Pelvic inflammatory disease (PID) – Better Health Channel

Pelvic inflammatory disease (PID) occurs when an infection spreads from the vagina to the cervix, the endometrium (lining of the uterus) and the fallopian tubes. The infection is usually sexually transmitted. It can also occur after a ruptured (burst) appendix or a bowel infection.

Some surgical procedures, such as abortion, curette or insertion of an intrauterine device (IUD), can lead to PID. The infection usually occurs in three stages – the cervix is infected first, followed by the endometrium and then the fallopian tubes.

PID is often called the ‘silent epidemic’ because it is common among sexually active women, but does not always cause symptoms. About 10,000 women in Australia are treated for PID in hospital each year and many more are treated as outpatients. Women aged 20 to 29 have the highest reported incidence of PID.

Symptoms of PID

Signs and symptoms of PID include:

• lower abdominal pain or tenderness
• menstrual disturbances
• a change in smell, colour or amount of vaginal discharge
• deep pain during sexual intercourse
• fever.

PID and female infertility

Scarring and blockage of the fallopian tubes is the most frequent long-term complication of PID. Infertility occurs because the fertilised egg cannot pass through the tube to the uterus.

Fertility risks that arise because of PID include:

• One episode of PID doubles the risk of tubal infertility.
• With three or more episodes of PID, the risk of fallopian tube blockage rises to 75 per cent.
• One episode of PID increases the risk of ectopic pregnancy (where the fetus develops outside the uterus) sevenfold.

Causes of PID

The most common causes of PID are the sexually transmissible bacterial infections, chlamydia and gonorrhoea. Chlamydia is responsible for 50 per cent of sexually acquired PID cases, while gonorrhoea is the cause in 25 per cent of cases. Mycoplasma genitalium has recently been recognised as another sexually transmissible infection associated with PID.

The risk of fallopian tube blockage is slightly higher for PID caused by gonorrhoea.

Diagnosis of PID

Your doctor will test for possible causes such as chlamydia and gonorrhoea. In some cases, a laparoscopy is required to correctly diagnose PID. Laparoscopy involves inserting an endoscope (which is like a surgical video camera) into the abdomen to view the reproductive organs.

Treatment of PID

Chronic pain and, sometimes, severe disability can occur if PID is not treated. This is usually due to extensive scarring. Early treatment of PID may minimise the risk of complications.

Treatment usually involves:

• taking a combination of antibiotics that are active against a broad range of organisms, usually taken for two weeks
• testing male partners and treating them – symptoms may be mild or non-existent in men, however, for STI-related PID, all partners should be treated, regardless of test results
• avoiding genital sexual contact until the treatment is complete and a negative test result is obtained.

Women with severe episodes of PID must be hospitalised for treatment.

Protecting yourself from PID

To help prevent the transmission of the bacteria that can cause PID:

• use condoms during vaginal or anal intercourse with any new partner
• have regular STI check-ups if you change your sexual partner.

The oral contraceptive pill and PID

Data collected in the 1970s indicated that sexually active women who were taking an oral contraceptive pill appeared to have only one third the risk of PID, compared to women not ‘on the pill’.

It is not known if the lower-dose contraceptive pills more commonly used now have the same protective effect, although it is likely that they do. Women taking the oral contraceptive pill still need to use condoms with any new partner to protect themselves from infection.

Where to get help

• Your doctor
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
• Women’s Health Information Centre, The Royal Women’s Hospital, Melbourne
  Tel. (03) 8345 3045, Regional or rural callers Tel. 1800 442 007
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

Things to remember

• PID is known as the silent epidemic because it is common and often does not cause symptoms.
• The sexually transmitted diseases chlamydia and gonorrhoea are the most common cause of PID.
• Use of condoms with any new partner and regular testing for sexually transmissible infections can help prevent PID.
• PID can lead to scarring of the fallopian tubes and infertility if left untreated, or with repeated episodes.

Chlamydia – Better Health Channel

Chlamydia is caused by the bacterium Chlamydia trachomatis and is a very common sexually transmissible infection (STI).

It is often called the ‘silent infection’ because most people do not realise they have it.

It can affect women and men of all ages, but most frequently occurs in young people (under 25) who regularly change sexual partners.

Chlamydia is spread by having unprotected sex of any kind with an infected person.

Who is at risk of chlamydia?

Anyone who is sexually active is at risk of chlamydia. You are at increased risk of infection if you:

• Are young (under 25).
• Often have different or multiple sexual partners.
• Have any type of unprotected sex (without condoms) with someone who is infected with chlamydia.

What are the symptoms of chlamydia in women?

Most women with chlamydia, have no signs or symptoms.

It can infect the cervix and spread to the uterus and fallopian tubes, causing:

If a pregnant woman has chlamydia, it can pass on to her baby during childbirth – causing lung or eye infections.

In women (if symptoms are present),  may include:

What are the symptoms of chlamydia in men?

Men who have chlamydia usually do not have any signs or symptoms.

In men, chlamydia infects the urethra and may spread to the epididymis – the tube that carries sperm from the testicles.

In men (if symptoms are present), may include:

• discharge from the penis
• discomfort when urinating
• sore, swollen testes.

How often should I get checked for chlamydia?

Sexual health check-ups are recommended for anyone who is sexually active.  Frequency of testing also depends on your STI risk:

• An annual sexual health check-up (which includes chlamydia testing) is highly recommended if you are sexually active – especially if you are under 25.
• Get checked more often during the year if you frequently change sexual partners.
• Remember, you are at greater risk if you have sex without a condom with 1 or  multiple sexual partners.

How does chlamydia spread?

Chlamydia is spread when a person has unprotected sex (sex without a male or female condom or dental dam) with an infected person.

Because chlamydial infection often has no symptoms, many people do not realise they have the infection.

Even if you know a person well, you may not be able to tell they have an STI, because people can look healthy and still have chlamydia.

Remember, you can get chlamydia and other STIs from a new sexual partner who has in the past had sex with someone who is infected.

It can also be spread from a long-term partner who has had sex with other people.

How is  chlamydia diagnosed?

Chlamydia is an easily diagnosed and curable STI.

Tests are painless and usually involve either:

• a simple urine test
• swab from the vagina, cervix, anus or penis.

The specimen is then sent to a laboratory for testing.

Getting your chlamydia test results

Test results are normally available within a week.

How is chlamydia treated?

If detected early, chlamydia can be treated with a single dose of antibiotic.

If complications from chlamydia infection are present – such as pelvic inflammatory disease (PID) in women – a longer course of antibiotics will be required.

Do not have sex for 7 days after you and your current partner have completed treatment. This includes all kinds of sex (vaginal, anal and oral) with or without a condom.

You can get reinfected with chlamydia if you have sex within the 7 days.

After you have completed treatment, have another test for chlamydia in 3 months’ time to make sure you have not been re-infected.

Can you get reinfected with chlamydia?

Chlamydia reinfection is common. Having chlamydia once does not stop you from getting it again.

Even after you’ve been successfully treated, you can still be reinfected if you have  unprotected sex with someone who has the infection.

Letting partners know you have chlamydia

Sexual partners may be infected too. If you have chlamydia, anyone you have had sex with  from the last 6 months needs  to be informed, tested and treated.

If they don’t know, they could reinfect you or infect someone else if they are not treated. don’t receive treatment.

Most people will appreciate being told they may have an infection and it is an important step in preventing further infection in the community.

Your local GP and sexual health centre can help you inform your partners and let them know that they need a test. This process is called ‘partner notification’. It can be done anonymously, and your confidentiality is always respected.

You can also anonymously notify your sexual partners of the need to get tested and treated for chlamydia via the Let Them Know website if you feel unable to speak to them personally.

There are also nurses (called partner notification officers) who can help you anonymously notify your partners. They can be contacted on (03) 9096 3367.

How to help partners get treatment

If you are not sure whether your sexual partner(s) will seek treatment,  ask your doctor for extra chlamydia medication (or a prescription). You can give it to them  so they can be treated as soon as possible.

This is known as patient delivered partner therapy (PDPT) for chlamydia. Talk to your doctor to see if PDPT is right for you and your sexual partner(s).

Reducing chlamydia transmission

Safer sex practices reduce the risk of STI transmission. Ways to reduce your risk of catching chlamydia include:

• Practise safe sex – use condoms and water-based lubricant (lube) for all types of sex. Female, (or internal) condoms can also be used for vaginal or anal sex.
• If you are sexually active, get a full sexual health check (including tests for syphilis, HIV, gonorrhoea and chlamydia) at least once a year. Get checked more often if you frequently change sexual partners.
• After you have completed chlamydia treatment, get tested in 3 months’ time to check you have not been re-infected.

Where to get help

Von Willebrand disease – Better Health Channel

Von Willebrand disease (VWD) is an inherited bleeding disorder. People with VWD have a problem with a protein in their blood called von Willebrand factor (VWF) that helps control bleeding. They do not have enough of the protein or it does not work the way it should. For people with VWD it takes longer for blood to clot and for bleeding to stop.

VWD is the most common inherited bleeding disorder worldwide. It affects both males and females from all racial backgrounds. 

It is thought that up to 1 in 100 people have VWD, but most people have few symptoms. Many people with VWD may not know they have the disorder because their bleeding symptoms are very mild. 

Most people with VWD are born with the disorder. Sometimes it is detected in childhood, but other people don’t find out they have VWD until they have a bleeding problem as an adult, such as heavy bleeding after a serious accident or a dental or surgical procedure. Some people don’t discover they have VWD until a relative is diagnosed and it is suggested that they are tested as well. 

The severity of VWD someone experiences depends on the type of VWD and the level of von Willebrand factor in their blood. Usually VWD is less severe than other bleeding disorders, such as haemophilia. 

With all forms of VWD there can be bleeding problems. Some people with VWD bleed quite often, for example with nosebleeds, bruising and heavy periods. A small number of people have a severe form of VWD and may experience joint and muscle bleeds, similar to haemophilia. 

VWD is a lifelong condition and there is no cure. There are safe, effective treatments for all types of VWD.

