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Tamoxifen - instructions for use, release form, composition, indications, side effects, analogues and price

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This document is not a substitute for instructions to the drug. The drug can not be administered independently. This drug is prescribed only by a doctor.

What is tamoxifen?

Tamoxifen is one of the most well-known, widely used drugs in the treatment of breast cancer. Tamoxifen is the “gold standard” in the prophylactic treatment of breast cancer in women with estrogen and progesterone positive receptors.

What is the mechanism of action of tamoxifen?

It is known that in some cases protein cells are located on a tumor cell. Receptors that can bind to female sex hormones and lead to the stimulation of tumor cell growth. Tamoxifen, falling on the surface of the tumor cell, blocks receptors and prevents the tumor cell from multiplying.

Indications for appointment of tamoxifen?

Estrogen-dependent (hormone-dependent breast cancer) in women (especially in menopause) and in men.

Tamoxifen can be used to treat ovarian cancer, endometrial cancer, kidney cancer, melanoma, soft tissue sarcoma (if there are receptors in the tumor), in the treatment of prostate cancer with resistance to other drugs.

Is it possible to determine the sensitivity to tamoxifen?

Contraindications

Pregnancy and breastfeeding

Hypersensitivity to the drug.

Side effects

Hot flashes (hot flashes)

Vaginal discharge or bleeding

Genital itching

Hair loss (complete loss is rare)

Pain in the tumor area

Weight gain

Fever

Visual impairment (including changes in the cornea, cataract, retinopathy)

Temporary decrease in leukocyte and platelet counts

Temporary elevation of liver enzymes (ALT and AST)

Fatty infiltration of the liver, cholestasis (stagnation of bile), hepatitis

Separately, the following side effects should be highlighted:

  • increased risk of blood clots and thromboembolism (risk increases with the simultaneous appointment of tamoxifen with chemotherapy)
  • endometrial hyperplasia (growth) and an increased risk of uterine cancer.
  • Bone pain at the start of the drug (they subsequently decrease and pass)
  • Termination of the menstrual cycle or irregular menstruation in women in the premenopausal period
  • The occurrence of cystic ovarian tumors

What is a flash reaction?

At the beginning of taking tamoxifen, "symptoms of exacerbation of the disease" may occur: pain in the area of ​​a breast tumor, pain in the bones, weakness, hot flashes. This reaction, called the “flash”, is gradually reduced with continued use of tamoxifen. Many patients regard this reaction as a pronounced side effect and stop taking the drug. If you notice a similar reaction - contact your doctor and discuss the situation.

How to take tamoxifen?

Tamoxifen can be taken regardless of the meal, with a small amount of water.

Is it possible to replace tamoxifen with a drug with fewer complications?

Yes. The second-generation drug Toremifen has fewer side effects.

In women in menopause (at the termination of the menstrual cycle), alternatives to tamoxifen are drugs from the group of aromatase inhibitors (extraza, vera-anastrozole, femara, arimidex).

In women with a preserved menstrual cycle, turning off ovarian function (zoladex, buserelin, goserelin) can be used as hormone therapy.

What are the benefits of tamoxifen?

Tamoxifen is an affordable drug with proven high efficacy against breast cancer.

What are the disadvantages of tamoxifen?

The disadvantages of tamoxifen are related to its side effects. It is important to note that side effects are inevitable with long-term use of any drug.

Are there differences in tamoxifen depending on the country of production?

According to reviews of my patients and my observations, there are no particular differences in the quality of tamoxifen of Russian or Finnish production. My patients complained of too many complications (possibly associated with poor cleaning) of Mexican-made tamoxifen.

What should I do when taking tamoxifen?

Be under the supervision of the attending physician

Regularly undergo a gynecologist examination (given the ability of tamoxifen to adversely affect the uterus)

Dmitry Andreevich Krasnozhon, especially for the site "Everything about breast cancer" (www.breast-cancer.ru), last revised December 12, 2014

Copyright © D.A. Krasnozhon, 2008-2018. Copying of materials is allowed only with indication of authorship.

The mechanism of action of the drug

Instructions for use Tamoxifen (Tamoxifenum) includes information that the drug has antiestrogenic and antitumor effects. It is a nonsteroidal drug that competitively inhibits (suppresses) peripheral estrogen receptors in target organs and tumors. As a result, a compound is formed with receptors and transfer cofactors, which is translated into the cell nucleus and does not allow hypertrophy to develop. A single dose of the dose leads to the preservation of the ability to block estrogen for several weeks.

The drug leads to the release of pituitary gonadotropic hormones, causes ovulation. When oligospermia in men, it leads to an increase in serum concentration of estrogen, luteotropin, testosterone, follitropina. The substance and some of its metabolites are potent oxidase inhibitors, exhibiting mixed functions of liver cytochrome monooxygenases.

According to research, in some patients, the drug has an effect on estrogen-independent tumors. Substance partially estrogenic effect on the fatty composition of blood plasma, bone tissue and endometrium. The active ingredient has a high absorption, reaches a maximum concentration after 4-7 hours after administration.

Sustained plasma concentration develops after one month of constant intake of 40 mg of the drug per day. The active substance is 99% bound to plasma proteins (albumin), metabolizes in the liver, is demethylated, hydroxylated and conjugated. Metabolites after conjugation are excreted in feces, urine in two stages. The initial period lasts 7-14 hours, the final slow interval is a week.

Indications for use

Purpose Tamoxifen due to its ability to have a pronounced therapeutic effect in the following pathologies:

  • endometrial oncology,
  • malignant transformations of breast tissue (especially often in women during menopause),
  • ductal breast cancer
  • estrogen-sensitive tumors,
  • breast cancer in women and men (after castration),
  • as a component of complex therapy in breast oncology (a combination of surgical, medical and radiation treatment),
  • for the treatment of gynecomastia in men (effective in the early stages and provided that the pathology is caused by the use of anabolic steroids).

special instructions

In the instructions for Tamoxifen there is a section of special instructions. It describes useful guidelines and recommendations for the patient:

  1. According to research, the drug has genotoxic and mutagenic effects, so during treatment women of reproductive age should be carefully protected from unwanted pregnancy.
  2. If a woman in the premenopausal period began to take pills, you should undergo a medical examination before taking them to prevent pregnancy. After 8 weeks from the end of the course, you can cancel contraception.
  3. Rarely, when taking the drug can suppress menstruation. During therapy, the frequency of changes in the endometrium increases, the formation of polyps, the development of cancer tumors, and tissue hyperplasia are possible.
  4. If during treatment there are abnormal bleeding, then you need to consult a doctor.
  5. Patients with bone metastases are at high risk of developing hypercalcemia.
  6. It causes ovulation.
  7. During treatment, it is necessary to control the level of calcium, leukocytes and platelets in the blood, blood pressure, state of vision. For hyperlipidemia, cholesterol and triglyceride tests are added to this list.
  8. During therapy, you can not drive vehicles, dangerous mechanisms, the tool affects the hypothalamus.

During pregnancy

As a result of scientific research conducted by pharmaceutical companies, it was found that the active ingredient of the drug can have a teratogenic (disfiguring) effect on the fetus. Taking tamoxifen during pregnancy is prohibited. During the period of breastfeeding, the drug is also prohibited, otherwise breastfeeding should be stopped.

Drug interactions

Tablets Tamoxifen may not be combined with all medications. There are combinations that you need to pay close attention. They are listed in the instructions:

  1. Simultaneous medication with cytostatics, diuretics leads to thrombosis.
  2. The combination of the drug with allopurinol leads to a hepatotoxic effect, with aminoglutetimid - to a decrease in the concentration of the active substance in plasma and globulin.
  3. The drug leads to prolongation of the neuromuscular blockade, which is caused by atracurium.
  4. When taking bromocriptine, dopaminergic effects are enhanced.
  5. The combination of an agent with the anticoagulant Warfarin leads to the risk of hematuria, hematomas, and an increase in prothrombin time.
  6. Due to rifampicin, the concentration of tamoxifen in the blood plasma is reduced.
  7. Estrogens may reduce the effect of the remedy.

Endometrial hyperplasia in patients receiving tamoxifen: the likelihood

Tamoxifen is a semisynthetic hormone drug containing estrogen. It is used for cancer of the breast in women. It has the inhibitory effect of estrogens, which cause breast cancer, but at the same time increases the level of the hormone in the formation of excess endometrium in the uterine cavity. Endometrial hyperplasia in patients receiving tamoxifen predominantly affects women over the age of 40 years who have a postmenopausal period.

