Uterine bleeding with menopause

Uterine bleeding in menopause is a very serious problem, and before proceeding with its treatment, it is necessary to know the etiology of this process. The period of menopause is characterized by the development of various pathologies against the background of a disturbance in the regulation of the hormonal background and it is very important to identify all these disorders and start treatment on time. The key to successful treatment is timely diagnosis, which is possible only in the case of knowledge of certain symptoms and clinical manifestations of such bleeding.

Causes of the uterine bleeding with menopause

Speaking about the causes of menopause development it is necessary to understand the general hormonal changes in the body of a woman during this period. During the normal menstrual cycle, there is a fluctuation of the main female steroid hormones that change, and accordingly these changes occur throughout the body, including the uterus.

Climax is a physiological process of changes in the female reproductive system, in which hormonal disorders occur in the body and these changes affect many processes in the body of a woman - menstrual function, nervous system, gastrointestinal tract and bone system, as well as work of the cardiovascular system. Therefore, the most characteristic manifestations of hormonal imbalance is the disruption of the work of these organs. The normal menstrual function is disrupted, which can have various manifestations, including in the form of uterine bleeding. The process of developing menopause must have its own consecutive stages. The period of menopause is conditionally divided:

1. premenopause - the period from 45 years to the onset of menopause;
2. Menopause is the period of the last menstruation, the average age is about fifty years;
3. Postmenopause - the period from the last menstruation to the end of a woman's life.

All these periods are characterized by their own characteristics, which you need to know in order to regulate the state of the body and know exactly when something is broken. So during the period of premenopause, the first clinical symptoms of uterine bleeding can arise, so in such a case it is necessary to correctly correct such violations and find the cause.

Thus, the main etiological factor of the occurrence of uterine bleeding in menopause can be called the beginning of the climax itself, which, with insufficient regulation of the hormonal background, can cause menstruation in the form of uterine bleeding. This develops due to the fact that the hypothalamus involution occurs and the hypothalamus sensitivity to the influence of estrogens gradually decreases, which violates its regulatory function by the principle of reverse regulation. There is insufficient stimulation of the pituitary gland and the release of follicle-stimulating and luteinizing hormones is broken, which leads to anovulatory cycle without isolation of the oocyte. This reduces the level of pituitary hormones - follicle-stimulating and luteinizing, which disrupts their normal concentration and the first changes in menstruation can occur. In the ovaries, the most specific changes occur in the form of follicular atresia, the destruction of the membranes, the death of oocytes and the preservation of only the stroma, which helps to reduce the amount of secreting estrogen. This, in turn, disrupts the functional layer of the endometrium, which can cause its premature and momentary detachment with the development of uterine bleeding. This can be one of the reasons for this bleeding.

Another very common cause of bleeding from the uterus in menopause may be a uterine myoma, which, depending on the shape and location, can have serious complications in the form of bleeding. Myoma of the uterus or fibromioma is a benign uterine disease, which is accompanied by high proliferative activity of myometrium cells with the formation of a circumscribed structure in the uterine cavity. This disease is hormone-dependent, that is, the stimulus of such active reproduction is female sex hormones. Therefore, the main cause can be considered hormonal imbalance, which occurs with the onset of menopause, so the development of these diseases is more typical for the climacteric period. In pathogenesis, the main role in the development of uterine fibroids in menopause belongs to the violation of the level of hormones. During menopause, the level of estrogen decreases, their regulatory effect on the first phase of the menstrual cycle decreases, which is accompanied by a decrease in the proliferation of endometrial cells. This, in turn, entails a compensatory increase in the proliferation of myometrium cells, which is accompanied by hyperplasia of these cells with the development of different types of uterine fibroids.

There are other reasons for the development of fibroids in menopause - a group of non-hormonal causes. The basis of these all causes is the natural physiological involution of myometrium cells in menopause in a woman, which is accompanied by changes in metabolism in myocyte cells, their antigenic changes. In this case, normal growth and multiplication of a cell with an increased tendency to proliferation may occur, as well as specific cytokines and vascular growth factors that further stimulate abnormal differentiation of these cells. As a result, uncontrolled division of cells, their multiplication and an increase in the volume of myometrium occurs, which may be local or diffuse. In the case of development of submucous forms of uterine myoma, uterine bleeding develops very often, which requires immediate action. Therefore, if the etiological factor of bleeding from the uterus is myoma, then the tactics of treatment here are different.