What are the symptoms of VWD?

Most people with VWD have few or no symptoms. The symptoms of VWD vary greatly from person to person. Even members of the same family may have different symptoms. 

The more common symptoms are: 

• having nose bleeds often or that are difficult to stop 
• easy bruising 
• very heavy or long menstrual periods 
• bleeding for a long time with minor cuts 
• bleeding from the gums 
• bleeding after injury, surgery or dental work that continues for a long time.

Bleeding in people with VWD usually involves the mucous membranes – the delicate tissues that line body passages such as the nose, mouth, uterus, vagina, stomach and intestines. 

Less common symptoms that older people might experience are: 

• blood in faeces (poo) from bleeding in the intestines or stomach 
• blood in urine from bleeding in the kidneys or bladder. 

People with severe forms of VWD, particularly type 3 VWD, may also have other bleeding problems similar to haemophilia, such as: 

• bleeding episodes that are spontaneous or happen for no obvious reason 
• bleeding into joints and muscles which can cause swelling and pain. 

The types of symptoms a person with VWD experiences can change over their lifetime. For example, they may have nosebleeds and easy bruising as a child and find this occurs less often as they grow older. However, their type of VWD will not change.

Women are more likely to show symptoms of VWD than men. Without treatment, women with VWD often bleed more or for longer than normal with menstruation (their period). 

Some women with VWD also have heavy bleeding a few days or weeks after giving birth and some have a lot of period pain or irregular periods. However, these symptoms are not always related to VWD and may have other causes. An assessment by a gynaecologist is an important part of understanding and treating these symptoms effectively.

What are the types of VWD?

There are three main types of VWD (bleeding symptoms can vary from person to person within each type):

• Type 1 VWD is the most common form. Around 80 per cent of all people with VWD have this form. In type 1 VWD, the von Willebrand Factor (VWF) works normally, but there is not enough of it. Symptoms are usually mild, depending on the level of VWF in the blood. 
• In type 2 VWD, the amount of VWF in people’s blood is often normal but the VWF doesn’t work properly. Type 2 VWD is divided into subtypes 2A, 2B, 2M and 2N. Certain subtypes may be treated differently, which makes knowing the exact type of VWD you have very important. 
• Type 3 VWD is very rare. People with type 3 VWD have very little or no VWF in their blood. Symptoms are more severe and can also include joint and muscle bleeding. Bleeding can occur more often.

How do you get VWD?

Von Willebrand disorder (VWD) is usually inherited, although it can also occur spontaneously (where there is no family history). 

Inheritance of VWD

Changes in the VWF gene can disrupt the formation of blood clots and can cause VWD. 

You inherit two copies of the VWF gene, one from your mother and one from your father. Most cases of type 1 and type 2 VWD are inherited in an ‘autosomal dominant pattern’, which means one copy of the changed gene is enough to cause the disease. 

Type 3, some cases of type 2 and a small number of type 1 cases are inherited in an ‘autosomal recessive pattern’, which means that if someone has this type of VWD, both of their copies of the VWF gene will have changes. In these cases, each parent carries one copy of the gene variation (gene change) but they don’t have symptoms themselves. 

VWD affects males and females in equal numbers – both sons and daughters can inherit it. Their symptoms can be different to their parent’s or to each other. 

If one member of a family is diagnosed with VWD, the doctor may recommend testing other members to see whether they have VWD as well. 

Where there is no family history of VWD 

Sometimes there is no family history of VWD and the genetic change may arise randomly during pregnancy Although their parents and their brothers and sisters do not have the VWD gene, the child will be able to pass the VWD gene on to their own children in the future.

Some people develop a form of VWD later in life due to other medical problems that affect their von Willebrand factor. This is called Acquired von Willebrand Syndrome (AVWS) and is very rare.

How is VWD diagnosed?

Many people’s VWD symptoms are mild and they may not be diagnosed until they have a major bleeding problem, for example from surgery or an injury. However, if they have a severe form of VWD, they will usually have major bleeding problems as a baby or small child and will often be diagnosed within their first year of life.

Diagnosing VWD involves: 

• a personal history of bleeding or bruising more than normal from mucous membranes or skin after injury, trauma or surgery, and 
• a family history of bleeding more than normal, and 
• specialised laboratory blood tests for VWD, and
• genetic testing that identifies a change in the VWF gene that causes VWD.

Routine blood tests often give normal results, which is why the person’s history of bleeding is so important. Testing is often repeated because a person’s VWF and factor VIII levels can vary at different times.

Things that can cause the level of VWF to rise in the blood and appear to be normal are:

• stress 
• exercise 
• pregnancy 
• normal hormonal changes during a woman’s monthly menstrual cycle
• hormone treatment
• inflammation with other health conditions
• inflammation in combination with blood type.  

If you think you have a bleeding problem, it is important to see a haematologist who specialises in bleeding disorders. In Australia, these haematologists can be found at haemophilia treatment services which are at some major hospitals. Talk to your general practitioner or your gynaecologist about a referral.

Other family members may also need to be tested for VWD.

How is VWD treated?

Specialist haemophilia treatment services have a team of health professionals with expertise in providing treatment and care to people with bleeding disorders including VWD. They can work with you to make a treatment plan and advise on ways to live well with VWD. 

The team includes: 

• haematologists: doctors who specialise in blood disorders 
• haemophilia nurses 
• social workers or counsellors 
• physiotherapists 
• other specialist health professionals.

The recommended treatment for VWD depends on the type of VWD you have and how severe it is. Usually people with mild VWD will only need treatment if they have surgery, dental work or an accident or injury. For some minor bleeding problems, like bruising, treatment may not be necessary.

There are several treatment options available:

• desmopressin – a synthetic hormone that releases the body’s stored VWF and factor VIII into the bloodstream to help blood clot. It can be given as a slow injection into a vein; as an injection into the fatty tissue under the skin; or as a nasal spray. Desmopressin is not suitable for everyone
• clotting factor concentrate made with von Willebrand factor (VWF) and factor VIII (FVIII) – this replaces the missing VWF and FVIII in the blood and helps blood to clot. It is made from the plasma (pale yellow fluid part) in human blood and is produced from blood donations. It is used when desmopressin is not suitable, or when it is likely the person will need treatment for more than two to three days. It is injected into a vein in the arm.
• tranexamic acid and aminocaproic acid are medicines that stop blood clots being dissolved once they have formed. They can be used to stop bleeding in the mouth or nosebleeds, gut bleeding, bleeding after dental work, minor surgery or an injury. Most commonly they are taken as tablets, syrup or as a mouthwash. They may be used by themselves or together with DDAVP or a clotting factor concentrate. 
• fibrin glue is a medical gel made from fibrinogen and thrombin, which are proteins in the body that help blood to clot. It can be applied directly onto a wound to stop bleeding
• hormone treatment, such as oral contraceptives (birth control pills), can help women who have heavy menstrual bleeding. The hormones can increase VWF and factor VIII levels.

The treatment you need may vary depending on your medical needs, what works best for you and the situation. Your haematologist will consider all of this when they work with you to decide the best treatment option.

Living well with VWD

Von Willebrand disorder may be part of life, but it doesn’t need to rule it. If you have VWD, you can still go to school, have adventures, play sports, raise a family, work, travel, and do the things that inspire you or enjoy the fun activities you love. 

Physical activity and VWD

Exercising regularly and being physically active is a great way to keep muscles and joints strong and stay in good health. Exercise can help to boost VWF levels and may even reduce the number of bleeding problems and episodes you experience. 

Being active with VWD can be a balance between taking on physical challenges and preventing injuries or dealing with accidents quickly. Know your limits and be prepared.

People with VWD generally have to find out for themselves what physical activities they can and can’t do. Many people with mild VWD take part in all kinds of sports, including active sports like soccer and moderate-risk sports like downhill skiing.  

People with type 3 or severe VWD might find that contact sports or sports with a high risk of injury, such as football or boxing, lead to serious bleeding and may prefer less injury-prone sports or to modify their activities.

It is important to give children the chance to discover what activities they can safely do. As they grow up, they will want to take part in the same sports as their friends. Naturally parents may want to protect their children from harm, but they can do this by making sure their children follow the current safety guidelines for all children in sport and being prepared for accidents. 

Travelling with VWD

If you are planning a trip overseas or interstate, contact your haemophilia treatment centre a few months before departure to plan ahead. They can:

• help with preparations tailored to your situation
• advise on documentation, medication and travel insurance – for example, documentation to carry medication and treatment equipment through security and customs may be required
• advise you on what to do if you need treatment while travelling.

In case you need them, find out the names, addresses, phone numbers and hours of operation of haemophilia treatment services along your route. Knowing where to go in the hospital may also be helpful.

Be sure to get travel insurance for overseas travel.

School and VWD

Having VWD shouldn’t affect a child’s ability to attend childcare, kinder or school. Most bleeding with Types 1 or 2 VWD is not serious enough to keep a child out of school. Occasionally, with type 3 or severe VWD, a serious bleed into a muscle or joint might mean that a child is absent from school for a short time – but with prompt treatment, this should only be for a day or two. 

Tips include:

• Provide information on VWD to childcare, kinder or school staff, including how to manage your child’s common bleeding problems, such as nosebleeds. 
• You may find it useful to organise an information session. Haemophilia treatment service staff are experienced in this and can assist.
• Let staff know that it is important that they contact you at any time if there is an emergency. 
• Provide the telephone number of your child’s haemophilia treatment service, and let them know when to use it.
• When you think your child is old enough, teach them how to manage their common bleeding problems too.

VWD issues for women and girls

Heavy bleeding with menstrual periods (menorrhagia) is a common symptom of VWD for women and girls. It may involve: 

• heavy menstrual periods (such as soaking through a tampon and pad around two hourly, or needing to change a pad during the night) 
• menstrual bleeding for longer than normal (for example, longer than eight days) 
• bleeding with clots bigger than a 50-cent piece in size. 

Heavy menstrual bleeding can lead to anaemia (low red blood cell count/low blood iron levels), with symptoms of fatigue, paleness, lack of energy and shortness of breath. 