The risk of hyperplasia when taking tamoxifen

Endometrium is a slimy epithelium that covers the entire uterine cavity. It consists of a large number of glands, feed from the stroma - a special tissue that nourishes the gland with nutritive components. The course of treatment while taking tamoxifen can cause the growth of glandular tissue of the mucous membrane. This process is explained by scientific studies that have discovered the direct effect of the incoming hormone estrogen.

The peak in the incidence of endometrial cancer when taking tamoxifen is observed after 5 years of use of the prescribed drug. During breast cancer treatment, significant improvements in the prognosis and getting rid of the disease are recorded. But in 20% of cases endometrial hyperplasia occurs after treatment with tamoxifen.

According to previous studies, an important nuance was observed - in 100% of breast cancer patients who did not take tamoxifen, malignant processes formed in the structure of the mucous epithelium of the uterine cavity with time.

When taking tamoxifen, an increase in estrogen is observed, which leads to endometrial cancer of the uterine cavity. The mucous glands increase in multiple sizes. To suggest the onset of the precancerous stage, the ratio of the glands per stroma is approximately 2: 1.

Most often, the pathology develops in the period of menopause, accompanied by chronic anovulation with incomplete or failed maturation of the egg. Such violations are much less common in young women and adolescents. If a disease is recorded before the age of 40, then hormonal disorders, the absence of a constant menstrual cycle often become the cause.

With the onset of full puberty, endometrial hyperplasia is a particular danger for owners of ovarian pathologies, polycystic disease. On average, one in ten women suffers from the proliferation of the lining of the uterus, regardless of the presence of breast cancer or taking tamoxifen.

The development of endometrial hyperplasia with increasing dosage of the drug occurs after 2 years of administration. Treatment that does not require an increase in the amount of tamoxifen is mainly carried out for 5 years or more. The likelihood of side effects increases with each year of therapy.

Women who take tamoxifen for their intended purpose must undergo several instrumental examinations. Modern diagnostics is able to determine the degree and type of endometrial hyperplasia in time and with great accuracy.

  1. Echographic monitoring. Ultrasound examination, which is able to determine the endometrial layer with an accuracy of 69% to 93%. If necessary, the patient is injected contrast fluid, which allows to make the examination more accurate. The necessary procedure in the appointment of scraping extra epithelium, prevents the defeat of healthy areas of the body.
  2. Histological examination. It is carried out in two ways: scraping and aspiration. During the aspiration method, saline is injected into the uterine cavity. Then, the contents are aspirated into the syringe and the tissue is sampled for examination. But aspiration is contraindicated in cases of suspected cancer, therefore curettage is used. The material is scraped using a scrubbing treatment. The cervix is ​​dilated with a special device - a dilator and the necessary material is scraped out of the cavity.
  3. Biopsy. For this method, the excision of cervical tissue. Based on this material, a material is prepared for histology.

Histological examination is considered the most accurate way to diagnose. The reliability of the results of the survey is 98%. If cysts and polyps were found during curettage, then it is indicated to remove them and also send them to the study. The bulge consisting of carcinoma will crumble, and surgical intervention must be immediately stopped.

The question of whether to refuse to take tamoxifen worries women who have already experienced its side effects. Scientists have shown that an incomplete course of the drug in most cases leads to a recurrence of the cancer process. Tamoxifen has proven to be highly effective in treating breast cancer. Especially in combination with radiation therapy.

The drug is prescribed in the postoperative period, having preventive properties. During the rejection of the drug before the end of the course of treatment, the cancer returned in 40% of cases. Tamoxifen therapy is one of the few ways to cure or prevent the recurrence of breast cancer.

The risks of side effects of the drug are not worth the risk of developing or unsuccessfully treating breast cancer. According to research data, less than 1% of women suffer from endometrial cancer while receiving tamoxifen. With the abolition of the drug or its absence, endometrial cancer occurs ten times more often. For constant monitoring and monitoring of the condition of the mucous membrane, it is necessary to undergo diagnostic measures once a year.

To refuse the drug is necessary only in the presence of individual intolerance or pregnancy.

If necessary, the drug can be replaced by another, with a less pronounced effect. But perhaps suitable for the individual characteristics of the course of cancer.

Substitution of tamoxifen is possible with the following drugs:

  1. Torimefen. It has a small amount of side effects. Designed to treat hormone-dependent cancer. The drug is a means of the second generation.
  2. Arimidex. It is prescribed if breast cancer is able to resist hormone therapy. It is the main substitute for tamoxifen.

In the event that the menstrual cycle is preserved, the following medications are prescribed to replace the drug, which can turn off the ovary, thereby reducing the production of estrogen:

Tamoxifen has its counterparts, which may have a slightly reduced efficiency: Nolvadex, Bilen, Tamoxen.

Before prescribing any hormonal drug for treating breast cancer, a tumor can be analyzed for sensitivity to the hormone estrogen and progesterone. This procedure allows you to assign the desired drug directional with great accuracy.

side effects in women with breast cancer

This drug is widely known and has been successfully operating for a very long time. Many women thanks to him, got almost a second life. A feature of the drug is the recognition of tumor cells and bring them to complete destruction.

Tamoxifen is prescribed most often to women diagnosed with breast cancer.

However, due to the ability to destroy cells with hormone receptors susceptible to Tamoxifen, this drug is prescribed to patients with other forms of cancer, such as:

  • ovarian cancer
  • endometrium,
  • in certain forms of skin, kidney and soft tissue cancers.

Naturally, such a serious drug requires an appointment only by a doctor, after a certain consultation and examination.

Тамоксифен (Нопвадекс, Тамоксимед) – состоит в группе гормональных препаратов, предназначенных для перорального приема в виде таблеток. Таблетки Тамоксифен принимаются каждый день по схеме, назначенной врачом.

The course is developed only by a doctor who looks at the general condition of the patient, treatment regimens, and analyzes. If a woman has a mammary gland tumor, endometrium of the kidneys, then from 10–20 mg / day (1-2 times a day), the dose can be increased to 30–40 mg / day (2 times a day), and in some cases up to 60 mg / day (3 times a day). Repetition of the course can be carried out only in 1-2 months. But the duration of the full course of treatment is usually 2-3 years.

Anovulatory conditions in women and oligospermia in men are treated according to a different scheme. Another dosage and course duration are also applied. In the case of anovulatory infertility, the initial dose is 10 mg 2 times a day. If necessary, you can apply up to 40 mg 2 times a day. The course lasts only 4 days.

Tamoxifen cannot completely stop the aromatization of steroids. It can only stop estrogen receptors for a certain period.

In this regard, after its use a sharp jump in the level of estrogen in the blood can be observed. Aromatase inhibitors that are taken along with a course of anti-estrogen drugs come to the rescue. The most effective is considered Proviron, which prevents aromatization of steroids against the background of the action of Tamoxifen, which deactivates estrogen receptors.

Such a combination of drugs, experts say, is the most optimal and suitable for most patients. When using Tamoxifen during radiotherapy or cytostatic therapy, there is a risk of thrombosis. If, however, to carry out simultaneous intake of this drug with allopurinol, there is a likelihood of abnormal liver function. Significantly reduce the effect of tamoxifen hormone-containing drugs, especially those that contain estrogen.

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Tamoxifen is very sensitive to sunlight. Its active substances are destroyed by direct rays. The most suitable storage space is a locker or a dark place in the corner of the room.

Post-course therapy is a prerequisite, despite the fact that the course was difficult or easy. Tamoxifen is a drug that should be used for the prevention and hormonal disorders. In this regard, the usual dosage is 10-30 mg / day. In some cases, the dosage can be increased to 40 mg / day. Reception of preparations proceeds within two three weeks.

Tamoxifen is strictly forbidden to use at the end of the course steroids containing Trenbolone or Nandrolone. This period is characterized by an increase in the level of estrogen in the blood, which provokes the development of side effects.

Tamoxifen is quite an aggressive drug. Its use is associated with a number of health complications observed in virtually every patient. In addition, Tamoxifen has individual contraindications.