Another cause of uterine bleeding may be an endometrioid cyst of the uterine cavity, which in case of its rupture can manifest itself with significant bleeding. Therefore, it is necessary not to exclude such a reason, which requires special tactics of examination and treatment to prevent infection.

That is why it is important to know about the main causes of development of uterine bleeding in menopause.

[1], [2], [3], [4], [5]

Symptoms of the uterine bleeding with menopause

Very often the symptoms of uterine bleeding in menopause develop against the background of certain changes, which are more often manifested by emotional and autonomic disorders. The woman is concerned about irritability, mood swings, depression, decreased sexual desire, insomnia, fatigue. Also, vegetative manifestations often can be attacks of sweating, heat, headache and palpitations.

If it is a matter of uterine bleeding, which is caused precisely by the peculiarities of menstruation, then such changes will be characteristic. Violation of the menstrual cycle with menopause has the character of irregular menstruation - one month is, but the next two are not present, and in the future they disappear altogether. There may also be copious monthly, and the next month their absence. At the same time, such a process takes about six months, no more, from changes in menstruation to their complete disappearance. Abundant hemorrhages with menopause, which often repeat require urgent intervention, because it affects the condition of a woman through the development of anemia and disruption of the general condition. At the same time there will be symptoms of dizziness, fainting, flickering of midges before your eyes. All these manifestations require immediate action.

If the cause of uterine bleeding with menopause is myoma, then often this disease has an asymptomatic course already before the onset of complications. If the uterine myoma begins in the premenopausal period, then the symptoms of the menstrual cycle can develop, which is associated with a violation of the structure of the endometrium due to the presence of nodes or with initial changes in the level of hormones. The first symptoms of uterine myoma in menopause may also be diverse - bleeding, pain in the lower abdomen or a feeling of heaviness in the pelvis, violation of sexual intercourse, decreased libido, malfunction of the bladder or rectum, secondary chronic iron-deficient anemia. These symptoms often appear even with significant amounts of fibroids due to the fact that the course is asymptomatic. There are some features of the uterine fibroids clinic in menopause depending on the location and form of education.

With the nodular form of uterine fibroids, clinical manifestations directly depend on the location of the node. With the formation of subserous nodules, the menstrual function is not impaired if it is preserved in the premenopause. Often there is a clinic of the acute abdomen, because such nodes are very labile in their position and can be displaced, forming a torsion or necrosis of the knee's leg. Sometimes the pains are not sharp, but stupid, aching, permanent, if the knot irritates the peritoneum or nerve endings, then there may also be a heaviness in the abdomen. If the subserous myomatous node is of considerable size, then it can cause compression syndrome of neighboring organs with difficulty of defecation with compression of the rectum, with difficulty of urination or reactivity of the bladder, and compression can disrupt the outflow of venous blood and lymph with stagnation in the small pelvis and development hemorrhoids. It is not uncommon for a subserous arrangement of the fibromatous node in uterine myomas when the climax is observed local neurological symptoms due to the compression of the nervous structures with the development of disorders like paresthesia or osteochondrosis of the lumbar spine. Then it is very important to correctly diagnose pathology, and not treat these neurological disorders.

With a submucous site, the clinic is less pronounced in terms of compression symptoms, but local manifestations are more pronounced. Metrorhagia may be observed, even if the menstrual period is not complete with the menopause, then such excretions can occur when the uterus is myomoid with menopause. These discharges are painful, accompanied by aching pain in the lower abdomen. Allocations of uterine myomas during menopause can also be in case of infection of the node, then infectious inflammation develops with yellow-green discharge with an unpleasant odor, which is also accompanied by symptoms of intoxication. But at some point there may be a development of severe bleeding from the node, which may be the first episode and the only symptom of this pathology.

If the cause of bleeding is the endometrioid cyst, then it is characterized by minor smearing secretions before and after menstruation, which can be a diagnostic sign of the disease. When the cyst is completely ruptured, there is severe uterine bleeding, which is accompanied by significant pain in the abdomen of a spasmodic nature.

Therefore, in case of any changes in the health of women, it is necessary to pay attention to this and carry out a comprehensive examination with the purpose of early diagnosis and prevention of such a complication.