Some women and girls with VWD also experience: 

• pain during their menstrual periods (dysmenorrhoea) 
• abdominal pain and sometimes bleeding during ovulation (when an egg is released from the ovaries, around the middle of the menstrual cycle).  

Although these can be symptoms of VWD, they can also be symptoms of a gynaecological disorder, so it is important to consult a gynaecologist.

If you are a woman or girl with VWD, a holistic or comprehensive care approach to your health care can help you to achieve better health and quality of life. Specialist gynaecological care over your lifetime, including during family planning, is important to manage any gynaecological issues that occur. These may not be related to VWD, but in some cases VWD may make the bleeding problems worse. 

Ideally your medical care team should work together on your health care and should include: 

• gynaecologist 
• haematologist specialising in bleeding disorders 
• GP 
• paediatrician (when relevant)
• obstetrician (when relevant).

Pregnancy and testing 

Most women with VWD do not have a problem with delivering a healthy baby. With the most common form of VWD (mild type 1), pregnancy will very often cause blood levels of VWF (von Willebrand factor) to increase into the normal range by the last three months of pregnancy, so that bleeding complications during pregnancy and childbirth are far less likely.  

Women with rarer or more severe forms of VWD are much more likely to need treatment to reduce the risk of bleeding problems during delivery. 

If you are planning to have a child, talk to your haemophilia treatment service and your obstetrician before you get pregnant, and to ask them to liaise with each other. You might also like to speak to a genetic counsellor. Prenatal diagnostic testing may be an option if the genetic variant in your family is known. Ask your haematologist if there needs to be any special care with having tests like amniocentesis. 

If you have VWD and are pregnant, let your medical care team know. You will need to be monitored and have blood tests for your VWF levels during your last three months of pregnancy to plan a safe delivery for you and your baby. This will also help in planning any treatments you might need to prevent possible heavy bleeding in the weeks after delivering your baby, when your factor levels return to their usual level.

Genetic counselling and VWD

If you, your child or another family member have been diagnosed with VWD, or if it runs in your family, it may be helpful to speak to a genetic counsellor.  

Genetic counsellors are health professionals qualified in both counselling and genetics. As well as providing emotional support, they can help you to understand VWD and what causes it, how it is inherited, and what a diagnosis means for your or your child’s health and development, and for your family. Genetic counsellors are trained to provide information and support that is sensitive to your family circumstances, culture and beliefs.

If VWD runs in your family, a genetic counsellor can explain what genetic testing options are available to you and other family members. You may choose to visit a genetic counsellor if you are planning a family – to find out your risk of passing the condition on to your child, or to arrange for prenatal tests.

Support for people and families with VWD

Haemophilia Foundation Victoria offers a variety of services and support for people and families living with VWD.

The Genetic Support Network of Victoria (GSNV) is connected with a wide range of support groups throughout Victoria and Australia and can also connect you with other individuals and families affected by VWD.

Where to get help

Leukaemia – Better Health Channel

Leukaemia is a cancer of the blood-forming cells, which are made in the bone marrow. Leukaemia causes large numbers of white blood cells to be produced. This can crowd the bone marrow and may affect the production of normal cells. A person with leukaemia is more likely to pick up infections and have trouble getting rid of them. About 790 Victorians develop leukaemia every year.

There are four main types of leukaemia. In many cases, leukaemia can be cured or kept under control for many years. Chemotherapy is the main treatment.

Blood cells and leukaemia

Blood is mostly made up of plasma, which is a clear fluid. Floating in this fluid are three types of cells, which are:

• red blood cells – that carry oxygen around the body
• white blood cells – that fight disease and infection
• platelets – that help to stop bleeding when it starts.

Blood cells are made in the bone marrow, which is the spongy part in the centre of the bone.

When the body is healthy, the numbers of red cells, white cells and platelets in the blood are kept in balance. In people with leukaemia, the bone marrow makes too many abnormal white blood cells. These abnormal cells are unable to carry out their normal function and can crowd the bone marrow. This means there is not enough room in the bone marrow for making normal white blood cells, red blood cells and platelets.

White blood cells normally help to fight infection. In a person with leukaemia, a large number of these cells are abnormal. If a person has too many abnormal white blood cells, they are more likely to pick up and have trouble getting rid of infections.

Causes of leukaemia

The cause of most cases of leukaemia is unknown. There are several risk factors that may increase your chance of developing this disease.

The main ones are:

• exposure to intense levels of radiation – no cases of leukaemia have been linked to radiation from x-rays and CT scans
• exposure to the chemical benzene – happens in a work environment over long periods of time
• cigarette smoking – this can increase your risk of some types of leukaemia
• genetic factors – certain inherited conditions can increase your risk of developing some types of leukaemia
• family history, age and gender – these may all have an effect on your risk of developing certain types of leukaemia (for example, males are at a higher risk of developing leukaemia than females).

Research into further possible causes of leukaemia is ongoing.

Types of leukaemia

There are different types of leukaemia and the treatment for each is different. The condition may:

• develop suddenly (over days or weeks) – this is called acute leukaemia
• develop over months or years – this is called chronic leukaemia
• involve either the myeloid or lymphoid cells – the condition is named for the type of blood cell affected.

The four main types of leukaemia are:

• acute lymphocytic leukaemia (ALL)
• chronic lymphocytic leukaemia (CLL)
• acute myeloid leukaemia (AML)
• chronic myeloid leukaemia (CML).

Acute lymphocytic leukaemia (ALL)

ALL affects lymphocytes (a type of white blood cell, whose main function is to protect the body from infection) so they cannot work properly. This may cause a serious infection. It also causes many abnormal lymphocytes to be made, which crowd out the normal red blood cells and platelets. ALL is the most common type in children. It is rare in adults.

Chronic lymphocytic leukaemia (CLL)

CLL also affects the lymphocytes, but develops more slowly than ALL. Most people with CLL are not even aware that they have the disease and may only be diagnosed during an examination for another medical problem. CLL affects adults and does not occur in children.

Acute myeloid leukaemia (AML)

AML mainly affects the myeloid cells known as granulocytes. These cells search for infectious invaders in the blood and nearby tissue. In AML, too many young myeloid cells are produced and there are not enough mature myeloid cells. The young myeloid cells can block blood vessels. AML mainly affects adults, but can occur in children and adolescents.

Chronic myeloid leukaemia (CML)

Too many mature myeloid cells are present in CML and they do not function properly. CML is also different from the more common types of leukaemia because it has two stages. In the first stage, abnormal cells slowly multiply, and then in the second stage, it quickly changes and becomes exactly like AML.

This leukaemia can occur at any age, but is uncommon under the age of 20 years.

Symptoms of leukaemia

The symptoms of leukaemia may vary slightly depending on the type and stage of leukaemia you have.

Symptoms for acute leukaemia usually happen quite suddenly. They include:

• weakness, tiredness and looking ‘washed out’
• regular infections and high temperatures
• bleeding easily
• bleeding from the gums and nose
• low red blood cells (anaemia) causing breathlessness and tiredness (more common in later stages of CLL)
• bruising easily with no obvious cause
• pain in the bones and joints
• weight loss
• swollen lymph glands
• abdominal discomfort due to an enlarged spleen.

People with chronic leukaemia will also have many of these symptoms, but they tend to develop over months or years.

Most people who have any of these symptoms will not have leukaemia. They are more likely to be suffering from a much less serious problem, such as an infection. However, it is always important to see your doctor if you have symptoms that persist.

Diagnosis of leukaemia

Tests to help diagnose leukaemia may include:

• Blood tests – these check for large numbers of abnormal white blood cells.
• Bone marrow biopsy – a small amount of bone marrow is taken from the hip bone using a needle. The samples are then examined under a microscope. This test can help work out which type of leukaemia is present.
• Lymph node biopsy – a small amount of tissue is removed with a needle from a swollen lymph node and examined under a microscope. This is more commonly used for lymphoma than leukaemia.
• Lumbar puncture – fluid is removed with a needle from a space between the bones in the back. The fluid is looked at under a microscope.

If these tests show that you do have leukaemia, you may also need to have further blood and bone marrow tests, as well as some scans (CT, ultrasound or MRI).

Test results can take a few days to come back. It is very natural to feel anxious while waiting to get your results. It can help to talk to a close friend or relative about how you are feeling. You could also contact the Cancer Information and Support Service on 13 11 20 and speak with a cancer nurse.

Treatment of leukaemia

Most children and many adults with acute leukaemia can expect to be cured. For most people, chronic leukaemia can be successfully managed for long periods of time.

Treatment depends on the type of leukaemia, but may include:

• Chemotherapy – medication to treat cancer by destroying or slowing the growth of fast-growing cancer cells. This is usually given intravenously, but may sometimes be given as tablets. For some people, chemotherapy for acute leukaemia will mean spending several weeks in hospital. Others may be able to stay at home, but will need regular hospital check-ups and further treatments.
• Stem cell transplant (stem cells are immature white blood cells) – a transplant allows you to have much higher doses of chemotherapy than usual. This helps improve the chances of curing some types of leukaemia or of prolonging remission. The high doses of chemotherapy, sometimes given with total body irradiation (TBI), destroy the bone marrow and stem cells. After the high-dose treatment, you will be given a drip (infusion) of either your own stem cells (autologous transplant) or stem cells from a donor (allogeneic transplant).
• Biological therapy – also known as immunotherapy. This is the use of substances that are naturally produced within the body to encourage the immune system to fight disease. Interferon and growth factors are used to treat leukaemia.
• Radiotherapy – may be used for different types of leukaemia to help control symptoms as part of intensive treatment regimes, or to treat cancer that has spread to the brain or spinal cord.
• Steroids – research has shown that treatment for some types of leukaemia is better if steroids are given alongside the chemotherapy.
• All-trans-retinoic acid – this is a form of vitamin A used to treat a type of acute myeloid leukaemia called acute promyeloid leukaemia or APML. It is usually taken as tablets with chemotherapy.
• Complementary and alternative therapies – when used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve quality of life. Others may not be so helpful and in some cases may be harmful. The Cancer Council Victoria booklet called Understanding complementary therapies (pdf) can be a useful resource.