Most often, experts observe:

  • severe thrombocytopenia,
  • hypercalcemia:
  • leukopenia,
  • kidney disease
  • increased blood clotting,
  • diabetes,
  • hormonal imbalance
  • hepatic colic.

It is forbidden to use this drug during pregnancy or lactation period. Tamoxifen medication affects many human systems. But in most cases, health disorders are transient, intermittent.

In most cases, the menstrual cycle is disturbed, its regularity disappears. However, a clinical change in the blood composition has never been observed.

After the end of taking the medication most often the above disorders go away. But it is not recommended to stop taking Tamoxifen and you should not even change the scheme by which this drug is taken. However, there are cases when the use of the drug should be discontinued, for example:

  • vaginal bleeding,
  • changes in various blood and liver samples first.
  • increased blood clotting and, as a result, thrombophlebitis and thromboembolism, more common in women who smoke.

Tamoxifen is a drug that should be taken very carefully, as it can cause side effects. It is necessary to pass a complex of examinations with specialists, to carry out the necessary analyzes.

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Special attention should be paid to patients with cardiovascular diseases, in particular thrombophlebia, and even if it has already passed. Another point of health that must be taken into account are all sorts of ophthalmic disorders. The drug itself can cause changes in the conjunctiva and retina, provoke retrobulbar neuritis.

In relation to the gastrointestinal tract, Tamoxifen causes nausea and even vomiting, decreased appetite, constipation occurs. The central nervous system manifests itself as headache, dizziness, depression, drowsiness, confusion of thoughts.

In many cases, the skin while taking the drug is covered with a rash, redness, it becomes dry, itchy in the genital area, hair loss occurs. In some cases, bleeding and ovarian enlargement are observed.

Positive for all these side effects is the fact that taken thrombophlebitis causes them far from every person. At the same time, in women suffering from cancer, the useful coefficient from taking the drug is huge.

Everyone knows that drinking drugs does not bring benefits while taking medicines. However, ethanol, which is part of Tamoxifen allows the use of certain doses of alcohol. Of course, the patient is obliged to consult with your doctor.

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Contraindications to the drug

This drug is strictly prohibited to use:

    during pregnancy, if a woman only plans to become pregnant, because the drug can harm the unborn baby (in order to be sure that there is no pregnancy, you should start taking tamoxifen after the start of your period or take a test), during the breastfeeding period, if you have an allergic reaction to this drug.

If a woman takes tamoxifen, and the delay in menstruation occurred on this background, you should immediately stop taking the medication and consult a doctor. Although the drug itself causes irregular menstruation, it can nevertheless be a pregnancy. Therefore, in any case, you need to consult a doctor.

If a woman plans to take tamoxifen to reduce the risk of breast cancer, its use is not recommended in the following situations:

    in the past there was an “excess with a thrombus” that required treatment (deep vein thrombosis, etc.), a woman takes anticoagulants (for example, warfarin), a long stay in an immobilized condition (treatment after fractures and so on), various forms of thrombophilia ( increased risk of blood clots).

Effect of tamoxifen on the uterus (endometrium)

In postmenopausal women, tamoxifen has an estrogen-agonist property and can stimulate endometrial proliferation, which leads to atypical hyperplasia and the appearance of uterine cancer. However, the drug in premenopausal patients has an effect on the endometrium as an antiestrogen.

It has been proven that in this category of women it does not increase the risk of developing polyps, hyperplasia or cancer of the uterus.

Do you continue to drink tamoxifen, if you started your period? In premenopausal patients, this drug acts on the ovaries like estrogen, it is to some extent involved in the restoration of the menstrual cycle in women who received chemotherapy, and does not have a detrimental effect on the endometrium. Therefore, do not worry about the resumption of the menstrual cycle of this category of women.

Release form and composition

The drug is available in the form of tablets: round, flat-cylindrical in shape, having a white or white color with a cream-gray tinge, tablets of 10 mg each are risky, 20 mg each - and faceted on one side. The tablets are packaged in 10, 20, 30, 40, 50, 60, 90, 100, 120, 150 or 300 pieces in blister packs, polymeric containers, plastic bottles or dark glass cans.

The active ingredient is tamoxifen (in the form of tamoxifen citrate). The content of the active substance in one tablet is 10 or 20 mg.

Excipients: lactose, corn starch, povidone, magnesium stearate, sodium starch glycolate, purified water.

Dosing and Administration

Tamoxifen is taken orally once or twice a day (in the morning or in the morning and in the evening). Tablets should be swallowed whole and drink a small amount of liquid.

The specific dosage is determined by the attending physician depending on the evidence. The standard dose is 20 mg daily for a long time. The maximum daily dose should not exceed 40 mg. If there are signs that indicate the progression of the disease, the drug is canceled.

In the treatment of breast cancer, 10–20 mg of Tamoxifen is prescribed 2 times a day (course dose - from 2400 to 9600 mg). In the case of regression of the disease, treatment should continue for another 1-2 months.

Side effects

  • digestive system: vomiting, increased activity of hepatic transaminases, nausea, constipation, isolated cases - cholestasis, fatty infiltration of the liver, hepatitis,
  • cardiovascular system: thromboembolism, phlebitis, edema,
  • circulatory system: rarely - leukopenia, thrombocytopenia,
  • nervous system: rarely - headache, depression, retrobulbar neuritis, dizziness, fatigue, drowsiness,
  • reproductive system: discharge or bleeding from the vagina, itching in the genital area, endometrial hyperplasia, reversible cystic ovarian tumor, in the premenopausal period - irregular menstrual cycle or amenorrhea, isolated cases - uterine sarcoma, endometrial cancer,
  • endocrine system: in women - an increase in body mass, hot flashes, in men - a decrease in libido, impotence,
  • organs of vision: rarely cataract, keratopathy, retinopathy,
  • integuments: itching, rash, alopecia,
  • other: fever, pain in lesions and bones, leg cramps.

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How to distinguish uterine bleeding from menstruation?

Blood is the fluid medium of the body, which forms the basis for the vital activity of the whole organism. Any blood loss - minor or massive - is dangerous for the body.

Women regularly lose several hundred milliliters of blood during menstrual flow. Another option for blood loss is uterine bleeding, which is dangerous for a woman at any age.

But how to distinguish menstruation from bleeding? You can understand and get an answer only by comparing the discharge during menstruation and bleeding caused by different reasons. That is, there are a number of physiological conditions of the female body, as a result of which blood can be released from the uterus, and everything that does not fall under this category is equal to pathology. How to distinguish bleeding from menstruation?

Comparative diagnosis of menstrual and uterine bleeding

Normally, a woman's menstrual cycle ranges from 28 to 35 days. All that goes beyond these limits can be distinguished as pathology and subjected to detailed examination. The duration of discharge with monthly 3 - 5 days, in rare cases, 7 days.

Some women’s menstrual cycle does not stabilize for a long time, especially in the early years after menarche, or because of the activity of the inflammatory process. As a rule, over time, women become accustomed to the lack of regular menstruation, and their sudden discharge does not frighten them. In such cases, women are required to be able to determine or distinguish that it is not the right time for menstruation or uterine bleeding.

The ability to distinguish the monthly allocation from others you will need:

  • endometriosis,
  • uterine fibroids,
  • endometrial polyp,
  • benign and malignant tumors of the cervix and body of the uterus.

    Postpartum bleeding

    First you need to figure out what it means to normal bleeding after childbirth or lochia. During pregnancy, the placenta is formed, providing life to the fetus. After childbirth, the remnants of this formation are excreted through minor but prolonged bleeding. The uterus passes through the involutive stage — a return to normal physiological parameters. The inner layer of the uterus necrosis, and gradually rejected in the form of lohii. The duration of normal discharge after birth is about 6 weeks.

    Monthly after childbirth does not occur throughout the year, if breastfeeding is done. With artificial feeding, a kind of “respite” from menstruation lasts about several weeks after birth.

