Kazan medical journalKazan medical journal0368-48142587-9359Eco-Vector1552210.17816/KMJ2019-589Research ArticleDisorders of hemostasis as the main pathogenetic mechanism in the development of menopausal abnormal uterine bleedingChechulinaO Vtimka_rus@inbox.ruKurmanbaevT Etimka_rus@inbox.ruTukhvatullinaL Mtimka_rus@inbox.ruKhairullinaE Atimka_rus@inbox.ruMustafinI Gtimka_rus@inbox.ruKazan State Medical AcademyCity Hospital №11Kazan State Medical University3107201910045895943007201930072019Copyright © 2019, Chechulina O.V., Kurmanbaev T.E., Tukhvatullina L.M., Khairullina E.A., Mustafin I.G.2019<p class="Титул_Annot_text" lang="ru-RU">The article presents our own clinical observations of cases of abnormal uterine bleeding in postmenopausal women, where the main cause was the pathology of hemostasis: a patient after liver transplantation for cirrhosis with chronic viral hepatitisC, and a patient with primary idiopathic thrombocytopenic purpura which manifested at a later age. Among the most common causes of abnormal uterine bleeding in postmenopausal women are hyperplasia and endometrial cancer, leiomyoma, are adenomyosis are distinguished. Pathology of the hemostasis system as the main cause of abnormal uterine bleeding, prevails in the pubertal and reproductive period. In the literature available we did not find any publications concerning uterine bleeding in postmenopausal patients against the background of the pathology of the blood coagulation system. This article illustrates the significance of hemostasis disorders both secondary and primary in the origin of abnormal bleeding in postmenopausal period. Careful collection of anamnesis, an indication of the occurrence of petechial rash, gingival bleeding should alert the doctor. It should also be remembered that suddenly arisen immune cytopenias and late-onset thrombosis are often manifestations of the hematological paraneoplastic syndrome and require the exclusion of neoplasia, first of all, of the hematopoietic system. These clinical observations allow recommending a mandatory examination of the hemostatic system in patients with postmenopausal bleeding.</p>abnormal uterine bleedingpostmenopausepathology of hemostasisprimary idiopathic thrombocytopenialiver transplantationаномальное маточное кровотечениепостменопаузапатология гемостазапервичная идиопатическая тромбоцитопеническая пурпурапересадка печени[Narice Brenda F., Delaney B., Dickson Jon M. Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis. BMC Family Practice. 2018; (19): 135. DOI: 10.1186/s12875-018-0817-3.][Zdravookhranenie v Rossii. 2017. Statisticheskiy sbornik. (Health care in Russia. 2017. Statistical collection.) Moscow: Rosstat. 2017; 175 р. (In Russ.)][Mishra D., Sultan S. FIGO’s PALM-COEIN classification of abnormal uterine bleeding: a clinico-histopathological correlation in Indian setting. J. Obstet. Gynecol. India. 2017; 67 (2): 119–125. DOI: 10.1007/s13224-016-0925-8.][Sukhikh G.T., Smetnik V.P., Andreeva E.N. et al. Menopauza i klimaktericheskoe sostoyanie u zhenshchiny. Klinicheskie rekomendatsii. (Menopause and climacteric state in females. Clinical guidelines.) 2016; 45 р. (In Russ.)][Nebgen D.R., Rhodes H.E., Hartman C. et al. Abnormal uterine bleeding as the presenting symptom of hematologic cancer. Obstet. Gynecol. 2016; 128 (2): 357–363. DOI: 10.1097/AOG.0000000000001529.][Tabakman Yu.Yu., Solopova A.G., Bishtavi A.Kh. et al. Abnormal uterine bleeding (AUB) — modern possibilities of optimization of tactics of treatment. Akusherstvo, ginekologiya, reproduktsiya. 2016; 1 (10): 123–128. (In Russ.)][Tripodi D. Hemostasis in acute and chronic liver disease. Semin. Liver Dis. 2017; 37: 28–32. DOI: 10.1055/s-0036-1597770.][Rukovodstvo po gematologii. (Guide on hematology.) Ed. By Vorobʹev A.I. In 3 vol. Vol. 3, corr. and suppl. Moscow: Nʹyudiamed. 2005; 416 р. (In Russ.)][Ünlüsoy Aksu A., Eğritaş Gürkan Ö., Sarı S. et al. Immune thrombocytopenic purpura in a liver transplant patient. Exp. Clin. Transplant. 2014; 12 (1): 175–177. PMID: 24635822.][Melikyan A.L., Pustovaya E.N., Tsvetaeva N.V. Klinicheskie rekomendatsii po diagnostike i lecheniyu idiopaticheskoy trombotsitopenicheskoy purpury (pervichnoy immunnoy trombotsitopenii) u vzroslykh. (Clinical guidelines for the diagnosis and treatment of idiopathic thrombocytopenic purpura (primary immune thrombocytopenia) in adults.) Ed. by V.G. Savchenko. National hematology society. 2014; 42 р. (In Russ.)][Bakalets N.F., Nikiforova O.L., Moiseenko O.I. Paraneoplasticheskie sindromy. Palliativnaya pomoshchʹ patsientam s onkologicheskoy patologiey. Ucheb.-metod. posobie dlya studentov. (Paraneoplastic syndromes. Palliative care for patients with oncological pathology. Study guide for students.) Gomelʹ: GomGMU. 2016; 116 р. (In Russ.)]