Bloody discharge after your period.

In women of fertile age in the norm of bloody discharge between menstrual periods should not be. Their presence is considered as a gynecological pathology and a prerequisite for examination, although in fact, in most cases, bloody discharge after menstruation can be caused by quite harmless reasons.

The discharge between menstrual periods should look like a clear, mucousy mass without traces of blood, odorless and not irritating to the vagina. By the middle of the cycle, this mass thickens and becomes more abundant, and by the time of a new menstruation, it becomes even more viscous and may acquire a faint sour odor. By the way, the duration of menstruation should be from three to seven days, the average blood loss is 250 ml, blood - scarlet, towards the end of brownish, a small number of clots are allowed, preliminary and final "smear" is absent.

But this is about the norm. Nevertheless, about a third of fertile women have bloody discharge in the intermenstrual period, not always caused by pathological reasons, but there is no such concept as the norm of bloody discharge after menstruation. It can be assumed that the absence of pain, odor, abundance - these are positive signs. In principle, so, but only by external indicators, no doctor will not give a hundred percent guarantee of well-being.

Causes of the postmenstrual bleeding

Bloody discharge after menstruation as a variant of the norm can appear due to:

• starting or discontinuing hormonal contraception, violation of their regimen;
• recent insertion or removal of an intrauterine contraceptive device;
• taking medications - blood thinners, hormonal, psychotropic and some others (see the instructions for the drug);
• recent gynecologic mini-interventions;
• Menstrual cycle disorders due to nervous disorders, prolonged unbalanced diet, increased physical exertion;
• in women with short menstrual cycles (21-22 days), oozing after menstruation can be a symptom of ovulation (rupture of the follicle wall) or an indication of pregnancy (implantation of the fetal egg in the uterine wall);
• Hormonal restructuring in an adolescent girl or woman with declining fertility.

Pathologic causes of bloodstains on laundry include:

• inflammation of the reproductive organs of infectious and non-infectious origin;
• vaginal trauma;
• female genital neoplasms;
• diseases of the endocrine system;
• clotting disorder;
• Iron and/or B vitamin deficiency;
• possible ectopic pregnancy.

Risk factors

1. Hormonal and/or intrauterine contraception.
2. Rough sex.
3. Diseases of the sexual sphere of various genesis.
4. Fluctuations in hormonal background - physiological, medication, caused by stressors.
5. Recent gynecologic manipulations.
6. Presence of endocrinologic diseases, systemic collagenosis, diseases of the hematopoietic system.
7. Pregnancy is naturally not a disease, however, it can contribute to untimely bloody discharge.

Pathogenesis

Triggers for the development of the pathogenetic mechanism leading to the appearance of bloody discharge after menses are diverse, but the result of their action should be:

• hormonal imbalance, which the body takes as a signal for extraordinary rejection of the exhausted endometrium;
• neoplasms of the uterus, its cervix and appendages, the development of which leads to stretching, for example, the inner lining of the uterus and rupture of the vessels, which it is densely permeated, which leads to bleeding (however, do not forget that these tumors are hormone-dependent and their "legs grow" from the first point);
• Blood thinning (reduced platelet count);
• traumatization of the vagina, uterus of iatrogenic or accidental origin.

Epidemiology

It is not known how often bloody discharge occurs exactly after menses. Medical statistics take into account the number of abnormal uterine bleeding of different intensity and at different times in general. In the structure of the reasons that prompt to turn to a specialist for help, complaints about bloody vaginal discharge account for about 10%. Moreover, the number of appeals with this gynecological problem increases with the age of patients. If up to 35 years of age every fourth patient complains of intermenstrual bloody discharge, then in the age group 35-49 years with this problem apply 35-55% of women. Among patients who have lost the ability to procreate, discharge with traces of blood is found in the majority (55-60%) of women who applied with gynecological pathologies.

Forms

The first signs of traces of blood in intermenstrual discharge are not a reason to panic, but you should not completely ignore such a "bell". Self-diagnosis is impossible, but analyze the previous events and observe yourself can every woman. One-time violations, as a rule, are not a sign of pathology, but if the event is repeated from month to month, it is necessary to undergo an examination.

Bloody discharge one day after your period may simply be a continuation of your period. Such discharge can be triggered by a stormy night, strong worries, overheating or high physical activity. In these cases, "anoints" a day or two and will pass. One-time situation should not cause much concern.

Stress, change of time zones, nervous or physical overstrain can also cause more prolonged menstrual irregularities. It is possible to differentiate such causes from more serious pathologies only after examination.

The regular appearance of traces of blood one day after your period is already a reason to be examined. Especially if there are other symptoms: pain, itching, fever, weakness, hypotension; if blood in the discharge appears daily, for example, for several days, or if the intensity of the discharge increases.