    How to distinguish menstruation from bleeding after childbirth:

    1. Time of occurrence. Lochias appear immediately after childbirth, when menstruation is out of the question,
    2. Duration. They are allocated for a long time - a few weeks (maximum 8), gradually decreasing. About the length of the month you read above
    3. Colour. The first days after birth the color of blood is bright red. From 4 to 10 days the composition varies slightly, impurities appear and the color may be pinkish or red-brown. After 10 days from the birth of the selection of light color, consisting of white blood cells, mucous and epithelial cells,
    4. Heavy current. More abundant discharge in the first days after birth, gradually the power of the stream decreases. Normally, with natural delivery, postpartum bleeding is 500 ml, and at caesarean section - 1000 ml. Increasing these boundaries requires an urgent request for medical care. For comparison, the first days of menstruation the blood flow is strong, but it lasts 2 - 3 days and the total blood loss during this time is 40-80 ml,

  • Additional clinic. Abundant discharge after childbirth predicts the development of other clinical symptoms - oliguria, tachycardia, shallow breathing, excessive sweating, dizziness, thirst, etc.
  • Women are prepared in advance, so after pregnancy, they usually have an idea of ​​lochia. Therefore, to distinguish the discharge after childbirth and menstruation is not difficult.

    Implant bleeding

    Not every woman suspects about pregnancy, but some departments have already begun to appear. You do not think that in the first weeks of pregnancy may be bleeding? Abundant can hardly be called, but still they are.

    This happens in the process of implanting a fertilized egg into the wall of the uterus. The main differences of discharge during pregnancy from menstruation and uterine bleeding are the recent sexual intercourse committed without contraceptives, the first signs of pregnancy:

    as well as a mass of gently pink color that lasts only a few hours. After it turns out, and a positive hormonal pregnancy test.

    Uterine bleeding with functional pathologies

    Suppose monthly periods come at the appropriate time, but something bothers you and the general condition is different from the usual. The following clinical symptoms will help to distinguish between the usual heavy periods and uterine bleeding:

    Complete swabbing or pads in less than an hour. Repeating this situation more than once,

  • Long-term discharge for more than 7 days, and pregnancy and childbirth were not there before, to suspect lochia,
  • Compared to normal menstrual periods, you notice an increasing amount of dark brown clots,
  • From massive blood loss, you feel constant weakness, dizziness and pallor,
  • Reduced physical performance. Painful copious discharge does not allow even ordinary business
  • When giving blood for a general hematological analysis, the diagnosis of "anemia",
  • Persistent pain in the lower abdomen, encircling in nature.

    The presence of two of the above symptoms is a sign of the need for additional examinations.

    Bleeding with inflammatory diseases of the uterus

    In another way they are called - ovulatory uterine bleeding. As a rule, causes of adhesions are fallopian tubes, inflammation of the ovaries, etc. Symptoms that help distinguish them from menstruation and lohii after pregnancy:

    • Between the monthly period, the interval is extended or shortened, and after that the well-deserved monthly “according to the schedule”
    • Almost throughout the entire menstrual cycle there is a slight spotting, periodically appearing and disappearing,

    Ovulatory uterine bleeding appears in women suffering from infertility, in the history of numerous spontaneous abortions.

    Dysfunctional uterine bleeding

    In this case, the causes of uterine bleeding are hormonal imbalance, psychological stress, abortion, the use of certain groups of drugs, poor diet.

    Evaluating the physiological development and extinction of the female body, it can be said that dysfunctional bleeding occurs in young girls and women preparing for menopause. This is due to impaired functional ability of the ovaries, which is subject to fluctuations.

    Tamoxifen contains 15.2, 30.4 or 45.6 mg tamoxifen citrate. which is equivalent to 10, 20 or 30 mg of tamoxifen, respectively.

    Tablets are packaged in blisters, containers or plastic bottles of 10, 20, 30, 40, 50, 60, 90, 100, 120, 150 or 300 pcs.

    It has anti-estrogenic and anti-tumor properties.

    Tamoxifen is nonsteroidal anti-tumor anti-estrogen drug. characterized by the ability to competitively inhibitperipheral estrogen receptors in the target organs and the tumors originating from them.

    The result is a complex “tamoxifen receptor transfer cofactor ”Which is translocating to cell nucleus. prevents hypertrophy of estrogen dependent cell regulation.

    The Sport Wiki states that the substance was first synthesized in 1971 and became the first antiestrogenic among the representatives of the class of selective estrogen receptor modulators (IMRE).

    Renders antigonadotropic effect and inhibits education prostaglandins in tumor tissue. slows the development of the tumor process, which is stimulated estrogen .

    After taking a single dose of the drug, the ability to block estrogens persists for several weeks.

    Promotes release pituitary gonadotropic hormones. thereby causing ovulation in women with her absence. With oligospermia in men increases serum concentration estrogen. testosterone . luteotropin and follitropina .

    Tamoxifen and some of its metabolites exhibit the properties of potent inhibitors (oxidases) with mixed functions (monooxygenases) of the liver cytochrome P450 system. However, how clinically significant these effects are is not known for sure.

    In some cases, Tamoxifen is effective in estrogen independent tumors. Substance has a partial estrogen-like effect on the lipid spectrum blood plasma . endometrium and bone tissue .

    Tamoxifen absorption is high, TCmax - from 4 to 7 hours after oral administration of the tablet. A steady plasma concentration is observed 4 weeks after the start of treatment with a dosage of 40 mg / day.

    WITH plasma albumin substance is 99% bound. Metabolization occurs in the liver by demethylation, hydroxylation and conjugation and with the participation of the isoenzyme CYP2C9.

    Metabolites are excreted primarily with the contents. intestines and partly by the kidneys (small amount). Removal is carried out in two stages. The initial half-life of the main metabolite circulating in the systemic circulation is from 7 to 14 hours, the final slow half-life is 7 days.

    Bodybuilding applications

    It is no secret that professional sport requires sacrifice. In relation to bodybuilding, this statement is true at 200%. It is impossible to achieve such indicators of muscle gain by training alone. In the 70s, the anabolic steroids craze began. Anabolic steroids - substances that enhance the anabolic processes in the body, mainly the synthesis of proteins and macromolecules. The active synthesis of muscle proteins leads to muscle hypertrophy, increase physical strength.

    In medicine, anabolic steroids are used for dystrophic diseases, to recover from severe injuries, burns, physical developmental delay, and others.

    Athletes using anabolic steroids, sacrifice first of all their health. The list of side effects of anabolic steroids is huge. Among them:

  • accelerated progression of atherosclerosis,
  • Iron-deficiency anemia,
  • peripheral edema,
  • dyspeptic symptoms
  • abnormal liver function, jaundice,
  • hypocoagulation, which is prone to bleeding,
  • hepatonecrosis,
  • liver cancer,
  • cholestatic hepatitis,
  • hypercalcemia,
  • in women: masculinization (the acquisition of traits characteristic of men).

    The use of steroids wears heart muscle, no wonder many bodybuilders die in the prime of myocardial infarction.

    Normally, men in the body estrogens are found in very small quantities. Mostly testosterone turns into estrogen. This transformation occurs with the participation of the cytochrome p450 enzyme system. When using anabolic steroids, testosterone synthesis is induced sharply, the body tries to eliminate the excess hormone, turning testosterone into estradiol, the main female sex hormone. Excess female sex hormone leads to breast growth in men or gynecomastia. There is a delay of water and sodium in the body, the subcutaneous fat is deposited on the female type.

    It is to prevent these side effects and apply tamoxifen. By linking estrogen receptors in breast cells, it prevents gynecomastia and other side effects associated with an increase in estrogen levels.

    Analogs, Dosage

    This is mainly imported drug. In Russia, produced by the pharmaceutical company Ozone.

    The dosage depends on the manufacturer; tablets of 20, 30, 40 mg are found on the market. Basically the most common is tamoxifen 20 mg.

    Pharmaceutical firms offering tamoxifen manufacturers:

    1. Active ingredient: tamoxifen citrate. Country of origin - Austria. Manufacturer manufacturer - Ebeve. Tamoxifen Ebeve: the manufacturer has tablets with a dosage of 10, 20, 30, 40 mg.

    2. Active ingredient: tamoxifen citrate. Country of origin - Finland. Firm producer - Orion Corporation. Dosage 10 and 20 mg.

    3. Active ingredient: tamoxifen citrate. Country of origin - Germany. Manufacturing company - Hexal AG. Dosage 10, 20, 30, 40 mg.

    4. Active ingredient: tamoxifen citrate. Country of origin - Russia. Manufacturing company - Pharmaceutical company Ozone. Dosage 10 and 20 mg.

