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Most women attain menopause between the ages of late 40s and early 60s, the average age being about 51. This is an important milestone in a women-s gynecological history. One major change is altered female hormone levels, and this leads to a lot of physiological changes. From hot flashes to mood swings, there is also increased predisposition to osteoporosis and uterine cancer.

If you have not had your menstrual cycles for close to 12 months, chances are you are into menopause. So, that means absolutely no vaginal bleeding anymore whatsoever. However, if you experience bleeding, even spotting, be on the alert. It is not normal and needs to be examined, and if required, diagnosed and treated.
Postmenopausal bleeding or PMB as it is popularly called can be due to a variety of reasons. While it could be something as trivial as inflammation of the uterine or vaginal lining, it could also be an indication of more severe issues like cancer.

- Atrophic vaginitis - Decreasing hormonal levels lead to increased dryness and therefore inflammation of the vaginal and uterine tissue. This is one of the common causes of bleeding after menopause.
- Endometrial atrophy - Also caused by lower hormone levels, the lining of the body of the uterus gradually thins down and can get inflamed.
- Polyps - Noncancerous growths in the uterus, cervix, vulva, or vagina can also lead to bleeding
- Infections - General infection of any area along the uterine tract could lead to occasional bleeding
- Cancers - Though only 1 in 10 PMB cases turn out to be cancers, the prognosis improves with early diagnosis and intervention.
Diagnosis: As repeated above, reach out to your doctor if you notice postmenopausal bleeding. Diagnostic methods could include the following:
- Physical exam
- Transvaginal ultrasound
- Endometrial biopsy
- Hysteroscopy
- Dilatation and Curettage


Treatment: Needless to say, this would depend on the diagnosis.
For very minor cases with diagnosis like altered hormone levels, no treatment may be required other than modification of the hormone replacement therapy.

For endometrial atrophy and atrophic vaginitis, use of estrogen creams and pessaries would be sufficient.
Polyps would require removal followed by cauterization (application of slight heat) to stop the bleeding.
Cancer - this would depend on the type and location and require a combination of chemotherapy and surgery. Removal of the uterus also may be required in some cases.
So, if you have had bleeding of any sort after ayear of menopause, do not ignore it.

Menorrhagia is menstrual condition characterized by an abnormal loss of blood or heavy, prolonged bleeding. Although heavy bleeding is not uncommon in premenopausal women, menorrhagia is a severe condition which generally interferes with your daily activities. If your vagina bleeds irregularly or between periods, in addition to such heavy bleeding that at least one pad or tampon gets soaked every few hours, it is highly recommended that you seek medical attention.

Symptoms:

Signs and symptoms of menorrhagia include:

Soaking through more than one tampon or sanitary pad for every few hours
The need to use double sanitary protection
Heavy bleeding for weeks on end
The need to wake up at night to change your sanitary protection
Restriction of daily activities due to heavy menstrual flow
Symptoms of fatigue, such as excessive tiredness as well as shortness of breath
Causes:

Although the exact causes are unknown, here are a few causes that may be responsible:

Hormonal imbalance is when there is an hormone imbalance, the endometrium develops in excess and sheds away with menstruation
In Ovary dysfunction, if your ovaries do not ovulate, your body won't be able to produce the hormone progesterone resulting in a hormonal imbalance problem which may lead to menorrhagia
Uterine fibroids are benign tumors which start appearing in your childbearing years
Polyps are small benign growths found on the uterine lining
Adenomyosis occurs when your glands from the endometrium becomes embedded in the uterine muscle
By using Intrauterine device (IUD) menorrhagia may occur as a side-effect
Pregnancy complications, for instance, an ectopic pregnancy can cause it
Inherited bleeding disorders, such as von Willebrand disease
Certain medications like anti-inflammatory drugs
Other medical conditions, like pelvic inflammatory disease or endometriosis
Treatment:

Treatment for menorrhagia depends on a number of factors like the cause and severity of the condition, or your tolerance for specific therapies or medications.