Bloody discharge 1, 2 weeks after your period can be caused by ovulation, because it does not always occur in the middle of the cycle, its beginning can be calculated. The length of the phase of the cycle before ovulation varies depending on its length, the second phase lasts 14 days for everyone. Therefore, in women with a short cycle (21 days) bloody discharge a week after the end of menstruation coincides with the beginning of ovulation and can be quite harmless. If it has already been two weeks after the period, it is generally quite common ovulatory period. Usually such discharges are small sucrose or brownish, there may be more pronounced, bright colors, there may even be small clots and accompanying aching pain in the lower abdomen. But, in any case, such symptoms are observed for a short time, one or two days. If the bloody discharge increases, does not go away, they have an unpleasant odor, foam, whitewash, pus, then it is necessary, without delay, to go to the doctor.

A week after the end of menstruation, bloody discharge appears again in anovulation, i.e. In the absence of ovulation. The possibility of this is additionally indicated by a habitually unstable menstrual cycle.

Quantitative characterization as abundant or scanty bloody discharge after menses does not tell anything to both the patient and the doctor. First, the assessment of quantity is subjective, secondly, the duration of the event and accompanying symptoms are of great importance. Dark, brown, pink ointmental discharge without pain, disposable and short-lived can be, for the most part, quite harmless. Especially if a woman has started using hormonal contraception or has placed an intrauterine device. If the condition has not stabilized after several months, the method of contraception should be changed.

At the same time, such small and short-lived symptoms may indicate the presence of cervical polyps / of the uterine cavity, cervical erosion (these pathologies are qualified as precancer!), as well as the initial stage of malignant tumor development. More pronounced symptoms will appear later, as the tumor process develops.

Dark or pink discharge after menstruation with odor is most often a symptom of inflammation. Brown or bloody streaks in white curd mass with a sour odor indicate the presence of vaginal candidiasis, in greenish-gray with a fishy odor - about dysbacteriosis of the vaginal mucosa, in yellowish-green - the presence of bacterial infection, in frothy - the acute stage of trichomoniasis. Bloody discharge with an unpleasant odor is characteristic of endometritis or endocervicitis, mucous with blood streaks can be with cervical erosion. Almost always the above discharges cause itching in the vagina. In addition, pure infections are rare, as a rule, they are combined, and on the background of inflammation often formed polyps, develop endometriosis.

Bloody discharge after menses and abdominal pulling can be symptoms of chronic endometritis or endometriosis, endometrial hyperplasia, uterine myoma, polyposis, ectopic pregnancy, precursors of early miscarriage. Discharges with blood clots are observed with poor coagulation, neoplasms, the presence of an intrauterine device.

After your period, bloody discharge after sex can be the result of damage to the vaginal wall. A small amount of fresh blood comes out of microcracks. The same clinical picture after sexual intercourse may be in the presence of cervical erosion or cervical polyp, inflammation of the cervical canal.

Bloody discharge after ovulation and before menstruation, scarlet or bloody discharge is characteristic of endometrial diseases, as well as cervical erosion can bleed. They can be caused hypothyroidism and other endocrinologic pathologies. Although often all of these conditions, especially in the beginning, are completely asymptomatic.

For quite a long time (about a month) bloody discharge can be observed after gynecological interventions - abortion, diagnostic scraping. However, if they are joined by pus and soreness, it is necessary to seek immediate help.

Any bloody discharge after menstruation is considered a potential pathology and can be a symptom of a serious disease, so do not ignore them, especially if their appearance is not a one-time event. Do not delay a visit to the doctor, if bloody discharge after your period is accompanied by:

• pelvic pain;
• lower abdominal pain, radiating to the leg;
• with a febrile condition;
• a decline in energy.

Diagnostics of the postmenstrual bleeding

Bloody discharge after menstruation is not a rare symptom, and the reasons that caused them are quite diverse. The presence of traces of blood in the discharge does not always indicate a serious pathology, but to rule it out, it is necessary to conduct an examination with laboratory and instrumental methods. To find out the cause usually takes time. First of all, the patient is interviewed to collect anamnesis and conducts a gynecological examination, during which the doctor takes vaginal smear and sends it to the laboratory for culture and cytological examination. The patient is prescribed general clinical tests of urine and blood, if necessary - blood chemistry, coagulogram, determine the level of sex hormones, thyroid hormones. Other tests may be prescribed, as well as consultations with specialized specialists.

The following instrumental diagnostics is most often prescribed for patients with the problem of bloody discharge after menses: ultrasound examination of the genitals, video colposcopy, hysteroscopy of the uterine cavity, magnetic resonance imaging of the pelvic organs. Diagnostic scraping of the cervical canal or uterine cavity with collection of material for histologic examination may be prescribed.

According to the results of the examination and the data of instrumental studies, differential diagnosis is carried out, consistently excluding the most dangerous conditions.

Treatment of the postmenstrual bleeding

It is not recommended to stop intermenstrual bleeding at home. It is necessary to consult a doctor, because it is strongly not recommended to take styptic and hormonal drugs without a doctor's supervision.