Complications and consequences

The main complications that can occur in the case of uterine bleeding are the development of acute posthemorrhagic anemia or hemorrhagic shock, if bleeding is very severe. Other complications that may occur are ascending infection with the development of secondary complications in the form of a purulent myometrium or suppuration of the myomatous node. There may be consequences if untimely diagnosis of fibroids. Then there are severe pains in the abdomen and spotting, which is associated with the rejection of the fibromatous node and its exit into the uterine cavity. This complication is very dangerous and requires prompt intervention with further complex therapy. Therefore, in case the uterine myoma has symptoms of uterine bleeding, this is an indication for conducting operative treatment to prevent such complications.

[6], [7], [8], [9], [10], [11], [12]

Diagnostics of the uterine bleeding with menopause

Timely diagnosis of uterine bleeding and proper differential diagnosis of its cause are very important not only for treating this pathology, but also for preventing episodes of repeated bleeding and preventing complications. Therefore, first of all, it is necessary to find out anamnestic data. It is necessary to carefully collect an anamnesis with details of complaints and an accurate definition of the obstetrical anamnesis. You should find out when the climacteric began, the characteristics of the menstrual cycle, the presence of an active sexual life. It is also necessary to find out whether bleeding is associated with profuse menstruation as a manifestation of menopause. If the cause of development of uterine bleeding is myoma, as a rule, a woman already knows about her presence, rarely happens when bleeding first indicates a disease. Then proceed to the examination. It is necessary to examine the woman on the armchair that allows to reveal the violations in the form of dryness of the mucous vagina, concomitant pathological discharge, the volume of uterine bleeding, which suggests a probable diagnosis. If we are talking about uterine myoma, then in a bimanual examination of a woman, a tumor-like formation of various sizes and localization is determined, it is painless, mobile - in case of nodal uterine myoma. If the myoma is diffuse, then the entire uterus increases, which corresponds to a certain period of pregnancy, the uterus is dense, inactive and painless. In this case, you can also palpate the submucous node, which caused bleeding. Analyzes that are necessary to clarify the diagnosis are general clinical and special. General - a blood test, a biochemical blood test with a lipidogram and indicators of kidney function, urine analysis. In a general blood test for prolonged uterine bleeding, chronic posthemorrhagic anemia can be determined, which allows one to judge the duration of the disease. As for special tests, it is necessary to determine the level of the main female hormones in the blood. This is necessary not only for the further treatment of menopause, but also for analyzing the level of hormonal changes and the duration of pathology.

Instrumental diagnosis of uterine bleeding in menopause is aimed at revealing etiology and excluding other organic pathologies. Conduct mandatory and special research methods. The ultrasound of the pelvic organs allows to reveal organic changes in the small pelvis, as well as to find out the status of the ovaries for the prediction of the pathology, if the uterine bleeding is an abundant menstruation, as a manifestation of menopause. If suspected of myoma, the ultrasound will give an opportunity to establish its size and localization, which is necessary for predicting the disease and choosing the tactics of treatment. This method allows one to see anehogenous formation in the case of a myomatous node with an accurate determination of the location of this formation, its size, structure, and the degree of uterine enlargement in the case of a diffuse form of fibroids.

Hysterography is one of the methods of special diagnostics, which is performed by filling the uterus with a contrast fluid in a volume of 5-7 milliliters with further registration of the changes. In this case, there may be a filling defect, which corresponds to the location of the site, as well as a decrease in the uterine cavity. Another examination - hysteroscopy. This is a special method for examining the uterine cavity with a special device with a video camera at the end that allows you to see the uterine cavity, and also to conduct a biopsy with further examination of the punctate for accurate verification of the diagnosis.

[13], [14], [15], [16], [17], [18], [19], [20], [21]

Differential diagnosis

Differential diagnosis of acute bleeding from the uterine cavity with menopause should be conducted primarily with complication of submucous uterine myoma in the form of metrorrhagia. In this case, anamnesis and objective examination are important. It is very important, taking into account the elderly woman's age, during the menopause to carry out differential diagnosis of uterine bleeding with endometrial cancer, since oncological alertness should always be present. The cancer of the endometrium is characterized by the appearance of bloody discharge a few years after the onset of menopause. But for hemorrhage in the case of uterine fibroids, periodic bleeding is characteristic, and the site is clearly defined during the examination. In case of doubt in the nature of education in the uterus, a diagnostic scraping of the uterine cavity is performed with a histological examination of this material, which allows to establish accurately the benign or malignant nature of the formation.