All treatments have side effects. These will vary depending on the type of treatment you are having. Many side effects are temporary, but some may be permanent. Your doctor will explain all the possible side effects before your treatment begins.

Research into leukaemia

Early detection and better treatment have improved survival for people with leukaemia. Research for leukaemia is ongoing. The Cancer Research UK website has information about research into all types of leukaemia.

Clinical trials can test the effectiveness of promising new treatments or new ways of combining cancer treatments. Always discuss treatment options with your doctor. There may be a clinical trial to suit your type of leukaemia.

Your sexuality and leukaemia

Having leukaemia and its treatment can affect the way you feel about your body, who you are, your relationships, the way you express yourself sexually and your sexual feelings (your ‘sexuality’). These changes can be very upsetting.

Your medical team should discuss these issues with you before and during your treatment. If you feel you would like to discuss things further, ask your doctor for a referral to a counsellor or call the Cancer Information and Support Service on 13 11 20.

If you have a partner, it helps to be as open as possible with them about how you are feeling. The Cancer Council Victoria booklet called Sexuality, intimacy and cancer may also be helpful to read.

Caring for someone with leukaemia

Caring for someone with leukaemia can be a difficult and emotional time. If you or someone you know is caring for someone with leukaemia, there is support available. The Cancer Council Victoria booklet called Caring for someone with cancer may also be helpful to read.

When a cure isn’t possible

If leukaemia has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving the symptoms (this is called ‘palliative’ treatment). Medication can be used to relieve pain, nausea and vomiting. The Cancer Council Victoria booklet called Living with advanced cancer may be helpful to read.

Where to get help

Causes, Symptoms, Diagnosis & Treatment

Overview

What are uterine polyps?

Uterine polyps are growths that occur in the endometrium, the inner lining of the uterus (the organ in which a fetus grows). For that reason, they are sometimes called endometrial polyps.

Uterine polyps are formed by the overgrowth of endometrial tissue. They are attached to the endometrium by a thin stalk or a broad base and extend inward into the uterus. The polyps may be round or oval, and range in size from a few millimeters (the size of a sesame seed) to a few centimeters (the size of a golf ball), or larger. There may be one or several polyps present. Uterine polyps are usually benign (noncancerous), but they may cause problems with periods (menstruation) or the ability to have children (fertility).

Who is affected by uterine polyps?

Uterine polyps are more likely to develop in women who are between 40 and 50 years old than in younger women. Uterine polyps can occur after menopause but rarely occur in women under 20 years old.

Your chances of developing uterine polyps may increase if you are overweight or obese, have high blood pressure (hypertension) or are taking tamoxifen, a drug that is used to treat breast cancer.

Symptoms and Causes

What causes uterine polyps?

The exact reason that polyps form is unknown, but swings in hormone levels may be a factor. Estrogen, which plays a role in causing the endometrium to thicken each month, also appears to be linked to the growth of uterine polyps.

What are the symptoms of uterine polyps?

The symptoms of uterine polyps include the following:

• Irregular menstrual periods
• Unusually heavy flow during menstrual periods
• Bleeding or spotting between periods
• Vaginal spotting or bleeding after menopause
• Infertility

The most common symptom of uterine polyps is irregular or unpredictable menstrual periods. Most women have periods that last four to seven days. A woman’s period usually occurs every 28 days, but normal menstrual cycles can range from 21 days to 35 days. Approximately half of women with uterine polyps have irregular periods.

Other symptoms include prolonged or excessive menstrual bleeding (menorrhagia), bleeding between periods, and bleeding after menopause or sexual intercourse. Uterine polyps are the cause of abnormal bleeding in about 25 percent of these cases.

The inability to become pregnant or carry a pregnancy to term may also be signs that uterine polyps are present.

Diagnosis and Tests

How are uterine polyps diagnosed?

Your doctor will ask you about your menstrual history, including how long your periods last and how often you have them. You should mention any unusual symptoms that you are experiencing, such as excessive bleeding or spotting between periods. The doctor will also ask whether you have had any difficulty becoming pregnant.

The doctor will also perform a gynecological exam and may order additional tests or procedures. Ask your doctor if any treatments such as antibiotics, pain medications, or medication to ease dilation of the cervix are recommended before the procedure.

These tests may include the following:

• Transvaginal ultrasound: this is a procedure in which a slim handheld device called an ultrasound transducer is inserted in the vagina. The device emits sound waves, which provide an image of the interior of the uterus, including any irregularities that may be present.
• Sonohysterography: this is a related procedure that may be performed after the transvaginal ultrasound. A sterile fluid is introduced into the uterus through a thin tube called a catheter. The fluid causes the uterus to expand, providing a clearer image of any growths within the uterine cavity during the ultrasound procedure.
• Hysteroscopy: this may be used to either diagnose or treat uterine polyps. During this procedure, a doctor inserts a long, thin tube with a lighted telescope (hysteroscope) through the vagina and cervix into the uterus. The hysteroscope allows the physician to examine the inside of the uterus. Hysteroscopy is sometimes used in combination with surgery to remove the polyps. See image below.

• Endometrial biopsy: the doctor uses a soft plastic instrument to collect tissue from the inner walls of the uterus. The sample is sent to the laboratory for testing to determine if any abnormalities are present.
• Curettage: done in an operating room, this procedure can both diagnose and treat polyps. The doctor uses a long metal instrument called a curette to collect tissue from the inner walls of the uterus. The curette has a small loop on the end that allows the doctor to scrape tissue or polyps. The tissue or polyps that are removed may be sent to the laboratory for testing to determine if cancer cells are present.

Management and Treatment

How are uterine polyps treated?

Treatment may not be necessary if the polyps do not cause any symptoms. However, polyps should be treated if they cause heavy bleeding during menstrual periods, or if they are suspected to be precancerous or cancerous. They should be removed if they cause problems during pregnancy, such as a miscarriage, or result in infertility in women who want to become pregnant. If a polyp is discovered after menopause, it should be removed.

Methods of treatment include the following:

• Medications: Drugs that help regulate the hormonal balance, such as progestins or gonadotropin-releasing hormone agonists, may be used as a temporary treatment. These medications help to relieve symptoms. However, the symptoms will usually return after the medications are stopped.
• Hysteroscopy: (see above) This may also be used as a treatment method. In treatment, the doctor will insert surgical instruments through the hysteroscope to remove any polyps that are found.
• Curettage: (see above) This may be performed along with hysteroscopy. While using the hysteroscope to look at the interior of the uterus, the doctor uses a curette to scrape the lining and remove any polyps. The polyps may be sent to a laboratory to determine whether they are benign or cancerous. This technique is effective for smaller polyps.
• Additional surgery may be necessary if a polyp cannot be removed using other methods, or if the polyps are cancerous. A hysterectomy, a surgical procedure in which the entire uterus is removed, may be necessary in cases where cancer cells are found in the uterine polyps.

Prevention

Can uterine polyps be prevented?

There is no way to prevent uterine polyps. It’s important to have regular gynecological checkups. Risk factors such as obesity, high blood pressure, or taking tamoxifen to treat breast cancer may increase the chance of developing polyps. Uterine polyps sometimes return after treatment, and additional treatment may be necessary.

Procedure Details, Schedule & Results

Overview

What is a pelvic exam?

A pelvic exam is a way for healthcare providers to look for signs of illness or disease in a woman’s body. The word “pelvic” refers to the organs in the pelvis. The exam is used to look at a woman’s:

• Uterus (the womb).
• Cervix (opening from the vagina to the uterus).
• Vagina (stretchy canal that connects the uterus and the cervix).
• Fallopian tubes (tubes that carry eggs to the womb).
• Ovaries (glands that produce eggs).
• Bladder (the sac that holds urine).
• Rectum (the chamber that connects the colon to the anus).

Often, a pelvic exam is performed by healthcare providers to assess female reproductive health and gynecological health.

When should I get a pelvic exam?

Pelvic exams are a part of your routine healthcare. Women should have their first pelvic exam at age 21. They are then regularly scheduled depending on your age and health risks.

Your healthcare provider may also recommend a pelvic exam for the following reasons:

Who should get a pelvic exam?

• Women who are 21 to 65 years of age.
• Individuals who have transitioned but not completed gender assignment surgery (female to male).

If you are a transgender man (identify as male but were assigned female at birth), it is important to find a healthcare provider who understands your health history, makes you feel comfortable and provides the care you need. If you still have female organs (vagina, cervix, uterus and ovaries), you are at risk for developing cancer in those organs. Pelvic exams should be still performed to check for irregularities, STIs and cancer. ­

How often do I need a pelvic exam?

Recommendations on how often you should get a pelvic exam can vary. The timing for your pelvic exams are typically based on your medical history, or if you’re experiencing problems or symptoms. Some healthcare providers may recommend annual visits. Others may recommend an exam every three years until you are 65 years old. Ask your provider when they recommend you come back for routine pelvic exams.

Test Details

Do I need to do anything to prepare for a pelvic exam?

You do not have to do anything special to get ready for a pelvic exam procedure. When you arrive at the office, your healthcare provider may ask if you need to use the bathroom. Sometimes, a urine sample is requested. If you’re on your period on the day of the exam, the doctor may suggest rescheduling for your comfort.

How long does a pelvic exam take?

The pelvic exam itself usually takes about 10 minutes.

Does a pelvic exam hurt?

You can expect to feel a little discomfort, but you should not feel pain during a pelvic exam. Take slow, deep breaths and urinate before the exam to help with any discomfort. If you feel pain or discomfort during your exam, tell your doctor.

It can also help to talk to your provider about your worries or concerns that the pelvic exam might be painful before your exam starts. They can walk you through the process and address your concerns.

How can I relax during a pelvic exam?

It is normal to feel a little nervous prior to a pelvic exam. It can help to:

• Take slow and deep breaths.
• Relax your shoulder, stomach and leg muscles.
• Ask your provider to explain what is about to happen.