Some drug therapies for menorrhagia include:

Iron supplements
Tranexamic acid
Oral progesterone
Non steroidal anti-inflammatory drugs
Oral contraceptives
Hormonal IUD
If drug therapy is ineffective, other treatment options may include:

Dilation and curettage
Focused ultrasound ablation
Uterine artery embolization
Endometrial ablation
Myomectomy
Endometrial resection
Hysterectomy

Most women attain menopause between the ages of late 40s and early 60s, the average age being about 51. This is an important milestone in a women's gynecological history. One major change is altered female hormone levels, and this leads to a lot of physiological changes. From hot flashes to mood swings, there is also increased predisposition to osteoporosis and uterine cancer.

If you have not had your menstrual cycles for close to 12 months, chances are you are into menopause. So, that means absolutely no vaginal bleeding anymore whatsoever. However, if you experience bleeding, even spotting, be on the alert. It is not normal and needs to be examined, and if required, diagnosed and treated.

Postmenopausal bleeding or PMB, as it is popularly called, can be due to a variety of reasons. While it could be something as trivial as inflammation of the uterine or vaginal lining, it could also be an indication of more severe issues like cancer.



Atrophic vaginitis: Decreasing hormonal levels lead to increased dryness and therefore inflammation of the vaginal and uterine tissue. This is one of the common causes of bleeding after menopause.
Endometrial atrophy: Also caused by lower hormone levels, the lining of the body of the uterus gradually thins down and can get inflamed.
Polyps: Noncancerous growths in the uterus, cervix, vulva, or vagina can also lead to bleeding.
Infections: General infection of any area along the uterine tract could lead to occasional bleeding.
Cancers: Though only 1 in 10 PMB cases turn out to be cancers, the prognosis improves with early diagnosis and intervention.
Diagnosis: As repeated above, reach out to your doctor if you notice postmenopausal bleeding. Diagnostic methods could include the following:

Physical examination
Transvaginal ultrasound
Endometrial biopsy
Hysteroscopy
Dilatation and Curettage
Treatment: Needless to say, this would depend on the diagnosis. For very minor cases with diagnosis like altered hormone levels, no treatment may be required other than modification of the hormone replacement therapy. For endometrial atrophy and atrophic vaginitis, use of estrogen creams and pessaries would be sufficient. Polyps would require removal followed by cauterization (application of slight heat) to stop the bleeding.

Cancer: This would depend on the type and location and require a combination of chemotherapy and surgery. Removal of the uterus also may be required in some cases. So, if you have had bleeding of any sort after a year of menopause, do not ignore it.

What is menopause?
Menopause is that phase in the life of a woman when she can no longer reproduce. It involves the loss of fertility and the cessation of the menstrual cycle. The woman will stop bleeding every month and the ovaries stop producing eggs that can be fertilized. Menopause normally sets on after the age of 40 and bleeding may permanently stop by the age of 50.

Post menopausal bleeding
You are known to reach menopause when you have not been bleeding for 1 entire year. Even a small amount of spotting should not have taken place. Post-menopausal bleeding is when bleeding occurs after a year of attaining menopause. It can be a serious health disorder and requires medical attention without any further delay.

Reasons behind post menopausal bleeding

Polyps that are mostly non-cancerous, unwanted growths on the cervical canal, uterus or ovaries are known to cause post-menopausal bleeding.
Thinning of the endometrium that lines the uterus can cause unexpected bleeding. It can be due to the rapidly receding levels of estrogen in the blood. It is also known as endometrial atrophy.
Endometrial hyperplasia is a condition that leads to the thickening of the inner lining of uterus (endometrium). It also leads to the growth of abnormal and malignant cells.
Endometrial cancer
Other health conditions such as reaction to hormone therapy, infections of the blood or reproductive organs, certain medications and blood-thinning drugs
Cancer of the ovaries, uterus or cervix
How it can be treated?

For diagnosis, you can undergo blood tests, ultrasounds, sonography and biopsy.
Hysterectomy is done to remove the uterus and cervix can be conducted for a complete cure. It also removes the ovaries, fallopian tubes and other lymph nodes.
Chemotherapy and other radiation therapies may be done for those who are in an advanced stage of endometrial cancer.
Medications such hormone regulators must be taken to prevent complications.