    There are many different manufacturers of this drug in the world. The availability of drugs from other companies in Moscow pharmacies should not confuse you. After the end of the patent for the exclusive production of the drug, many companies begin to produce analogues, especially if the drug works well. Compliance with the original drug is checked in the laboratory.

    Can antiestrogens be used in the treatment of infertility?

    Anti-estrogens, which include tamoxifen, have a positive effect by reducing the level of gonadotropic hormones in men and women. The effect of using this drug with a decrease in the number of spermatozoa has been proven.

    Since the drug blocks the production of the female sex hormone estradiol, the level of gonadotropic homones (luteinizing and follicle-stimulating) and testosterone increases. In 20% of patients a positive effect of tamoxifen on sperm motility was observed.

    Gonadotropic hormones in a woman's body affect the ovary, causing the growth and development of follicles. Luteinizing hormone promotes ovulation, as well as the transformation of the follicle into the corpus luteum. The drug is on the list of drugs for the treatment of male and female infertility.

    pharmachologic effect

    This is an anticancer drug from the group of antiestrogens. It inhibits (blocks) estrogen receptors found in tumors. Therefore, it inhibits the progression of the tumor process, if it is stimulated by estrogen. Tamoxifen (Vero - tamoxifen) is a non-steroidal (non-hormonal) substance. The ability to block estrogens persists for several weeks after a single dose.

    Its other action is related to the ability to cause ovulation in women, if it is absent. It stimulates the release of pituitary gonadotropic hormones. The purpose of the drug for men with oligospermia increases the level of luteinizing and follicle-stimulating hormones, testosterone and estrogen.

    Under the action of luteinizing hormone in men, the permeability of the seminiferous tubules for testosterone increases, therefore, the output of testosterone from the testes increases and its concentration in the blood increases.

    Follicle-stimulating hormone in men is the main stimulator of the growth of the sperm tubules, so this hormone indirectly increases the level of testosterone in the blood, and provides the process of maturation of spermatozoa.

    Indications for use

  • hormone-dependent breast, ovarian and endometrial cancers,
  • cancer of the kidney, melanoma and soft tissue sarcoma,
  • prostate cancer.

    Vero-tamoxifen is prescribed for anovulatory conditions in women and oligospermia in men.

    Contraindications

  • hypersensitivity to the drug,
  • severe tombocytopenia, leukopenia, hypercalcemia,
  • pregnancy and lactation,

    When taking the medicine, it is necessary to carefully monitor people with kidney disease and diabetes. It is carefully prescribed to patients with ophthalmologic diseases and in the presence of thromboembolic disorders in the past.

    Tamoxifen tablets and dosage

    The dose of tamoxifen tablets (prob-tamoxifen) is determined individually according to indications. Usually, for the treatment of cancer, the drug is prescribed 40 mg or more per day. Tamoxifen should be taken daily. The tablets are taken without chewing, washed down with a small amount of water.

    The daily dose of veno-tamoxifen can be divided into 2 doses (in the morning and evening) or the entire dose in the morning. Duration of treatment is 2-3 years (in the treatment of cancer).

    For the treatment of anovulatory conditions in women and oligospermia in men, different dosages of the drug and the duration of treatment are used. With anovulatory infertility, the drug is taken on 10 mg 2 times a day from the 2nd day of menstruation, only 4 days. In the future, it is possible to increase the dose to 20 mg and 40 mg 2 times a day. Of course, this question must be solved by a doctor.

    When oligospermia, vero-tamoxifen is administered 10 mg 2 times a day. Taking medicine, you need to know about the possible side effects.

    While taking the drug in women, the menstrual cycle may become irregular or the periods may stop completely. Such violations occur with prolonged (for years) taking the drug. Most often, adverse reactions are transient or disappear after reducing the dose of the drug.

    In rare cases, it causes a change in the blood picture. The occurrence of adverse reactions usually does not require discontinuation or changes in treatment regimen, and long-term use of any drug side effects are unavoidable.

    At reception there are special instructions.

    Before treatment with tamoxifen woman must undergo a gynecological examination to exclude pregnancy. Women need to know that it is necessary to use effective contraceptives while taking tamoxifen.

    Patients who receive Vermo-Tamoxifen for a long time should be wary of the appearance of bleeding from the vagina, in which case it is necessary to consult a gynecologist to decide on the further intake of the drug.

    When taking medication, it is necessary to control the content of platelets and calcium in the blood. With caution, the drug is prescribed to persons who initially have a low content of white blood cells and platelets in the blood, and the calcium content is increased.

    It is not recommended to combine tamoxifen tablets with drugs that contain hormones (especially estrogens). Since tamoxifen enhances the action of anticoagulants, with the simultaneous appointment of tamoxifen and anticoagulants, it is necessary to reduce their dose.

    Intermenstrual bleeding

    Small bleeding outside of menstruation or bleeding between periods is fairly common. They are found in many women. Spotting, as a rule, occurs before menstruation or a few days after its completion. However, they can appear on any day in the middle of the cycle. Most often, the nature of such secretions is normal and is not considered a symptom of any serious illness. But the gratuitous occurrence of bleeding, which is abundant in nature, may be a sign of diseases of the uterus and other disorders of the female genital organs.

    It should be pointed out that the normal duration of the menstrual cycle is from 21 to 35 days, the duration of menstrual bleeding is 3-7 days, while blood loss ranges from 40 to 80 ml. Monthly blood loss of more than 50-60 ml contribute to the emergence of an acute shortage of iron in the female body.

    Causes of bleeding in the middle of the cycle.

    Under intermenstrual bleeding understand uterine or vaginal bleeding that occurs during the period between menstruation, earlier or later than the expected date of onset of menstruation. This phenomenon is also known as “vaginal bleeding between menstruation” and is expressed as discharge of blood clots in the middle of the menstrual cycle. Some women attribute this phenomenon to a short cycle, but this is not at all the case. A short cycle (polymenorrhea) provides for strong blood loss occurring on the 13th or 15th day after the end of the last menstruation. Such a phenomenon as polymenorrhea, as a rule, is observed in case of a disorder of uterine contractions under conditions of slow regeneration of the mucous membrane of its cavity, as well as bleeding disorders. Therefore, this kind of phenomenon does not apply to polymenorrhea.

    Intermenstrual bleeding most often occurs on days 10-16 after the end of the last menstrual period. This type of bleeding is not abundant (that is, you can get by using “daily”) and lasts an average of twelve to seventy-two hours. If the intensity of the bleeding does not change, then there is no reason to worry. If blood loss increases, and the duration of bleeding is more than three days, you must attend an appointment with a gynecologist. In case of severe bleeding, an ambulance should be called. It also happens that, having already become pregnant, the woman has the last menstruation, while she does not know at all about conception. Поэтому в случаях, когда такие кровотечения сопровождаются сильными болями, возникает подозрение на внематочную беременность, выкидыш и т.д.

    Intermenstrual bleeding is observed in almost thirty percent of women and is the norm. This phenomenon is caused by fluctuations in estrogen levels during ovulation, which cause a weakening of the endometrium, and bleeding occurs. Most often, in this situation, women are prescribed hormones with estrogen to normalize hormone levels. Bleeding in the middle of the cycle is observed in women with frequent dysfunctions of the urogenital system, and the nature of the bleeding is more intense.

    There are two main types of bleeding that occur between menstruation:

  • bleeding between two periods - intermenstrual bleeding,
  • metrorrhagia - severe uterine bleeding.

    There are several causes of intermenstrual bleeding:

  • hormonal changes or disorders in the body,
  • insufficient amount of thyroid hormones,
  • miscarriage,
  • endometrial diseases of the uterus,
  • use of intrauterine contraception (spiral),
  • start taking birth control pills or discontinue it,
  • starting or stopping estrogen based medications,
  • severe depression or stress
  • cervical disease,
  • carrying out some gynecological procedures (in particular, cauterization and cervical biopsy),
  • taking certain medications
  • vaginal infection or vaginal trauma,
  • benign neoplasms in the cervix, vagina or urethra.
  • It should be said that this type of bleeding does not affect the absence of pregnancy in the future.

    In cases of intermenstrual bleeding, it is recommended to relax more and avoid stressful situations and depressive conditions in every possible way. Therapy of this type of bleeding is necessary if this phenomenon causes pain in a woman and also is caused by the development of serious diseases. In these cases, appropriate treatment is prescribed.