If you have experienced sexual trauma, speak with your healthcare provider so that they can be supportive of your feelings and make your exam as comfortable as possible.

How is a pelvic exam performed?

When it’s time for your pelvic exam, you’ll start by taking off your clothes in private. You are given a gown, sheet or other covering. You will be asked to lie on your back and relax the muscles of your stomach and legs. Your healthcare provider will have you to slide down to the end of the table and place your feet in holders called stirrups.

There are a few things that may happen during your pelvic exam:

• External exam: Your healthcare provider will visually inspect your vagina and vulva.
• Manual exam: Your provider will place one or two fingers inside the vagina and use the other hand to gently press down on the area they can feel from the outside. They will feel the size and shape of your organs or if any areas are tender or enlarged.
• Speculum exam: A duck-billed shaped device called a speculum will be inserted into the vagina. The speculum is then opened to widen and spread the vaginal wall so that the vagina and cervix can be more easily seen.
• Pap test: Your provider will use a plastic spatula and small brush to take a sample of cells from the cervix. A sample of fluid may also be taken from the vagina to test for infection. This is called a Pap test or Pap smear. This test looks for precancerous cells on the cervix. A Pap test is not always performed during a pelvic exam. You should not place anything inside your vagina for 48 hours prior to your Pap test.
• Rectal exam: Your healthcare provider may insert a finger into the rectum to detect any tumors or other abnormalities.

What do pelvic exams check for?

During your pelvic exam, your provider may test for:

• Cervical cancer: If your healthcare provider performed a Pap test during your exam, it’s to look for precancers, or cell changes on the cervix that could become cancer.
• HPV (human papillomavirus): This test is also used to screen for cervical cancer. The test looks for HPV, which can cause cell changes in the cervix. These cell changes can lead to cancer.
• Sexually transmitted diseases or infections (STIs): Your doctor may swab your vagina to test for chlamydia and gonorrhea.

The samples your provider takes during the pelvic exam are sent to a lab where they are examined. Results can take several days.

Frequently Asked Questions

Will I bleed after a pelvic exam?

A little spotting (very light bleeding) is normal after a pelvic exam. If you have heavy bleeding, call your healthcare provider.

Will I have pain after a pelvic exam?

You should not feel pain. Mild cramping may occur. If you feel severe cramping or pain, contact your healthcare provider.

When do I know the results of a pelvic exam?

Your healthcare provider will know certain results right away after your pelvic exam. If a Pap or HPV test was done, those results typically take a few days.

Do pregnant women need pelvic exams?

Yes, pregnant women need to have pelvic exams. The healthcare provider working with you will usually perform a pelvic exam at your first prenatal visit.

Do menopausal women need pelvic exams?

Because the risk of cancer increases with age, having regular pelvic exams may help prevent certain cancers in both menopausal and postmenopausal women. Your healthcare provider will advise you on how frequently you will need pelvic exams in the future and the best recommendations for this exam as you age.

A note from Cleveland Clinic:

Talk to your healthcare provider about how often you should schedule a pelvic exam. Feel free to discuss any worries or concerns you may have about the test. Your provider is there to listen to you and work with you to make sure you are receiving the care you need.

Heavy Menstrual Bleeding | ACOG

Adenomyosis: A condition in which the tissue that normally lines the uterus begins to grow in the muscle wall of the uterus.

Birth Control: Devices or medications used to prevent pregnancy.

Cells: The smallest units of a structure in the body. Cells are the building blocks for all parts of the body.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Dilation and Curettage (D&C): A procedure that opens the cervix so tissue in the uterus can be removed using an instrument called a curette.

Ectopic Pregnancy: A pregnancy in a place other than the uterus, usually in one of the fallopian tubes.

Endometrial Ablation: A minor surgical procedure in which the lining of the uterus is destroyed to stop or reduce menstrual bleeding.

Endometrial Biopsy: A procedure in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Endometrial Cancer: Cancer of the lining of the uterus.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Endometrium: The lining of the uterus.

Fibroids: Growths that form in the muscle of the uterus. Fibroids usually are noncancerous.

Gonadotropin-releasing Hormone (GnRH) Agonists: A hormone made in the brain that tells the pituitary gland when to produce follicle-stimulating hormone (FSH) and luteinizing hormone.

Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve symptoms that may happen around the time of menopause.

Hypothyroidism: A condition in which the thyroid gland makes too little thyroid hormone.

Hysterectomy: Surgery to remove the uterus.

Hysteroscopy: A procedure in which a lighted telescope is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Iron-Deficiency Anemia: Abnormally low levels of iron in the blood.

Magnetic Resonance Imaging (MRI): A test to view internal organs and structures by using a strong magnetic field and sound waves.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined from the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Miscarriage: Loss of a pregnancy that is in the uterus.

Myomectomy: Surgery to uterine fibroids only, leaving the uterus in place.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Drugs that relieve pain by reducing inflammation. Many types are available over the counter, including ibuprofen and naproxen.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Ovulation: The time when an ovary releases an egg.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Pelvic Inflammatory Disease (PID): An infection of the upper female genital tract.

Perimenopause: The time period leading up to menopause.

Polycystic Ovary Syndrome (PCOS): A condition that leads to a hormone imbalance that affects a woman’s monthly menstrual periods, ovulation, ability to get pregnant, and metabolism.

Polyps: Abnormal tissue growths that can develop on the inside of an organ.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Puberty: The stage of life when the reproductive organs start to function and other sex features develop. For women, this is the time when menstrual periods start and the breasts develop.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Sonohysterography: A procedure in which sterile fluid is injected into the uterus through the cervix while ultrasound images are taken of the inside of the uterus.

Sterilization: A permanent method of birth control.

Tranexamic Acid: A medication prescribed to treat or prevent heavy bleeding.

Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

Uterine Artery Embolization: A procedure to block the blood vessels to the uterus. This procedure is used to stop bleeding after delivery. It is also used to stop other causes of bleeding from the uterus.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Chaika Clinics – Chaika.com

Uterine bleeding is the discharge of blood from the uterine cavity.

The inner part of the uterus has two layers. The thin inner layer is called the endometrium. The thick external muscle wall is the myometrium. In women with regular periods, the endometrium thickens throughout the cycle in preparation for pregnancy. If a woman does not become pregnant, the endometrium is rejected during menstruation. Menstruation occurs 10-14 days after ovulation. With menopause, ovulation stops, the endometrium stops growing and becomes thinner.

Normally, a woman loses a limited amount of blood during each menstrual period (less than five tablespoons, or 80 ml). Bleeding that occurs erratically or excessively heavy regular menstrual bleeding is considered abnormal uterine bleeding. After a woman who is not taking hormone therapy enters menopause and her menstrual cycle ends, any uterine bleeding is considered abnormal.

Causes of abnormal bleeding.

Abnormal uterine bleeding can be caused by a variety of conditions. Some conditions are more typical for certain periods of a woman’s life.

Abnormal uterine bleeding in young girls. Bleeding before menarche (the first menstrual period in a girl’s life) is always abnormal. It can be caused by trauma, a foreign body (such as toys, coins, or hygiene products), irritation to the genital area (from soap, lotions, or infection), or urinary tract problems. Bleeding can also occur as a result of sexual assault.

Abnormal uterine bleeding in adolescents. Many girls have episodes of irregular bleeding during the first few months after their first menstrual period. This usually resolves without treatment when the hormonal cycle and ovulation return to normal. If irregular bleeding persists or if the bleeding is profuse, an examination is necessary.

Abnormal bleeding during adolescence can also be caused by any of the factors that cause bleeding in premenopausal women, such as pregnancy, infection, and certain medical conditions.

Abnormal uterine bleeding in women of reproductive age. Many conditions can cause abnormal bleeding in women between adolescence and menopause. For example, a sudden change in hormone levels during ovulation.

Some women with regular periods experience excessive bleeding during their period (extremely heavy periods) or intermenstrual bleeding. The most common causes of such bleeding are uterine fibroids (a benign mass in the muscle layer of the uterus), adenomyosis (a condition in which the endometrium grows into the muscle layer of the uterus), or endometrial polyps (usually a benign focal proliferation of the uterine lining with the formation of a node on a wide base or on leg). These conditions are common causes of abnormal uterine bleeding. Fibroids, adenomyosis, and polyps can also occur in women with irregular periods.

Other causes of abnormal uterine bleeding in women of reproductive age include:

• pregnancy;
• Cancer or precancerous (dysplasia) of the cervix or endometrium;
• Infection or inflammation of the cervix or endometrium;
• Blood clotting disorders such as von Willebrand disease, platelet abnormality, etc.;
• comorbidities such as hypothyroidism, liver disease or chronic kidney disease.

Hormonal contraception. Girls and women who use hormonal contraceptives (eg, pills, rings, patches) may have breakthrough bleeding between periods. If this occurs within the first few months of starting contraceptive use, it may be due to changes in the endometrium of the uterus. If bleeding continues for more than a few months, testing may be required and / or a change in contraceptive may be recommended. Women who use injectable contraception often experience irregular bleeding at first, but bleeding stops over time. Irregular bleeding is common in women using a contraceptive implant. In women using an IUD, bleeding is often irregular at first. Over time, the bleeding becomes easier, and then these women often have scanty menstruation before it is completely absent (amenorrhea).

Breakthrough bleeding can also occur if the contraceptive regimen is violated (the pill is missed or the pill is taken too late).In this situation, there is a risk of becoming pregnant.

Abnormal uterine bleeding in women during the menopausal transition. Before the end of her menstrual cycle, a woman goes through a period called the menopausal transition, or perimenopause. During perimenopause, the menstrual cycle begins to change when menstruation becomes less regular. While the ovaries in perimenopausal women continue to produce the hormone estrogen, the secretion of the hormone progesterone decreases. These hormonal changes can lead to the growth of the endometrium and the formation of excess tissue.This increases the likelihood of developing endometrial polyps or hyperplasia (thickening of the endometrium that can degenerate into endometrial cancer). These conditions can cause abnormal bleeding. The transition to menopause is the time when women are more likely to experience abnormal uterine bleeding.