Every woman has her own pattern of menstruation. Abnormal bleeding can lead to excessive and unnecessary blood loss and may result into anemia. If a woman notices that the amount and or number of days of menstruation are more... she should get herself checked to find out why is she having excessive bleeding. Many women think that it is good that they are bleeding heavily. But that is a myth.

Causes:

Hormonal imbalance
Polyps or fibroids
Uterine infections
Cancer of the cervix, endometrium, or uterus
Pregnancy
Pre-menopausal age, when there is ovulation and altered levels of hormones
Hormone replacement therapy after menopause
Diagnosis:

Blood test to check hemoglobin level
Pregnancy test
Ultrasound
Endometrial biopsy to check for growths
Hysteroscopy
Management: Once the cause is diagnosed, then depending on the age and the woman s gynecologic history, a treatment plan is made.



Weight loss: Obesity is one of the causes of excessive bleeding so losing weight can help in controlling bleeding. Optimal weight also helps in controlling hormone levels.
Hormonal imbalance: This can be corrected medically. A medicated intrauterine device lthat releases the medication in sustained manner can help in controlling bleeding.
Birth control pills: These are hormones again which can prevent the lining of the uterus from becoming too thick, which in turn contributes to the bleeding. It also helps to regularize the cycles and controls cramping.
Dilation and curettage: A biopsy is obtained from the lining of the uterus by sucking it out or scraping it out. This can guide the doctor to decide what medicine will be best suited to treat the condition. There are many medications available to treat the condition, thus avoiding surgery completely.

Postpartum hemorrhage is a condition where a woman may lose a lot of blood (approximately 500ml to 1000ml) from her vulva shortly after childbirth. This usually occurs within the first 24 hrs of childbirth and can even result in severe blood loss threatening the mother s life in case the blood loss is over 2000 ml. Secondary postpartum hemorrhage can also occur until 12 weeks after childbirth and this extra care should be taken, if there is any such possibility.

Symptoms of postpartum hemorrhage:
1. Rapid increase in heart rate.
2. Feeling dizzy while standing up.
3. Increase breathing rate.
4. Feeling cold and chilly even if the room temperature is normal.
5. Sudden fall in blood pressure levels.
6. Fainting or becoming unconscious.

Causes of postpartum hemorrhage:

Uterine atony: This is a condition in which the uterus contracts and may lead to excessive bleeding. Infection in the placental tissue can also lead to postpartum hemorrhage.
Trauma: This is a very common cause for postpartum hemorrhage. Sometimes, the uterus (womb), vagina, cervix (passage forming the lower end of the womb) and the perineum (area between the vulva and the anus) can get injured. These areas become vascular during the course of pregnancy and may rupture in the process of childbirth causing excessive bleeding.
Tissue: At times, the whole placenta or fetus tissue does not come out of the body after childbirth. This can lead to profound blood loss resulting in postpartum hemorrhage.
Thrombin: This is a disorder which occurs when there is excessive bleeding when the blood fails to clot inside the body.
How can you prevent postpartum haemorrage?

Oxytocin is a substance which is used after the delivery of the baby. This prevents postpartum hemorrhage. It can be administered in the following ways :
As an injection which is directly injected into the blood stream.
After delivery, breastfeeding your baby can also trigger natural oxytocin. This occurs as encouraging the baby to suckle also stimulates the nipples which release oxytocin, thus preventing postpartum hemorrhage.
In the form of intravenous drips mixed in with important medications. IV drips can administer oxytocin along with other important fluids along with it.
Uterine massage is also recommended to prevent postpartum hemorrhage. After delivery, massaging the uterus makes the muscles relax and contract. This reduces the risks of excessive bleeding.
A lot of women can also die due to excessive bleeding after childbirth, especially in developing countries including India. This is a cause for concern and proper care should be taken if you start experiencing these symptoms.

Rare Disease Day is an observance held on the last day of February to raise awareness for rare diseases and improve access to treatment and medical representation for individuals with rare diseases and their families.
Hemophilia is an inherited genetic disorder that impairs the body's ability to make blood clots because it lacks sufficient blood-clotting proteins (clotting factors).