    It is very important to visit a gynecologist to prevent the development of serious diseases with a constant delay of menstruation, with painful menstruation, with abundant or scarce bleeding during menstruation, in violation of their duration. No need to despair if any pathology was identified during the diagnosis, because the treatment of the disease at an early stage is quite effective.

    Spotting in the middle of the cycle.

    Spotting, which is scanty (mostly do not need to use pads), occur more often intermenstrual bleeding. They are expressed in the form of mucus pinkish or light cinnamon from the vagina, which can be seen only on toilet paper. The underwear is not soiled.

    This kind of discharge is observed approximately two weeks before the beginning of menstruation and is absolutely normal. Basically, this period falls on ovulation, so the discharge indicates the readiness of the egg to fertilize. Such secretions help to accurately determine the time of ovulation. increasing the chances of conception.

    Possible causes of mid cycle discharge:

  • an increase in estrogen level during ovulation leads to rejection of the uterine lining,
  • decreased thyroid activity,
  • taking certain medications
  • the release of the egg from the follicle,
  • polyps and fibromas of the uterus. the presence of adhesions,
  • taking oral contraceptives
  • genital tract infections,
  • the presence of an intrauterine device,
  • uterine cancer.

    Pharmacodynamics and pharmacokinetics

    Pharmacodynamics

    Nolvadex - nonsteroidal estrogen antagonist. Specifically binds to estrogen receptors in peripheral and tumor tissues. Thus, it eliminates the effect of estrogens produced in the body and stimulating the growth of cancer cells.

    Slows the progression of the tumor process. After taking a single dose for several weeks, the ability to block estrogens will remain. Causes ovulation in women, in men with oligospermia increases the level of LH and FSH.

    Pharmacokinetics

    When ingestion is rapidly absorbed, and after 5-7 hours in the blood creates the maximum concentration. 99% bound to blood proteins (albumin ). Removal takes place in two phases: the initial T 1/2 is from 8 to 14 h, the final T 1/2 is 7 days. Excreted in the feces, only a small part of the urine.

    Nolvadex is used for:

    Nolvadex tablets are contraindicated in:

    Instructions for use (method and dosage)

    Nolvadex tablets are taken orally without chewing, drinking water. You can take the entire dose at a time in the morning or in two doses - in the morning and in the evening. With breast cancer prescribed 20-40 mg, with endometrial cancer - 30-40 mg. The maximum DM - 40 mg. The treatment is carried out for a long time, often in combination with cytostatic and radiation therapy .

    During treatment, blood clotting, leukocytes, platelets, calcium levels in the blood, and liver function are controlled. An oculist is examined quarterly and a pelvic examination is performed. The drug Nolvadex is ineffective in the presence of metastasis (especially in the liver).

    Interaction

    Nolvadex (Tamoxifen ) enhances the effect anticoagulants. Simultaneous administration of the drug with estrogen-containing contraceptives causes a decrease in the effects of both drugs.

    H2-histamine receptor blockers and antacids may cause premature dissolution of the enteric tablet, so the time between taking these drugs should be 2 hours

    Causes of uterine bleeding

    Causes of uterine bleeding may be different. Often they are caused by diseases of the uterus and appendages, such as fibroids, endometriosis. adenomyosis), benign and malignant tumors. Bleeding can also occur as a complication of pregnancy and childbirth. In addition, there are dysfunctional uterine bleeding - when there is a violation of their function without visible pathology on the part of the genitals. They are associated with impaired hormone production. affecting the genitals (disorders in the hypothalamus-pituitary-ovaries).

    More rarely, the cause of this pathology can be the so-called extragenital diseases (not associated with the genitals). Uterine bleeding can occur with liver damage. in diseases associated with impaired blood clotting (for example, von Willebrand disease). In this case, in addition to the uterine, patients are also worried about nasal bleeding, bleeding gums, the appearance of bruises with minor injuries. prolonged bleeding with cuts and other the symptoms .

    Symptoms of uterine bleeding

    The main symptom of this pathology is the discharge of blood from the vagina.

    Unlike normal menstruation, uterine bleeding is characterized by the following features:

    1. Increased blood flow. Normally, menstruation is allocated from 40 to 80 ml of blood. In uterine bleeding, the volume of blood lost increases to more than 80 ml. This can be determined if it becomes necessary to change hygiene products too often (every 0.5 - 2 hours).

    2. Increased bleeding duration. Normally, menstrual discharge lasts from 3 to 7 days. In uterine bleeding, the duration of blood excretion exceeds 7 days.

    3. Violation of the regularity of discharge - on average, the menstrual cycle is 21-35 days. Increasing or decreasing this interval indicates bleeding.

    4. Bleeding after intercourse.

    5. Postmenopausal bleeding - at the age when menstruation has already stopped.

    Thus, the following symptoms of uterine bleeding can be distinguished:

  • Menorrhagia (hypermenorrhea) - excessive (more than 80 ml) and prolonged menstruation (more than 7 days), while their regularity is maintained (occur after 21-35 days).
  • Metrorrhagia - irregular bleeding. Occur more often in the middle of the cycle, and are not very intense.
  • Menometerorrhagia - long and irregular bleeding.
  • Polymenorrhea - menstruation occurring more often than after 21 days.

    In addition, due to the loss of rather large volumes of blood, iron deficiency anemia (a decrease in the amount of hemoglobin in the blood) is a very frequent symptom of this pathology. It is often accompanied by weakness, shortness of breath. dizziness. pallor of the skin.

    Types of uterine bleeding

    Depending on the time of occurrence, uterine bleeding can be divided into the following types:

    1. Uterine hemorrhages in the neonatal period are scanty bleeding from the vagina. arising most often in the first week of life. They are due to the fact that during this period there is a sharp change in hormonal levels. They pass independently and do not require treatment.

    2. Uterine hemorrhages of the first decade (before puberty) are rare, and are associated with ovarian tumors that can secrete an increased amount of sex hormones (hormonally active tumors). Thus, the so-called false puberty occurs.

    3. Juvenile uterine bleeding - occurs at the age of 12-18 years (pubertal period).

    4. Reproductive bleeding (age from 18 to 45 years) - may be dysfunctional, organic, or associated with pregnancy and childbirth.

    5. Uterine bleeding in menopause - due to impaired hormone production or diseases of the genital organs.

    Depending on the cause, uterine bleeding is divided into:

  • Dysfunctional bleeding (may be ovulatory and anovulatory).
  • Organic bleeding - related to the pathology of the genital organs or systemic diseases (for example, diseases of the blood, liver, etc.).
  • Iatrogenic bleeding - result from the use of non-hormonal and hormonal contraceptives. drugs that thin blood, due to the installation of intrauterine devices.

    Juvenile uterine bleeding

    Juvenile uterine bleeding develops during puberty (age from 12 to 18 years). The most common cause of bleeding in this period is ovarian dysfunction - chronic infections adversely affect the proper hormone production. frequent colds. psychological trauma. physical exertion, improper nutrition. For their occurrence is characterized by seasonality - the winter and spring months. Bleeding in most cases are anovulatory - i.e. due to a violation of hormone production, ovulation does not occur. Sometimes the cause of bleeding can be a violation of blood clotting, tumors of the ovaries, body and cervix, tuberculosis of the genital organs.

    The duration and intensity of juvenile bleeding may vary. Excessive and prolonged bleeding leads to anemia, which is manifested by weakness, shortness of breath, pallor and other symptoms. In any case, the appearance of bleeding in adolescence, treatment and monitoring should take place in a hospital. If you experience bleeding at home, you can provide rest and bed rest, give 1-2 tablets of Vicasol. put a cold heating pad on the lower abdomen and call an ambulance.

    Treatment, depending on the condition, may be symptomatic - use the following remedies:

  • hemostatic drugs: dicine. Vicasol, aminocaproic acid,
  • vitamins
  • iron preparations
  • physiotherapeutic procedures.

    In case of insufficiency of symptomatic treatment, bleeding is stopped with the help of hormonal drugs. Scraping is done only with heavy and life-threatening bleeding.

    For the prevention of recurrent bleeding prescribed courses of vitamins, physiotherapy. acupuncture. After stopping the bleeding, estrogen-progestin drugs are prescribed to restore the normal menstrual cycle. Of great importance in the recovery period is hardening and exercise, good nutrition, treatment of chronic infections.