Menopausal transition women are also at risk for other conditions that cause abnormal bleeding, such as cancer, infections, and general illnesses.

Perimenopausal women still ovulate for a while and may become pregnant.The pregnancy itself can cause abnormal bleeding. In addition, perimenopausal women may use hormonal contraceptives, which can cause breakthrough bleeding.

Abnormal uterine bleeding in postmenopausal women. Women taking hormone replacement therapy may experience intermittent bleeding. Otherwise, bleeding during menopause is abnormal and should be investigated. Causes of abnormal bleeding during menopause include:

• Atrophy or excessive thinning of the tissue lining the vagina and uterus caused by low hormone levels.
• Cancer or precancerous changes (hyperplasia) of the endometrium.
• Polyps or fibroids.
• Uterine infection.
• Use of blood thinners (antiplatelet agents or anticoagulants).
• Side effects of radiation therapy.

Diagnosis of abnormal uterine bleeding.

1. Initial estimate. By examining the woman’s medical history (history), the doctor checks the duration and amount of bleeding; factors that lead to bleeding; symptoms that occur with bleeding, such as pain, fever, or odor from vaginal discharge.The doctor will find out if bleeding occurs after intercourse and if there is a personal or family history of bleeding disorders. He finds out the woman’s medical history and checks the medications she is taking. It is also important for the doctor to have a recent weight change, stress, a new fitness program, or comorbid conditions. The doctor will do a physical exam to assess the woman’s general health and a vaginal exam to confirm that the bleeding is from the uterus and not from another location (such as the vulva or rectum).
2. Laboratory tests. In women of reproductive age, a pregnancy test is done. If there is any abnormal vaginal discharge, an examination of the cervix may be done. Blood tests may be done to check for anemia (low hemoglobin in the blood), blood clotting problems, and other common conditions such as thyroid disease, liver disease, or kidney disease.
3. Evaluation of the endometrium. To rule out endometrial cancer and structural abnormalities (uterine fibroids or polyps), tests that evaluate the endometrium may be performed.These tests include:

• Endometrial biopsy. Endometrial biopsies are often performed on women aged 45 and older to rule out endometrial cancer. A biopsy can also be done in women younger than 45 if they have risk factors for endometrial cancer. Endometrial cancer risks include obesity, chronic anovulation, use of tamoxifen (a drug used to treat breast cancer), or a family history of breast or colon cancer. During the biopsy, a thin instrument is inserted through the vagina and cervix to obtain a small sample of endometrial tissue.The biopsy can be performed on an outpatient basis without anesthesia.
• Transvaginal ultrasound. Ultrasound uses sound waves to measure the shape and structure of an organ. An ultrasound probe is inserted into the vagina and provides a clear image of the uterus. Ultrasound may not always be able to distinguish between different types of abnormalities (for example, distinguishing a polyp from a cancer), and further testing may be required.
• Hysteroscopy. A method for examining the inner surface of the uterus using an endoscopic device inserted into it – a hysteroscope.
• Scraping. A surgical method of removing the contents of the uterine cavity is used, for example, when there is a suspicion of malignant degeneration of tissues.

Treatment.

Birth control pills are often used to treat uterine bleeding caused by hormonal changes or hormonal imbalances. Hormonal contraceptives can be used in women with irregular periods to establish regular cycles and prevent endometrial overgrowth.In women with regular periods, they can be used to treat excessively heavy menstrual bleeding.

During perimenopause, hormonal contraceptives can be used to regulate the menstrual cycle and prevent endometrial overgrowth.

Progesterone, a hormone produced by the ovary, is also often used in treatment. It is effective in preventing or treating excessive bleeding in women with irregular periods.A synthetic form of progesterone called progestin may be recommended to treat abnormal bleeding. The progestin can be in the form of tablets, injections, implants, or intrauterine devices.

Surgical treatment may be required to remove abnormal uterine structures (eg fibroids, polyps). Women who have completed childbirth and have heavy menstrual bleeding may consider endometrial ablation, a surgical procedure that uses heat, cold, electrical energy, or a laser to destroy the lining of the uterus (endometrium).

For women with uterine fibroids, surgical treatment is used – by removing the fibroid (for example, myomectomy) or by reducing the blood supply to the fibroid (for example, uterine artery embolization). The most radical surgical treatment for abnormal uterine bleeding is a hysterectomy, or removal of the entire uterus. Hysterectomy can be performed using conventional laparoscopy, through the vagina, or by open access – laparotomy (dissection of the anterior abdominal wall to gain access to the abdominal and pelvic organs).

Menopause symptoms – Clinic Health 365 Yekaterinburg

What is menopause

Diagnosis of menopause

Examinations necessary for a woman during menopause

How to cope with the symptoms of menopause

Hormone therapy at menopause

Alternatives to hormone therapy

Prevention of menopause

Good to know about menopause

What questions should you ask your doctor

Frequently asked questions about menopause

Advice on lifestyle during menopause

Irregular menstruation : The changes associated with menopause begin in the body about four to eight years before the onset of natural menopause. One of the most annoying symptoms in 40-50 years old is irregular menstruation. In one month, the bleeding may be severe, and in the next scanty. Your period can be shorter or longer. There is also the possibility of missing your period for several months or not being able to tell when your period will start and when it will end. These symptoms are caused by irregular levels of the hormones estrogen and progesterone.

Note: Although irregular menstruation is common before menopause, irregular menstruation can also be a symptom of uterine disease or uterine cancer.

Consult a doctor as soon as possible if:

• menstruation does not appear for several months and then begins again, accompanied by heavy bleeding;
• if irregular bleeding or bleeding occurs after sexual intercourse;
• if bleeding occurs after menopause.

Be sure to talk about any abnormalities in the menstrual cycle.

The only reliable method to establish the cause of irregular menstruation is hysteroscopy with histological examination. Hysteroscopy is performed if abnormalities are detected in the uterus during a transvaginal ultrasound examination. Irregular bleeding can also indicate cervical cancer, which can be detected with a Pap test.

Changes in hormonal levels. Hormone levels fluctuate and may be above or below normal during any cycle. For example, not ovulating for a month (this often happens in women aged 45-50) means that progesterone is not produced to stimulate menstruation, and estrogen levels continue to rise.Because of this, bloody discharge or heavy bleeding during menstruation may occur throughout the cycle.

Other menopausal symptoms:

• Hot flushes (a sudden sensation of heat, sometimes accompanied by redness of the skin)
• Night sweats (hot flashes at night can often interfere with sleep)
• Fatigue (possible due to sleep disturbance)
• Mood swings
• Vaginal dryness
• Sexual instability
• Sleep disorders

Diseases associated with menopause.

Although there are many possible diseases associated with menopause, most women with natural menopause experience little discomfort during perimenopause. However, it should be noted that over the years, at least two serious diseases can develop – coronary heart disease and osteoporosis.

Ischemic heart disease 90 120. Normal estrogen levels prevent blood clots. It raises cholesterol – HDL (good cholesterol), which helps eliminate cholesterol – LDL (cholesterol, which promotes the deposition of fat and platelets along the walls of arteries).

With age, the risk of developing coronary heart disease (CHD), a disease in which the veins and arteries that carry blood to the heart become narrowed or blocked by atherosclerotic plaques and blood clots. Heart attacks and infarctions are in many cases due to atherosclerotic heart disease.

Osteoporosis 90 120. Estrogen in the body prevents the breakdown of bones and, together with calcium and other hormones and minerals, strengthens them. The body constantly strengthens and renews bones, a process called resorption and deposition.Until the age of 30, the body produces more bone tissue than it is destroyed. But when estrogen levels begin to drop, the process of bone renewal slows down.

At the onset of menopause, bones are destroyed to a greater extent than the body repairs them. During the first years of menopause (five to seven years), some women lose up to 20 percent of their bone mass. The breakdown of the bones is eventually stabilized, but keeping the bones strong and healthy afterwards becomes a real challenge to prevent osteoporosis.When bones become too weak and brittle to support normal activity, osteoporosis occurs.

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Complications after childbirth – causes and consequences

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After giving birth, a woman often thinks that all worries and anxieties are over. But, alas, sometimes the first, happiest days or weeks of a mother and baby’s life together can be overshadowed by various complications. In what cases are postpartum changes normal, and when is it worth seeing a doctor?

Labor ends after the third stage of labor, that is, after the birth of the placenta. Following this, the uterus immediately significantly decreases in size, becomes spherical, its cavity is filled with blood clots; the bottom of the uterus at this moment is approximately halfway between the bosom and the navel.The early postpartum period lasts for 2 hours and during this time the woman is in the maternity ward. Then comes the late postpartum period. This period lasts 6-8 weeks. During this time, there is a reverse development (involution) of all organs and systems that have undergone changes in connection with pregnancy and childbirth. The exception is the mammary glands, whose function reaches its peak precisely in the postpartum period. The most pronounced involutional changes occur in the genitals, especially in the uterus. The rate of involutional changes is most pronounced in the first 8-12 days. The uterus and cervix are significantly reduced in size. After the birth of the placenta, a large wound surface remains in the uterus, which takes about 4-6 weeks to heal. During this period, the placental site in the uterus bleeds, spotting – lochia – in the first days has a bloody character, gradually their color changes from red to reddish-brown, brownish, by the 4th week the discharge almost stops and soon disappears completely.In women who have undergone a caesarean section, everything happens more slowly, since, due to the presence of a suture on the uterus, it contracts worse. Their total amount of bloody discharge during the postpartum period is 500-1500 ml.