Also, differential diagnosis should be carried out with the cyst of the uterus, which burst, especially if it is an endometrioid cyst. With ultrasound, the cyst has an anechoic structure, an oval shape, distinct edges with a thin capsule and a uniform content. The myomatous node is also anechoic, but it is non-uniform and in density corresponds to myometrium, often has a pedicle and is well circulated, in contrast to the cyst, which is avascular.

Uterine hemorrhage with menopause also needs to be differentiated with internal endometriosis, which can also be accompanied by copious bleeding from the uterus. But with endometriosis there is a characteristic anamnesis in the form of bleeding that corresponds to menstruation. It is possible to accurately verify these two diagnoses using histology, as well as accurate ultrasound diagnosis.

Given the climax period, that is, not the young age of the woman, it is necessary to carefully diagnose uterine bleeding and differential diagnosis, since different malignant processes at this age are possible, which must be diagnosed as early as possible with the start of appropriate treatment. It is very important to provide timely assistance, because this is life-threatening condition.

[22], [23], [24], [25], [26]

Treatment of the uterine bleeding with menopause

The tactics of treating acute bleeding from the uterus in menopause should be immediate and have a haemostatic character, as well as a preventive nature to prevent repeated bleeding and the development of more serious symptoms. There are medicamentous and non-medicamentous methods of treatment. Medical methods of treatment are mainly directed to the use of hemostatic drugs, as well as to substitution therapy for a lack of hormones in menopause or uterine myoma. Non-drug treatment is aimed at correcting hormonal imbalance on the one hand and on the preventive effect on the other hand. You can also use herbs and infusions, which contribute to the recovery of the body after bleeding. Therefore, the use of alternative drugs is a priority only in complex treatment during the period of remission.

The means of stopping such bleeding must be precisely known in order to determine tactics. This issue should be a priority in case of acute uterine bleeding and for this use hemostatic drugs.

1. Traneksam is one of the most widely used haemostatic devices in gynecology. This drug affects the external mechanism of coagulation by inhibiting the formation of plasmin from plasminogen. Due to this effect, its antifibrinolytic property is revealed. The drug is produced in pharmacological form of tablets and solution in ampoules for injections. In acute uterine bleeding tranexamic acid is used intravenously drip. Dosage in this case is about ten to fifteen milligrams per kilogram of body weight with intravenous drip administration at a rate of about one drop per minute. Indications for the use of the drug are acute bleeding, mainly in the postoperative period or those that are accompanied by an increased amount of fibrinolysin. Also, the drug has an anti-inflammatory and anti-allergic property, which relieves symptomatic symptoms in uterine myomas or endometrioid cysts. Contraindications to the use of Tranexam - is hypersensitivity to the containing elements of the drug, as well as the pathology of blood vessels in the form of thrombosis in a history, stroke or heart attack. Side effects possible in the form of allergic manifestations, as well as changes in the digestive system - a violation of appetite, heartburn, abdominal pain, nausea. Possible manifestations of the vascular system in the form of hypotension with rapid administration of the drug, as well as increased heart rate, increased thrombotic activity with the threat of thrombosis or thromboembolism.
2. Dicinone is an additional tool for the treatment of acute uterine bleeding in menopause, since the drug has an effect mainly on the vascular-platelet unit of hemostasis. The drug increases the permeability of the vascular cell, and also increases the rate of formation of thromboplastin, which increases the reaction to the formation of the primary thrombus during bleeding. The drug starts to act a few minutes after the administration, and the duration of the action is about five hours. The drug is available in pharmacological form of tablets and solution for intravenous injection. In the case of acute uterine bleeding, the drug is administered at a dose of 500 milligrams intramuscularly. Contraindications to the use of the drug - is hypersensitivity to the components of the drug, as well as the pathology of blood vessels in the form of thromboses in the anamnesis, stroke or heart attack, overdose of drugs from the group of anticoagulants. Side effects possible in the form of allergic manifestations, as well as changes from the gastrointestinal tract - nausea, heartburn, abdominal pain, decreased appetite. Possible manifestations of the nervous system in the form of dizziness, drowsiness, sleep disturbance, headache.

Hormonal therapy with concomitant uterine myoma, if it is an etiological factor of bleeding, is mandatory, and also as a correction of hormonal imbalance in menopause. In this case, hormone replacement therapy is used.

Hormonal therapy for uterine fibroids may include several groups of drugs:

1. Gonadotropin-releasing agonists whose representative is Diferelin or Tryptorelin - the drug is used from 3 days of the menstrual cycle for six months to 3.75 milligrams.

