prescribe special medications. The most common diseases that cause spotting are:

• adnexal tumor;
• fibroma;
• malignant neoplasm in the uterus;
• sarcoma;
• cervical cancer or erosion;

• endometritis;
• not external adenomyosis.

These diseases are extremely dangerous and not only provoke changes in the cycle, but some can be fatal. In addition to dangerous diseases, bleeding can occur for other reasons that are less life-threatening, but can also lead to reproductive dysfunction and other unpleasant consequences.

Diagnosis of bleeding in the middle of the cycle

First of all, to diagnose the causes of intermenstrual bleeding, a gynecological examination is necessary. In addition, you must undergo the following examinations:

• cytological studies of aspirate from the uterine cavity;
• Ultrasound of the pelvic organs;
• study of the hormonal background of the body;
• thyroid examination;
• hysteroscopy and curettage of the uterine cavity and cervical canal;
• histological examination of scrapings obtained from the uterine cavity and cervical canal.

Also, if necessary, the gynecologist can prescribe a study of the pituitary gland using magnetic resonance imaging, radiography, computed tomography. Sometimes the brain is also examined using these methods.