What complications can arise after childbirth

A doctor should be consulted in the following cases:

1. If the amount of discharge increased sharply , profuse bleeding appeared after its amount had already begun to decrease, or abundant spotting did not stop for a long time, large blood clots appeared. When bleeding occurs, you need to see an obstetrician-gynecologist, preferably in the maternity hospital where the birth took place. If the bleeding is very profuse (several pads are required within an hour), you do not need to go to the hospital yourself, you need to call an ambulance.
2. The most common cause of late postpartum haemorrhage (that is, those that occurred later than 2 hours after delivery) is retained part of the placenta in the uterine cavity . The diagnosis in this case is confirmed by ultrasound examination.To remove the remnants of the placenta, curettage of the walls of the uterus is performed under general intravenous anesthesia with mandatory subsequent antibiotic therapy to prevent infectious complications.
   In rare cases, the causes of bleeding can be changes in the blood coagulation system hereditary or acquired, blood diseases. In these cases, complex drug therapy is required.
   Perhaps the development of bleeding associated with violation of the contraction of the muscles of the uterus . This is the so-called hypotonic bleeding. In the subsequent period, the hypotonic state of the uterus can be caused by its overstretching due to many days, multiple pregnancy, large fetus, underdevelopment of the uterus. A decrease in the contractility of the uterus is also caused by changes in its very wall (fibroids, the consequences of inflammatory processes, frequent abortions). These bleeding most often occur in the first hours after childbirth and require active treatment with medication, and in severe cases, surgery.
   A sharp, unexpected cessation of bloody discharge should also alert a woman and requires an urgent visit to a doctor. In this case, the outflow of blood from the uterus may be disturbed, that is, lochia accumulates in the cavity and the so-called lochiometer develops. Blood clots are a good breeding ground for bacteria, therefore, if the lochiometer is not treated in time, bacteria penetrate into the uterine cavity and endometritis develops – an inflammation of the uterine lining. After a cesarean section, a lochiometer occurs more often than after a vaginal birth.Treatment consists in the appointment of drugs that reduce the uterus, with the simultaneous use of antispasmodics to relax the cervix and restore the outflow of lochia. In some cases, it is necessary to resort to vacuum aspiration of the contents of the uterus under general intravenous anesthesia and mandatory subsequent antibiotic therapy.
3. Discharge has acquired an unpleasant odor . This may indicate the development of an inflammatory process in the vagina or in the uterus. In the postpartum period, there was a significant increase in the composition of most groups of bacteria, including bacteroids, E. coli, streptococci, staphylococci.Potentially, all of these species can be the cause of postpartum infectious diseases. A common problem in women after childbirth is the development of bacterial vaginosis. Bacterial vaginosis is a pathology of the vaginal ecosystem caused by the increased growth of predominantly anaerobic bacteria (that is, those that grow in an oxygen-free environment), which actively multiply in the postpartum period in the woman’s vagina and can be pathogens in postpartum endometritis or suppuration of the vaginal and cervical sutures. Diagnosis of bacterial vaginosis is based on measuring the acidity of the vagina and detecting in a smear on the flora specific for this disease “key cells” (these are cells of the vaginal mucosa covered with anaerobic bacteria). Treatment of bacterial vaginosis in the postpartum period is carried out with local preparations.
4. The appearance of cheesy discharge, itching, burning in the genital area, redness indicates the development of candidiasis of the vagina (thrush) .The risk of this complication is increased with antibiotics. Diagnosis is based on the detection of a large number of yeast-like fungi in a smear on the flora. For treatment, local preparations are used in the form of vaginal suppositories or tablets.
5. Pus-like discharge, lower abdominal pain, increased body temperature 90 120. These symptoms may indicate the development of a serious complication – postpartum endometritis (inflammation of the inner lining of the uterus). Most often, endometritis occurs in patients after a cesarean section, manual examination of the postpartum uterus, manual separation of the placenta and discharge of the placenta (if independent separation of the placenta is difficult due to impaired uterine contractile function), with a prolonged anhydrous interval (more than 12 hours from the moment of amniotic fluid discharge to birth of a baby), in women admitted for childbirth with inflammatory diseases of the genital tract (for example, against the background of sexually transmitted infections), in patients with a large number of abortions in the past.The classic form of endometritis occurs on days 1-5. The body temperature rises to 38-39 degrees, the heart rate increases to 80-100 beats per minute. Depression of the general condition, chills, dryness and hyperemia of the skin, soreness of the body of the uterus, purulent discharge with a smell is noted. The erased form appears on the 5-7th day, develops sluggishly. The temperature does not exceed 38 degrees, there is no chill. Endometritis after cesarean section is always severe.
   In making a diagnosis, the doctor is assisted by an ultrasound examination of the uterus and a complete blood count, in which signs of inflammation are detected.Endometritis treatment should be started as early as possible. They spend it in a hospital. Assign bed rest, with acute endometritis cold on the lower abdomen. Postpartum endomeritis is necessarily treated with antibiotics, together with them, agents that reduce the uterus are used. Currently, in many clinics and maternity hospitals, the uterine cavity is washed with chilled antiseptic solutions. In severe cases, intravenous infusion of saline solutions is required to improve blood circulation, relieve symptoms of intoxication.
   With untimely treatment, there is a very high risk of the spread of the inflammatory process to the entire uterus, small pelvis, the development of sepsis (the appearance of infectious agents in the blood), up to the death of the patient.
6. In the postpartum period, the appearance of pain in the mammary glands is possible , a feeling of fullness, an increase in body temperature. When these symptoms appear, it is imperative to consult a doctor – an obstetrician-gynecologist in a antenatal clinic or a surgeon.
   Possible reasons for the appearance of pain in the mammary glands and the accompanying increase in temperature are lactostasis and mastitis.
   Lactostasis (stagnation of milk in the gland) is caused by blockage of the excretory ducts. Most often, this condition develops with improper attachment of the baby to the breast, violation of the feeding regime. Lactostasis often affects primiparous women. With stagnation of milk, the mammary gland increases in volume, its dense enlarged lobules are determined. Body temperature can rise to 38-40 degrees. There is no redness of the skin and swelling of the glandular tissue, which usually appear with inflammation.After expressing the mammary gland with lactostasis, the pain disappears, painless lobules with clear contours are small in size, and the body temperature decreases. If lactostasis is not eliminated within 3-4 days, mastitis (inflammation of the mammary gland) occurs, since during stagnation of milk the number of microbial cells in the milk ducts increases dramatically, milk is a good breeding ground for various bacteria, which contributes to the rapid progression of inflammation. With the development of mastitis, the body temperature constantly remains high, accompanied by chills.Symptoms of intoxication appear (general weakness, weakness, headache). The patient is disturbed at first by a feeling of heaviness, and then by pain in the mammary gland, which is accompanied by stagnation of milk. The mammary gland increases in volume, areas of redness are noted on the skin. Expressing milk is painful and does not bring relief, after expressing, dense painful areas remain, and a high body temperature remains. In severe cases, pus impurities can be detected in milk.
   To eliminate lactostasis, pumping, local anti-inflammatory ointments, and physiotherapy are used. Mastitis is treated with antibiotics. In some cases, suppression of lactation and surgical treatment are required.
7. Fever, back or side pain, painful urination 90 120. These symptoms may indicate the development of postpartum pyelonephritis, that is, inflammation of the kidneys. Doctors consider the critical periods for the development of postpartum pyelonephritis 4-6 and 12-14 days of the postpartum period. The development of the disease is associated with the ingress of infection into the urinary tract from the genital tract.Most often, the disease develops in women in childbirth, in whose urine during pregnancy a small amount of bacteria was found. An ultrasound examination of the kidneys and bladder and urinalysis are helpful in making the diagnosis.
   Treatment of pyelonephritis is necessarily carried out with antibiotics.
8. Leg pain, swelling, redness on the legs along the vein, increased pain when walking – these are symptoms of a serious pathology – venous thrombosis (the formation of blood clots in the veins) and require an urgent visit to a surgeon or phlebologist. The most dangerous periods for the occurrence of thrombosis are considered 5-6 days after childbirth or a cesarean section, less often thrombosis occurs 2-3 weeks after childbirth. The causes of thrombosis are changes in the blood coagulation system that occur during pregnancy and after childbirth. Physiologically, in the postpartum period, the coagulation system is activated. As the body tries to stop the bleeding. At the same time, the tone of the vessels of the small pelvis and lower extremities is reduced, the veins have not yet had time to adapt to work in the new conditions.These conditions trigger the mechanisms of blood clot formation. An important role in the development of postpartum venous thrombosis is played by the hormonal background, which changes sharply after the end of pregnancy.
   The risk of developing venous thrombosis is especially high in women with various pathologies of the blood coagulation system, which are detected even before pregnancy or while carrying a baby. There is a high probability of thromboembolic complications and in the presence of diseases of the cardiovascular system, overweight.The risk of thrombosis also increases in women in the age group after 40 years, in the presence of varicose veins of the lower extremities. The risk of blood clots is increased in women who have undergone caesarean section.
   In making a diagnosis, the doctor is assisted by an ultrasound examination of the veins, with Doppler ultrasound, that is, an assessment of the blood flow in the vessels.
   For the treatment of venous thrombosis, medications are used, wearing compression hosiery.
   A serious complication of venous thrombosis is the separation of a part of the thrombus and its movement along the vascular bed.In this case, blood clots, getting into the vessels of the lung or brain, cause strokes (impaired cerebral circulation) or thromboembolism of the pulmonary arteries (clogging of the pulmonary arteries by a thrombus). This serious complication appears a sharp cough, shortness of breath, pain in the chest, hemoptysis may begin – the appearance of streaks of blood in the sputum when coughing. In severe cases, the work of the heart is disrupted and death can occur.
9. May be troubling discomfort in the area of ​​postoperative sutures after cesarean section or in the area of ​​sutures on the perineum.Normally, after suturing vaginal tears, there may be slight painful sensations for 1-2 days, but they quickly pass. Pain in the postoperative wound area after a cesarean section may bother for 2 weeks, gradually decreasing. A feeling of heaviness, distention, pain in the area of ​​the postoperative wound may indicate the accumulation of hematoma (blood) in the area of ​​the sutures. This usually happens in the first three days after childbirth and requires surgical treatment – removal of accumulated blood. Pain, burning, bleeding of the seams, the appearance of discharge with an unpleasant odor, swelling in the area of ​​sutures, an increase in body temperature indicates the addition of infection and suppuration of the seams.In these cases, you should also consult a doctor for treating the wound and deciding on a further method of treatment.
10. Violation of the physiological functions of the pelvic organs of varying degrees (bladder, rectum), which can appear as in the postpartum period – incontinence of urine, feces, uterine prolapse. The problem of prolapse of the genitals arises when the pelvic floor muscles have lost the ability to contract so much that individual organs or their parts do not fall into the projection of the supporting apparatus.The most common cause of pelvic organ prolapse is trauma to the pelvic floor muscles during childbirth.
11. Hemorrhoids . Quite often, women after childbirth are worried about the appearance of hemorrhoids – varicose veins of the rectum. The predisposing factor in this case is a significant increase in intra-abdominal pressure during pregnancy and during childbirth. In the case of hemorrhoids, formations appear in the anus, which can be painless, but most often they are painful, bleeding and itchy.The appearance of intense pain in the anus, bloody discharge from the rectum is a reason to consult a doctor – a proctologist. Most often, uncomplicated forms of hemorrhoids are treated with local medications – creams and suppositories, in case of complications (pinching of the node, bleeding), surgical treatment is required.