When prescribing treatment, the doctor will be guided by the results of the examination. If a woman has significant blood loss, anemia, then regardless of the diagnosis, she will be prescribed hemostatic agents and drugs that help restore blood composition. These can be vitamin, mineral, protein and iron complexes.

Estrogens, progesterones and their various combinations are used to restore normal hormone levels. Oxytocin, which increases the contractility of the uterus, may be prescribed to stop heavy bloody discharge.

In case of drug-induced bleeding, the drug that caused it is canceled or its dose is adjusted, and an alternative method of protection against unwanted pregnancy is selected.

When detected not gynecological pathology that caused intermenstrual bleeding, treat the underlying disease, in parallel compensating for blood loss and eliminating the disruption of hormonal balance. If the discharge is caused by prolonged insomnia, severe stress, the patient is prescribed sedatives.

Inflammatory diseases of non-infectious origin and sexually transmitted diseases are treated conservatively. Depending on the results of the examination and the causes found, an appropriate course of treatment is prescribed.

If the bloody discharge is caused by neoplasms, surgical treatment is resorted to.

If benign neoplasms are detected (polyp of the cervix or uterine cavity, endometrial hyperplasia), the tumor is first of all removed with the performance of diagnostic scraping of the contents of the uterine cavity. Then, after its histological examination, an individual conservative treatment is prescribed to prevent re-growth of the neoplasm.

Currently, preference is given to minimally invasive interventions. Widely used hysteroscopy is an endoscopic operation performed under computer control, which makes it possible to remove only parts of the mucosa with signs of benign pathology. The mucous membrane of the uterus is traumatized much less than in classical scraping. After hysteroscopy, patients recover faster, but it is not used if there are suspicions of a malignant process. In such a case, only diagnostic resection is performed with the help of a hysteroscope.

Electrosurgical or laser ablation of the endometrium, or, more simply, endometrial burning, may be used for extensive lesions of the inner uterine mucosa. Such interventions are usually used in patients who have lost the ability to procreate with prolonged bleeding and/or contraindications to hormonal therapy. Patients of childbearing age, this intervention is performed on strict indications, because after electroablation endometrium is not recoverable. Cryodestruction (freezing) is also used.

If histology shows the presence of malignant changes in the cells of the genital organ, it is usually indicated to remove it. Gynecologic cancer includes malignant neoplasms of the body of the uterus, its cervix and ovaries. The extent of surgery depends on the degree of prevalence of the process and the localization of the tumor.

Young women are tried to preserve their fertility as much as possible. Laparoscopic surgeries are preferred in all cases, as they are less traumatic. Many clinics are now able to perform total laparoscopic ectomies. Surgery is followed by chemotherapy and/or radiation therapy as indicated.

Complications and consequences

If a woman monitors her health and does not ignore the appearance of alarming symptoms, there should not be serious consequences for health. Any disease at an early stage is always easier to treat, and the result of treatment will be favorable.

The presence of blood in the vagina changes the acid-base balance of the vagina and its microflora - the predominant becomes an opportunistic environment, which leads to inflammatory diseases and opens the gate to infections.

In the case of regular and prolonged bloody discharge without medical intervention may develop complications associated with blood loss (anemia), with gynecological and systemic pathologies. Diseases progress and the development of conditions that threaten the safety of fertility and even the life of the woman is not excluded.

Prevention

1. Preventive visit to the gynecological office once a year, if there is any chronic disease of the sexual sphere - once every six months.
2. If a problem arises - don't put off seeing a doctor for too long.
3. Abandonment of bad habits, which are an oncogenic factor.
4. Whole Foods.
5. As much physical activity as possible, maintaining a normal body weight.
6. Maintain a menstruation cycle tracking calendar.
7. Adherence to the rules of sexual hygiene.
8. Try to avoid stress, decompensation of chronic diseases.

Forecast

In the vast majority of cases involving conservative treatment, bloody discharge after menstruation is eliminated without loss of fertility. The prognosis for life is favorable.

Even a timely diagnosed malignant neoplasm can be cured completely, although fertility can not always be preserved. The same applies to benign formations. After ovario- or hysterectomy, ablation, it is possible to live quite qualitatively, but the ability to procreate is lost.

The prognosis is least favorable for life in endometrial cancer and disseminated cancer process involving several organs.

Literature

• Ailamazyan, E. K. Obstetrics. National guide. Brief edition / edited by E. K. Ailamazyan, V. N. Serov, V. E. Radzinsky, G. M. Savelieva. - Moscow : GEOTAR-Media, 2021. - 608 с.
• Savelieva, G. M. Gynecology : national guide / edited by G. M. Savelieva, G. T. Sukhikh, V. N. Serov, V. E. Radzinsky, I. B. Manukhin. - 2nd ed. Moscow : GEOTAR-Media, 2022.