    Uterine bleeding in the reproductive period

    In the reproductive period, there are a lot of causes of uterine bleeding. Basically, these are dysfunctional factors - when a violation of the correct hormone production occurs after an abortion. against the background of endocrine, infectious diseases, stress. intoxication. taking certain medications.

    During pregnancy, in the early stages, uterine bleeding can be a manifestation of a miscarriage or an ectopic pregnancy. In the later stages of bleeding due to placenta previa, cystic sweep. During birth, uterine bleeding is especially dangerous, the volume of blood loss can be large. A frequent cause of bleeding during childbirth is placental abruption. atony or hypotonia of the uterus. In the postpartum period, bleeding occurs due to the remaining parts of the membranes in the uterus, hypotonia of the uterus, or a bleeding disorder.

    Often the causes of uterine bleeding in the childbearing period can be various diseases of the uterus:

  • myoma,
  • endometriosis of the uterus,
  • benign and malignant tumors of the body and cervix,
  • chronic endometritis (inflammation of the uterus),
  • hormonally active ovarian tumors.

    Pregnancy and childbirth bleeding

    In the first half of pregnancy, uterine bleeding occurs when there is a threat of termination of a normal one, or when an ectopic pregnancy is interrupted. These conditions are characterized by abdominal pain. delayed menstruation. as well as subjective signs of pregnancy. In any case, if there is bleeding after the establishment of pregnancy, it is urgent to seek medical attention. In the initial stages of spontaneous miscarriage with the onset and active treatment at the right time, you can save the pregnancy. In the later stages there is a need for curettage.

    Ectopic pregnancy can develop in the fallopian tubes, cervix. At the first signs of bleeding, accompanied by subjective symptoms of pregnancy against the background of even a slight delay in menstruation, it is necessary to urgently seek medical help.

    In the second half of pregnancy, bleeding is a great danger to the life of the mother and fetus, so they require urgent treatment to the doctor. Bleeding occurs with placenta previa (when the placenta is not formed on the back wall of the uterus, but partially or completely blocks the entrance to the uterus), detachment of a normally located placenta, or at a rupture of the uterus. In such cases, the bleeding can be internal or external, and requires emergency caesarean section. Women who are at risk for such conditions should be under close medical supervision.

    During childbirth, bleeding is also associated with placenta previa or abruption. In the postpartum period, the common causes of bleeding are:

  • reduced uterine tone and its ability to reduce,
  • remaining in the uterus of the placenta,
  • bleeding disorders.

    In cases where the bleeding occurred after discharge from the maternity hospital, it is necessary to call an ambulance for urgent hospitalization.

    Uterine bleeding with menopause

    In menopause, hormonal changes occur in the body, and uterine bleeding occurs quite often. Despite this, they can become a manifestation of more serious diseases, such as benign (fibroids, polyps) or malignant neoplasms. Particularly wary should be the appearance of bleeding in postmenopausal menstruation, when menstruation has completely stopped. It is extremely important to consult a doctor at the first sign of bleeding, since in the early stages, tumor processes are better treatable. For the purpose of diagnosis, separate diagnostic curettage of the cervical canal and the uterus body is performed. Then a histological examination of the scraping is performed to determine the cause of the bleeding. In the case of dysfunctional uterine bleeding, it is necessary to select the optimal hormonal therapy.

    Dysfunctional bleeding is one of the most common types of uterine bleeding. They can occur at any age - from puberty to menopause. The cause of their occurrence is a violation of hormone production by the endocrine system - a malfunction of the hypothalamus. pituitary gland. ovaries or adrenal glands. This complex system regulates the production of hormones that determine the regularity and duration of menstrual bleeding. The following pathologies can cause dysfunction of this system:

  • acute and chronic inflammation of the genital organs (ovaries, appendages, uterus),
  • endocrine diseases (thyroid dysfunction. diabetes mellitus. obesity),
  • stresses
  • physical and mental fatigue,
  • climate change.

    Very often, dysfunctional bleeding is the result of artificial or spontaneous abortion.

    Dysfunctional uterine bleeding can be:

    1. Ovulatory - associated with menstruation.

    2. Anovulatory - occur between menstruation.

    When ovulatory bleeding occurs, deviations in the duration and volume of blood secreted during menstruation. Anovulatory bleeding is not associated with the menstrual cycle, most often occurs after a delayed menstruation, or less than 21 days after the last menstruation.

    Ovarian dysfunction can cause infertility.miscarriage, therefore, it is extremely important to consult a doctor promptly if any irregular menstruation occurs.

    Breakthrough uterine bleeding

    Breakthrough is called uterine bleeding that occurred while taking hormonal contraceptives. Such bleeding may be minor, which is a sign of the period of adaptation to the drug.

    In such cases, you should consult your doctor to review the dose of the means used. Most often, if breakthrough bleeding has appeared, it is recommended to increase the dose of the drug being taken for a while. If the bleeding does not stop, or becomes more abundant, an additional examination should be conducted, since the cause may be various diseases of the reproductive organs. Bleeding can also occur if the uterus wall is damaged by the intrauterine device. In this case it is necessary to remove the spiral as soon as possible.

    To which doctor to treat for uterine bleeding?

    If uterine bleeding occurs, regardless of the age of the woman or girl, refer to gynecologist (to sign up). If uterine bleeding began in a girl or a young girl, it is advisable to contact a pediatric gynecologist. But if for any reason it is impossible to get to that, then you should contact an ordinary gynecologist at the women's clinic or a private clinic.

    Unfortunately, uterine bleeding can be a sign of not only a long-term chronic disease of the internal genital organs of a woman, which requires a routine examination and treatment, but also symptoms of an emergency. Emergency conditions imply acute illness, in which a woman needs urgent qualified medical assistance to save her life. And if such help is not provided for emergency bleeding, the woman will die.

    Accordingly, it is necessary to contact a gynecologist at the clinic for uterine bleeding when there are no signs of an emergency. If uterine bleeding is combined with signs of an emergency, you should immediately call an Ambulance or on your own transport in the shortest possible time to get to the nearest hospital with a gynecological department. Consider the cases in which uterine bleeding should be considered as an emergency.

    First of all, all women should be aware that uterine bleeding at any gestational age (even if the pregnancy is not confirmed, but there is a delay of at least a week) should be considered as an emergency condition, since the release of blood is usually triggered by life-threatening fetuses and future mothers with conditions such as placental abruption, miscarriage, etc. And in such conditions, a woman should be provided with qualified assistance to save her life and, if possible, to preserve the life of the fetus.

    Secondly, uterine bleeding that began during or some time after sexual intercourse should be considered a sign of an emergency. Such bleeding may be due to the pathology of pregnancy or severe trauma to the genital organs during previous intercourse. In such a situation, help to a woman is vital, since in her absence the bleeding will not stop and the woman will die from blood loss incompatible with life. To stop the bleeding in a similar situation, it is necessary to close all tears and injuries of the internal genital organs or to terminate the pregnancy.

    Thirdly, uterine bleeding should be considered an urgent condition, which is abundant, does not decrease with time, is combined with severe pain in the lower abdomen or lower back, causes a sharp deterioration in health, blanching, a decrease in pressure. heartbeat. increased sweating. possibly swooning. A common characteristic of an emergency in uterine bleeding is the fact of a sharp deterioration in a woman’s well-being, when she cannot perform simple household and daily activities (she cannot stand up, turn her head, it is hard for her to talk, if she tries to sit in bed, immediately falls, etc.) , and literally lies or even is unconscious.

    What tests and examinations can a doctor prescribe for uterine bleeding?

    Despite the fact that uterine bleeding can be triggered by various diseases, when they appear, use the same methods of examination (tests and instrumental diagnostics). This is due to the fact that the pathological process in uterine bleeding is localized in the same organs - the uterus or ovaries.

    Moreover, at the first stage, various examinations are carried out to assess the condition of the uterus, since most often uterine bleeding is caused by the pathology of this particular organ. And only if after the examination, the pathology of the uterus was not detected, methods of examination of the ovaries are used, since in such a situation the bleeding is caused by a disorder in the regulatory function of the ovaries. That is, the ovaries do not produce the required amount of hormones in different periods of the menstrual cycle, and therefore bleeding occurs as a response to hormonal imbalance.