Epidemiology
Hemophilia is rare, and it has only about one instance in every 10,000 births for hemophilia A and 1 in 50,000 births for hemophilia B. Hemophilia usually occur in males.

Types
There are two main types of hemophilia:

Hemophilia A: It occurs due to unavailability of enough clotting factor VIII.
Hemophilia B: It occurs due to unavailability of enough clotting factor IX.
Other types include:

Hemophilia C: It occurs due to unavailability of enough clotting factor XI.
Parahemophilia: It occurs due to unavailability of enough clotting factor V.
Acquired hemophilia: It is associated with cancers, autoimmune disorders, and pregnancy.
Causes
When a person bleeds, the body pools blood cells together to form a clot to stop the bleeding. The clotting process is encouraged by certain clotting factors.

Acquired hemophilia is a rare variant of the condition. It occurs when a person's immune system attacks clotting factors in the blood. It can be associated with the following factors:

Pregnancy
Autoimmune conditions
Cancer
Multiple sclerosis
Signs and Symptoms
It may vary, depending on the level of clotting factors. If the clotting factor level is mildly reduced, the patient may bleed only after surgery or trauma. If the deficiency is severe, the patient may experience spontaneous bleeding symptoms which include following signs and symptoms:

Unexplained and excessive bleeding from cuts or injuries, or after surgery, or dental work
Unusual bleeding after vaccinations
Blood in urine or stool
Nosebleed
Many large or deep bruises
Pain, swelling, or tightness in joints
In infants, there is presence of unexplained irritability
Bleeding into the brain leading to painful and prolonged headache, repeated vomiting, sleepiness or lethargy, double vision, sudden weakness or clumsiness, convulsions, or seizures

Complications
Deep internal bleeding
Damage to joints due to internal bleeding causing arthritis or destruction of the joint
Infection due to blood transfusions
In few people with hemophilia, the immune system has a negative reaction to the clotting factors used to treat bleeding. The immune system develops proteins (known as inhibitors) that inactivate the clotting factors, which make the treatment less effective

Diagnosis
Can be made with positive family history
A blood test can show a clotting-factor deficiency in children and adults
Some people come to know they have hemophilia after they bleed excessively during a surgical procedure

Treatment
Replacement of the specific clotting factor that body needs
Desmopressin (DDAVP): This hormone can stimulate your body to release more clotting factor
Clot-preserving medications (antifibrinolytic)
Fibrin sealants: Applied directly to wound sites to promote clotting and healing

Nosebleed is a condition wherein blood vessels burst in the nasal lining. Nosebleeds are fairly common and it is rarely a serious condition.
I. Anterior nosebleed:It is caused by the eruption of a blood vessel at the tip of the nose. Anterior nosebleeds are generally easy to control by yourself or by a doctor.
II. Posterior nosebleed: It is a rare type of nosebleed. Posterior nosebleed mostly occurs in older people. It occurs when an artery bursts behind the nose, which causes the blood to flow down the throat. Posterior nosebleeds are, thus, dangerous, and they need immediate medical attention.

Causes
1. There are numerous causes of nosebleeds. The most common cause of nosebleeds is dry air. Dry climates dehydrate the nasal membranes (internal nasal tissues). This dryness leads to crusting which can cause irritation or itching.
2. Also, if you pick or scratch your nose too much, it can start to bleed.
3. Decongestants for allergies, sinus infection or cold and antihistamines can make the nasal membranes dry and cause nosebleeds as well.