• Goserelin - applied for six months to 3.6 milligrams subcutaneously
• Buserelin - 200 micrograms per nose twice a day with a course of six months
• Zoladex - from the 1st to the 5th day of the cycle injectively.

1. The antagonists of gonadotropic hormones, of which the drug Danazol is a drug, is used 400-800 milligrams per day, also with a six-month course of treatment.
2. Preparations progesterene series - a variety of drugs that are able to regulate ovario-menstrual cycle in the failure of its second luteal phase. The main representatives of this series are:

• Norethysterone acetate - applied from the fifth day of the menstrual cycle to 5-10 milligrams twice a day for six months.
• Medroxyprogesterone acetate is used in the same dose and the same course.
• The Mirena system is an intrauterine device that is placed for five years with a status check.
• Norkolut and Primoluth are drugs that are used from the 16th to the 25th day of the menstrual cycle for three to six months.

You can also use combined oral hormone drugs biphasic with a large amount of progesterone.

1. Triziston is a complex hormone replacement. This drug is produced in a pharmacological form of a three-color dragee, which are applied on a special schedule for three weeks, then break for a week. The course of treatment is not less than three to six months. Contraindications for the prescription of the drug are malignant formations of any localization, pathology of blood vessels in the form of thromboses in the anamnesis, hepatitises. It should be used with caution in diabetes, because the drug can change glucose tolerance, as well as with hypertension. Side effects can appear in the form of cholestasis, impaired liver function, embolism, as well as allergic and dyspeptic reactions.
2. Logest is a preparation containing estradiol and gestagen in its composition, it is a highly dosed drug, due to which its prophylactic role is manifested not only in the correction of the hormonal background, but also in the prevention of oncological diseases of the female reproductive system. The drug helps to equalize the hormonal inconsistency and due to this disturbance in menopause have a less pronounced character, especially as regards abundant bloody discharge. Logest is available in pharmacological form capsules, contained in 21 pieces per package. The reception must start from the first day of the cycle. You can begin to receive and the fifth day of the menstrual cycle in the case of menopause in women. The course of admission is one capsule per day for three weeks, then a break of seven days, then you need to resume reception. Adverse events are possible on the part of the digestive tract in the form of a stool, nausea, a feeling of bitterness in the mouth, vomiting. There may also be asthenovegetative reactions, manifestations of hormonal treatment from the side of the chest in the form of sensation of severity, soreness, discharge, and also an increase in the secretion of the vaginal secretion. Contraindication to the use of the drug for treatment - a problem with blood coagulability and a history of heart attack or a stroke, malignant neoplasms, severe liver damage, pancreatic damage and diabetes.

Operative treatment of acute bleeding from the uterine cavity with menopause is carried out if the cause of bleeding is the myomatous node. In this case, after simple preoperative preparation, surgical treatment is performed. Be sure to stop bleeding, confirm the presence of the node and only after that perform surgical treatment. Operative treatment can be carried out in the amount of organ-preserving intervention and radical intervention. Tactics depends on the type of myoma, its size, location, as well as the duration of the operation. Organ-saving operations are myomectomy - removal of the myomatous node within healthy tissues - and embolization of uterine arteries, which disrupts the blood supply of the node and it regresses.

Radical operations are supravaginal amputation of the uterus, subtotal hysterectomy and uterine extirpation, which also depends on the size and location of the fibroids and the age of the woman, as well as the possibility of a quick stop of uterine bleeding.

Alternative treatment of uterine bleeding with menopause

Alternative treatment of uterine bleeding, in view of its risk of complications, is performed during remission. The methods of alternative treatment that are used are aimed at the correction of hormonal homeostasis and the main ones are:

1. Honey has the properties to enhance local immunity and stimulate regeneration. To create a medicine from honey, it is necessary to take the core of the bulb and place it in a glass with honey so that it is completely filled with it. This solution must be insisted overnight and moistened with a tampon in the solution in the morning and inserted into the vagina at night, which should be repeated for 10 days, after which the myoma, if it caused bleeding, should decrease.
2. Honey, as a natural source of nutrients and trace elements, which increase local immunity and stimulate regeneration, is widely used to treat the pathology of female genital organs, including in menopause. To create a medicine from honey, you need to make a solution of three tablespoons of honey, five drops of flaxseed oil and three tablespoons of boiled water and take a teaspoon twice a day, the course - 10 days. Such a tool helps normalize the hormonal background, which is also aimed at preventing violations from local immunity.
3. The leaves of aloe, which has a pronounced anti-inflammatory and regenerating effect, are squeezed into a glass and dipped in a tampon, inserted into the vagina, repeating the procedure once a day for a whole month.
4. Juice burdock perfectly removes irritation, swelling and has an antiproliferative effect, which increases the ability of the endometrioid cyst to resolve. To do this, from the burdock leaves pre-washed, it is necessary to squeeze out the juice and take five days for one teaspoon three times a day, and then one teaspoon twice a day for five more days.
5. Leaves of barberry, valerian, lime, coriander, motherwort and oregano must be filled with a liter of hot water and after being infused, drink in the morning and in the evening 2 teaspoons. Such a solution calms the nervous system and reduces bloody discharge by stabilizing the hemostasis system. This prevents the disturbance of the nervous system during climax, which removes the symptoms of vegetative and emotional manifestations and prevents violations of vascular tone.

Homeopathic remedies can not only correct the hormonal imbalance, but also they can be taken with the purpose of restoring the body after bleeding.

1. Climacchel is a homeopathic remedy that has a composition similar to phytoestrogen drugs and promotes the normalization of the hormonal background in menopause. The drug also reduces proliferative processes at the cell level. Apply Climacchel in tablets one tablet before meals or an hour after it three times a day. The duration of treatment with the drug is about two months. There were no side effects. Contraindications to the admission of Climackthel is an increased sensitivity to the components of Climacchel.
2. Dysmenorm is a homeopathic remedy that regulates the hormonal background and affects benign uterine formations in the form of a cyst or myoma. Dysmenorm is used for treatment in tablets at a dose of one tablet three times a day one hour after a meal.
3. Remens is a preparation of the homeopathic series that promotes regulation of hormonal imbalance in menopause due to influence on the hypothalamic-pituitary zone, and also has protective properties on the endometrium. This prevents the development of repeated bleeding and restores the functional layer of the uterus. The drug is available in the form of a solution and tablets. The medicine is applied on the first and second day in an increased dose - one tablet or ten drops eight times a day, and then for three months at the same dose, but only three times a day. There were no side effects. Contraindications to the admission of Remens - is hypersensitivity to the individual contents of the drug.
4. Ginekohel - a combined homeopathic remedy, which has an effect on the disturbances in menopause by normalizing the synthesis of estrogen and progesterone, which helps reduce the effect of deficiency of these hormones. The drug is released in drops and dosed ten drops three times a day, can be dissolved in water or take a clean solution. Side effects are not common, but there may be stool disorders, dyspepsia and allergic reactions. No contraindications found.

Thus, the main thing in the treatment of uterine bleeding in menopause is immediate stopping it, and only then do additional research methods, clarify the diagnosis and decide the tactics of further treatment - operative or conservative. Such a wide range of medicines not only medicinal, but also alternative drugs, as well as homeopathic medicines, allows you to choose the necessary treatment and successfully correct the changes in the hormonal background in menopause with the prevention of further disorders, but these methods are possible in the remission period.

[27], [28], [29], [30], [31], [32]

Prevention

Specific prophylaxis can be carried out in the case of the first symptoms of menopause, then you can begin preventive reception of homeopathic remedies for the purpose of regulating the hormonal background, which can prevent serious menstruation disorders in the form of abundant uterine bleeding. Nonspecific preventive measures consist of regular examinations at the gynecologist, examination in the case of the first symptoms of menopause. This can reveal the fibroids or uterine cysts in the early stages, which makes it possible to use early treatment of the pathology and to prevent complications such as uterine bleeding.

[33], [34], [35]

Forecast

The prognosis of uterine bleeding with climax for recovery is relatively favorable in case of timely treatment and proper treatment, since this condition has a direct threat to life. The prognosis for life is favorable, since bleeding with proper treatment can be stopped and other complications prevented.

Uterine bleeding in menopause is a very serious symptom that can develop as a manifestation of climax itself, and may also be a symptom of uterine myoma or endometrioid cyst. Therefore, it is important to conduct differential diagnosis and, after stopping bleeding, resolve the issue with the treatment of pathology. But the best option in this case is to prevent such bleeding by timely research and monitoring your health.

[36], [37], [38], [39], [40], [41], [42]