    So, when uterine bleeding in the first place, the doctor prescribes the following tests and examinations:

  • General blood analysis ,
  • Coagulogram (indicators of the blood coagulation system) (enroll) ,
  • Gynecological examination (book) and inspection in the mirrors,
  • Ultrasound of the pelvic organs (to sign up) .

    A general blood test is needed to assess the degree of blood loss and whether the woman has anemia. Also, a general blood test allows you to identify whether there are inflammatory processes in the body that can cause dysfunctional uterine bleeding.

    The coagulogram allows to evaluate the functioning of the blood coagulation system. And if the parameters of the coagulogram are not normal, then the woman should consult and undergo the necessary treatment in hematologist (to sign up) .

    Gynecological examination allows the doctor to grope with his hands various tumors in the uterus and ovaries, to determine the presence of inflammation by changing the consistency of organs. A survey in the mirrors allows you to see the cervix and vagina, to detect tumors in the cervical canal or to suspect cervical cancer.

    Ultrasound is a highly informative method that allows you to identify inflammatory processes, tumors, cysts, polyps in the uterus and ovaries, endometrial hyperplasia. as well as endometriosis. That is, in fact, an ultrasound scan allows you to identify almost all diseases that can cause uterine bleeding. But, unfortunately, the informational content of ultrasound is insufficient for a final diagnosis, as this method provides only an indication of the diagnosis - for example, an ultrasound scan can reveal uterine fibroids or endometriosis, but determine the exact location of the tumor or ectopic foci, determine their type and assess the condition of the organ. and surrounding tissue is impossible. Thus, an ultrasound scan allows one to determine the type of pathology present, but to clarify its various parameters and determine the causes of this disease, it is necessary to use other methods of examination.

    When the gynecological examination, examination in the mirrors, ultrasound, and complete blood count and coagulogram are made, it depends on what pathological process was detected in the genitals. Based on these examinations, the doctor may prescribe the following diagnostic procedures:

    So, if endometrial hyperplasia, polyps of the cervical canal or endometrium or endometritis are detected, the doctor usually prescribe a separate diagnostic curettage followed by a histological examination of the material. Histology can tell if there is a malignant tumor or the malignancy of normal tissue in the uterus. In addition to curettage, the doctor may prescribe a hysteroscopy, during which the uterus and cervical canal are inspected from the inside with a special device - a hysteroscope. In this case, hysteroscopy is usually performed first, and then curettage.

    If fibroids or other tumors of the uterus were detected, the doctor prescribes hysteroscopy in order to examine the organ cavity and see the tumor with the eye.

    If endometriosis was detected, the doctor may prescribe magnetic resonance imaging in order to clarify the location of ectopic foci. In addition, when the identified endometriosis, the doctor may prescribe a blood test for the content of follicle-stimulating, luteinizing hormones, testosterone in order to clarify the causes of the disease.

    If cysts, tumors or inflammation in the ovaries were detected, no additional examinations are carried out, as they are not needed. The only thing a doctor can prescribe in this case is laparoscopic surgery (enroll) to remove tumors and conservative treatment for the inflammatory process.

    In the case when the results Ultrasound (enroll). gynecological examination and examination in the mirrors did not reveal any pathology of the uterus or ovaries, dysfunctional bleeding due to hormonal imbalance in the body is assumed. In this situation, the doctor prescribes the following tests to determine the concentration of hormones that can influence the menstrual cycle and the appearance of uterine bleeding:

  • Blood test for cortisol (hydrocortisone),
  • Blood test for the level of thyroid stimulating hormone (TSH, thyrotropin),
  • Blood test for triiodothyronine (T3) level,
  • Blood test for thyroxin level (T4),
  • A blood test for the presence of antibodies to thyroperoxidase (AT-TPO),
  • A blood test for the presence of antibodies to thyroglobulin (AT-TG),
  • A blood test for follicle-stimulating hormone (FSH) levels,
  • A blood test for luteinizing hormone (LH) levels,
  • Blood test for prolactin level (to sign up) ,
  • Blood test for estradiol,
  • Blood test for dehydroepiandrosterone sulfate (DEA-S04),
  • Blood test for testosterone levels,
  • Blood test for the level of globulin that binds sex hormones (SHBG),
  • Blood test for progesterone level 17-OH (17-OP) (sign up) .

    Treatment of uterine bleeding

    Treatment of uterine bleeding is primarily aimed at stopping bleeding, filling up blood loss, as well as eliminating the cause and prevention. Treat all bleeding in the hospital, because First of all, it is necessary to carry out diagnostic measures to determine their cause.

    Methods to stop bleeding depend on age, their cause, severity of the condition. One of the main methods of surgical treatment of bleeding is separate diagnostic curettage - it also helps to identify the cause of this symptom. To do this, scraping the endometrium (mucous membrane) is sent for histological examination. Scraping is not carried out with juvenile bleeding (only if heavy bleeding does not stop under the influence of hormones, and is life threatening). Another way to stop bleeding is hormonal hemostasis (the use of large doses of hormones) - estrogenic or combined oral contraceptives (non-ovlon. Rigevidon. Mercilon. Marvelon).

    During symptomatic therapy, the following medications are used:

  • haemostatic drugs (vikasol, dicinone, aminocaproic acid),
  • uterus-reducing agents (oxytocin),
  • at low hemoglobin values ​​- iron preparations (maltofer, phenules) or blood components (fresh frozen plasma, erythrocyte mass),
  • vitamins and vessel-strengthening drugs (askorutin. vitamins C, B6. AT12. folic acid ).

    After stopping bleeding, they are prevented from resuming. In the case of dysfunction, this is a course of hormonal drugs (combined oral contraceptives or gestagens), a hormone-producing intrauterine device (Mirena). When identifying intrauterine pathology - the treatment of chronic endometritis, endometrial polyps, uterine fibroids. adenomyosis, endometrial hyperplasia.

    Hemostatic agents used in uterine

    Hemostatic agents are used for uterine bleeding as part of symptomatic treatment. Most commonly prescribed:

  • ditsinon,
  • etamzilat,
  • Vikasol,
  • calcium supplements
  • aminocaproic acid.

    In addition, the hemostatic effect in uterine bleeding has uterine contraction - oxytocin, pituitrin, gyfotocin. All of these tools are most often prescribed in addition to surgical or hormonal methods to stop the bleeding.

    Dicine for uterine bleeding

    Ditsinon (etamzilat) - one of the most common tools used for uterine bleeding. It belongs to the group of hemostatic (hemostatic) drugs. Dicineon acts directly on the walls of the capillaries (the smallest vessels), reduces their permeability and fragility, improves microcirculation (blood flow in the capillaries), and also improves blood clotting in places of damage to small vessels. However, it does not cause hypercoagulation (increased blood clots), and does not constrict blood vessels.

    The drug begins to act within 5-15 minutes after intravenous administration. Its effect lasts 4-6 hours.

    Dicine is contraindicated in the following cases:

  • thrombosis and thromboembolism,
  • malignant blood diseases,
  • hypersensitivity to the drug.

    The route of administration and dosage is determined by the physician in each particular case of bleeding. For menorrhagia, it is recommended to take dicinone in pills starting from the 5th day of the proposed menstruation and ending on the fifth day of the next cycle.

    Folk remedies

    As folk remedies for the treatment of uterine bleeding, decoctions and extracts of yarrow are used. water pepper, shepherd's bag. nettle. raspberry leaves. burnet and other medicinal plants. Here are some simple recipes:

    1.Yarrow herb infusion: 2 teaspoons of a dry grass fill in with a glass of boiled water, insist 1 hour and filter. Take 4 times a day, 1/4 cup of infusion before meals.

    2.Shepherd's purse herb infusion: 1 tablespoon of dry grass is poured with a glass of boiling water, infused for 1 hour, previously wrapped, then filtered. Take 1 tablespoon, 3-4 times a day before meals.

    3.Infusion of nettle: 1 tablespoon of dry leaves is poured with a glass of boiling water, boiled for 10 minutes over low heat, then cooled and filtered. Take 1 tablespoon 4-5 times a day.

    The use of folk remedies is permissible only after consulting a doctor. because uterine bleeding is a symptom of various diseases, often quite serious. Therefore, it is extremely important to find the cause of this condition and start treatment as soon as possible.

    Before use, you should consult with a specialist.

    Author: Pashkov M.K.Content Coordinator.

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