Some other causes of nosebleeds include
1. Some sort of foreign object stuck in the nasal cavity
2. Allergic reactions
3. Repeated sneezing
4. Nose injuries (For example, car accidents, a punch to the face, etc.)
5. Chemical irritants
6. Cold air
7. Respiratory infection
8. Consuming high doses of aspirin-high dosage thins the blood down, thus triggering nosebleeds

There are other rarer causes as well, such as:
1. High blood pressure
2. Bleeding disorder
3. Blood clotting problems
4. Cancer

Treatment
A nosebleed can easily be treated at home. While in a sitting position, close your nostril by squeezing the soft part of your nose. Hold your nose for ten minutes, then lean slightly forward. Inhale and exhale slowly using your mouth.
Never lie down when you are trying to stop a nosebleed, as you will end up swallowing the blood which can upset your stomach. Remove your hand from your nose after 10 minutes and check if the bleeding has stopped. If it has not, repeat the steps all over again.
However, consult a doctor if the bleeding does not stop or if there is a foreign object stuck in your nose.

Vaginal bleeding is a common phenomenon in women. Sometimes it is due to cyclical changes in the cycle, while other times, it may be indicative of something unnatural and perhaps severe.

Abnormal vaginal bleeding includes:

Heavy periods: This is a very common phenomenon. Bleeding during periods cannot be measured with optimum accuracy but periods can be considered heavy if it lasts over 7 days, if you need double protection, or if you seem to pass too much clots. It is recommended to consult your doctor if it starts to affect your lifestyle and causes hindrance in your day to day activities. The cause of heavy bleeding during menses is often unclear, but it may be indicative of uterine fibroids or cysts.
Post coital bleeding: Post coital bleeding happens when you bleed after sex. The most likely reason for this to happen is if there is inflammation in the neck of the cervical opening or it is sore. The common cause of this can probably be sexually transmitted diseases such as Chlamydia.
Inter menstraul bleeding: Bleeding between your periods is also a possibility. There can be several causes for this. It can be broadly indicative of uterine polyps or infections. Polyps are fleshy masses of cells which are basically an abnormal growth in the uterus or cervix.
Break through bleed: These bleeds happen very suddenly and spontaneously in the middle of the cycles or close to the menstrual cycles. These can happen when you start contraceptive pills and usually settle down in a matter of few months.
Post menopausal bleeding: Bleeding or spotting post menopause can be indicative of something more serious. The common causes can be uterine or cervical cancer. Often, it may also happen that the uterus starts to degrade, and small fibrous bleeding or spotting may be visible.
In case you have a concern or query you can always consult an expert & get answers to your questions!

Unexpected or abnormal vaginal bleeding usually refers to the kind of bleeding that occurs any time outside of the normal time of menstruation. Also termed as spotting, inter-menstrual bleeding or metrorrhagia, bleeding between periods always calls for extra measures to be taken against it, and is a matter of serious concern.

The primary causes for unexpected vaginal bleeding generally are:

An imbalance of progesterone and estrogen levels triggered by a variety of causes like thyroid gland problems, dysfunctional ovaries and irregular doses of birth control pills, which may eventually lead to spotting. However, one must take note of the fact that hormonal contraceptives, in many cases, may cause abnormal bleeding for the first few months, after which it always subsides.
Noncancerous growth such as uterine fibroids are also potential causes of spotting or abnormal bleeding.
Miscarriages, ectopic pregnancy, and other kinds of complications involved during childbirth can cause abnormal vaginal bleeding.
Infection of reproductive organs caused due to intercourse, vaginal douching, pelvic inflammatory disease, or STDs (sexually transmitted diseases) may lead to bleeding and inflammation.
Cancer of the vagina, uterus, cervix, or ovaries, albeit extremely rare in nature, may cause abnormal bleeding of the vagina.
While in most cases, this type of bleeding is naturally corrected, some women might need to undergo treatments when the case is severe. Overlooking an otherwise minor issue might thrust you in the face of life-threatening circumstances, if it develops into a case of cancer, infection, or any other type of disorder.

Prevention of vaginal bleeding, as such, is indeed a narrow possibility and the measures will almost always vary since the factors that cause intermenstrual bleeding aren t the same in all cases. However, what your doctor will always advise you in this regard will be to ensure that your diet is balanced, your weight under control and your lifestyle is essentially healthy. If you happen to be on birth control medications, be so while adhering to medical instructions. Resorting to taking aspirin doses often might also influence the incidence of such abnormal conditions. If your pain still persists after you experience unexpected bleeding, you must consult your doctor without any further delay.