In any case, if you experience any symptoms that cause concern, it is advisable to consult a doctor, because it is better to prevent or treat any complication at the very initial stage.

Shell glue stops blood and heals a wound in 15 seconds // Watch

Scientists have invented a trauma glue that mimics the substance shells use to adhere to rocks, ships and whales.

Inspired by the substance that makes shell-living molluscs adhere to rocks, ship hulls and whales, MIT engineers have developed a strong, biocompatible adhesive to stop bleeding and bond damaged body tissues.An article about this invention was published in the scientific journal Nature Biomedical Engineering.

The peculiarity of this glue is that it sticks to surfaces, even if they are covered with blood. The glue in the form of a paste forms a film tightly adhering to the wound approximately 15 seconds after application. The glue offers a much more effective way to treat serious injuries and help control bleeding during surgery, the researchers said.

We have previously talked about similar developments.However, scientists around the world continue to improve their inventions. After all, large blood loss is the most common cause of death in wounded military personnel and the second on the list – with injuries of the civilian population.

Modern styptic patches and dressings stop bleeding only after a few minutes and are not always suitable for severe bleeding.

In search of a solution to the problem, a team of engineers at the Massachusetts Institute of Technology looked closely at shells – small marine crustaceans that are so firmly attached to the bottoms of ships that entire scientific laboratories are developing means to combat them.In this case, molluscs deal with wet and dirty surfaces, but they stick to them tightly.

“It got our attention,” says MIT’s Hyunwoo Yuk. a creature living in a marine environment does exactly what we do when dealing with complex bleeding. ”

Analysis of the glue of the shell showed that the substance has a unique composition.The sticky protein molecules that help the shells attach to the surface are suspended in oil. The latter removes water and any dirt from the surface and thus allows the sticky proteins to adhere firmly to it.

Researchers attempted to mimic shell glue using a previously developed in-house polyacrylic acid based glue. It is, by the way, used as an absorbent in baby diapers. A mixture of polyacrylic acid with chitosan and sugar, filled with NHS ether, was rolled into sheets and frozen.Then the sheets were crushed to microparticles and mixed with medical grade silicone oil.

When the paste obtained by the researchers is applied to a damp surface such as blood-covered skin, the oil repels blood and other substances that may be present on the skin. This allows the micro-glue particles to adhere to the skin, bond and form a dense film on the wound.

In tests on rats, scientists have shown that within 15 to 30 seconds after applying the glue, it hardens and the bleeding stops.

The advantage of the styptic paste over the plaster is its plasticity.

“The plastic paste can flow into any wound and seal it,” says Jingjing Wu, one of the authors of the development.

The glutinous paste was also tested on pigs during surgery at the Mayo Clinic.

Cardiologist-anesthesiologist Christoph Nabzdyk and his medical colleagues have found that the adhesive can quickly stop bleeding in the liver and is much faster and more effective than other available hemostatic agents.

The hemostatic properties of the paste worked even when pigs were injected with a blood thinner (heparin). It prevents blood clots from forming during the clotting process.

Medical research has also shown that a “filling” made from an adhesive paste remains intact for several weeks, giving the tissue underneath time to heal.

However, as noted by the testers, the glue causes slight inflammation. But this process accompanies the use of other currently used hemostatic agents.

The new glue is slowly absorbed in the body over several months. But it can be removed earlier with a special solvent, in case a new surgical procedure is required.

Now doctors are planning to test the glue on larger wounds.

“We are technically capable of many complex operations, but we are not that far advanced in being able to quickly control very severe bleeding,” says Nabzdik.

Another potential use of shell glue is to stop bleeding in patients with catheters in the blood vessels, for example, in extracorporeal membrane oxygenation (ECMO). During ECMO, the patient’s blood is passed through a machine that oxygenates it. The procedure is used to treat people with deep heart or lung failure. Tubes often remain in veins and arteries for weeks or months, and bleeding at the insertion sites can lead to infection.

New materials never cease to amaze, and we wrote earlier that the new bioplastics are no longer afraid of boiling water, and that the new material purifies the air and uses carbon for self-repair. We also talked about how we got transparent wood with the help of orange peel.

You will find more interesting science news in the “Science” and Medicine sections on the “Look” media platform.

Dysfunctional uterine bleeding – Medical center “Liko-Med”

Publication date
3 October 2018

What is it?

Dysfunctional uterine bleeding (UUH) – vaginal bleeding that is not part of normal menstruation and is not caused by injury or illness.This problem is a consequence of the imbalance of the female sex hormones estrogen and progesterone. The most common cause of this condition is a menstrual cycle in which there is no ovulation. In the absence of an egg, the body does not produce progesterone, without which estrogen provokes a thickening and enlargement of the lining of the uterus (endometrium). When the endometrium is rejected, which can happen at any point in the cycle, it is accompanied by heavy bleeding, often with clots. DMC are most common during adolescence and in women approaching menopause.Other causes of bleeding may include pregnancy, cancer, fibroids, trauma, certain medications, or hereditary bleeding disorders.

What to expect?

With DMC, the intervals between periods may change monthly. There may also be spotting and blood in the urine between periods. Bleeding, either between or during periods, is extremely heavy, and replacement of the pad or tampon is required hourly. Menstrual bleeding can last for more than seven days.If the bleeding is caused by an imbalance in hormones, the cycle usually returns to normal within a few months after starting birth control pill treatment.

Prevalence

About 1 in 10 women will experience excessive vaginal bleeding at some point in their lives.

Treatment

Treatment for DMC usually includes hormonal therapy, such as birth control pills, to restore normal balance and regulate the menstrual cycle if no other cause of bleeding is found.Treatment for abnormal bleeding that is not caused by hormonal problems is determined by the cause.

What can you do yourself?

Any unusual vaginal bleeding should be evaluated by a physician. In addition:

• bed rest helps relieve symptoms;
• Do not take aspirin or other non-steroidal pain relievers, as this may increase bleeding;
• It is necessary to track the number of tampons and pads used to help the doctor determine how much bleeding is.

What makes it worse?

Aspirin and other non-steroidal pain medications that can increase bleeding, blood thinners, physical activity (walking, running) can aggravate the severity of the manifestations of the pathology.

When to see a doctor?

See a doctor for any unusual vaginal bleeding. If the problem is accompanied by dizziness, severe pain or fever, you need to go to an ambulance.

What to ask a doctor?

• What could be causing this bleeding?
• How can the bleeding be stopped?
• What symptoms should be alarming?
• How can you prevent recurrence of the problem?

Making a diagnosis

When making a diagnosis, the doctor examines the medical history and carries out a physical, including a thorough gynecological, examination.Tests to identify or rule out possible causes of bleeding may include: smear, pregnancy test, blood test (to check for anemia), endometrial biopsy, ultrasound, hysteroscopy, and possibly dilation and curettage.

Risk factors

• Adolescence.
• Recent onset of menses.
• The period before menopause.

90,000 Complications after tooth implantation – Dentistry in Voronezh “Holident”

Dental implantation – a method of prosthetics based on an artificial tooth root.With this method, the functionality of the jaw can be restored and a beautiful smile restored.

Placing an implant is an operation, and therefore the procedure is associated with certain risks. Most of the postoperative complications are natural, associated with the surgical intervention. These complications are not dangerous and go away without consequences.

But in some cases (with a probability of 1-2%), serious complications may develop, requiring a visit to a doctor.

Possible complications after tooth implantation

Some complications come on quickly, others appear over time.The first group includes:

• Pain in the jaw – normally disappears within a week; if, after 7 days from the date of the procedure, the pain does not stop, and even intensifies, this may indicate an inflammatory process or nerve damage.

• Edema – disappears within a few days; if the swelling has increased in size or painful sensations appear, this is a sign of possible inflammation.

• Temperature rise is a natural reaction of the body to the introduction of a foreign body; if the temperature remains elevated after a week, see a doctor.

• Bleeding gums – normally minor bleeding is possible in the place where the gum incision was made; if there is severe bleeding, this indicates vascular damage.

• Numbness – the effect of anesthesia usually ends within 24 hours; if the numbness persists over time, the nerve may have been damaged during the operation.

Sometimes the effects of implantation appear after several months or even years.The most common are:

• Peri-implantitis – inflammation of the tissue around the implant, which can lead to the destruction of gingival and bone tissue.

• Implant rejection – can be suspected by the following signs: inflammation, deepening of the gingival pocket, implant mobility.

These complications can occur if the operation was not performed correctly or the patient did not inform the doctor about the contraindications.

Complications during implantation of the upper jaw

Due to the proximity of nerve bundles, vessels and maxillary sinuses, these operations are considered difficult.

Possible complications:

• Damage to the nasopalatine neurovascular bundle – manifested by bleeding or numbness.

• Damage to the sinuses (maxillary sinuses) – can lead to swelling, inflammation, impaired nasal breathing.