The menopause can affect individual women in many different ways and there is often a tendency to attribute various diverse symptoms to this important phase of physiological change in a woman’s life. Nosebleeds in particular can happen for many different reasons and it may be or may be not related to the menopause. Therefore, the proper medical evaluation is recommended. Remember that hypertension, or high blood pressure is an important cause of nose bleeding, and that condition should, at least, be excluded as a possible cause.
The changes in hormones during menopause can cause the tissues in the nose to dry out or become smaller. Therefore, the nose tissue is more prone to cracks, cuts and bleeding. Reoccurring nosebleeds are usually another symptom that menopause is occurring.
Nose bleeding is more common during the winter and should not be cause for concern, unless it is unreasonably frequent or severe. Older individuals, in general, are more susceptible to nosebleeds in winter because their mucous membranes are not as lush and the dry air causes the thinning blood vessels in the nose to break. Postmenopausal women are especially vulnerable to nose bleeding because of the decrease in estrogen that increases bodily fluids. Anyone who is taking blood thinners, such as an aspirin regimen or Coumadin, also have higher risk for nose bleeding.
The nose is a part of the body rich in blood vessels (vascular) and is situated in a vulnerable position protruding on the face. As a result, trauma to the face can cause nasal injury and bleeding. The bleeding may be profuse, or simply a minor complication. Nosebleeds can occur spontaneously when the nasal membranes dry out and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to a bloody nose if they take medications that prevent normal blood clotting (warfarin [Coumadin], aspirin, or any anti-inflammatory medication). In this situation, even a minor trauma could result in significant bleeding.
The following factors predispose people to nosebleeds:
* Allergic and non-allergic rhinitis
* Hypertension (high blood pressure)
* Use of blood thinning medications
* Vigorous nose blowing
* Alcohol abuse
* Cocaine use
* Diseases that may affect blood clotting, such as liver disease, kidney disease, or hemophilia (inability of blood to clot)
* Recently taken chemotherapy.
* High altitude - as altitude increases, the availability of oxygen decreases, making the air thinner and drier.
Types of Nosebleed
The bleeding originates from the lower nasal septum (nasal partition - the wall between the two nostrils). This part of the nose contains many delicate blood vessels that receive blood from the carotid arteries, two principal arteries in the front of the neck that supply blood to the head and neck. The slightest knock or bump can cause these vessels to bleed. Anterior nosebleeds are easily treated at home.
The bleeding originates further back and higher up the nose where artery branches supply blood to the nose, which is why it is heavier. Posterior nosebleeds are often more serious than anterior nosebleeds and may require medical attention. They are more common in adults.
When the tissue becomes dry and cracked, it is important to keep the skin lubricated and soft. Simple items such as lotion or an antibiotic, such as Neosporin, can help to moisturize the dry skin inside of the nose. You can prevent further cracking by using a humidifier, which allows moisture to accumulate in the air you breathe. Avoid air conditioners and furnaces because they dry out the air.
Get a humidifier and run it, especially in the bedrooms, with the door closed, a few hours before bed. You will be spending eight hours or so asleep and your nose, like you, needs a soothing rest.
A dab of petroleum jelly on either side of the septum, two times per day, will aid moisture. Saline sprays and specialized gels and ointments also are readily available at stores.
When nosebleeds do occur, it is important to treat it properly. Here are the recommendations on how to deal with it:
* When the blood first begins flowing, squeeze and hold your nostrils together tightly. The nosebleed will usually clot and the added pressure helps it form a scab.
* Lean forward slightly with the head tilted forward. Leaning back or tilting the head back allows the blood to run back into the sinuses and throat and can cause gagging or inhaling the blood.
* Hold the nose for at least five minutes. Repeat as necessary until the nose has stopped bleeding.
* Sit quietly, keeping the head higher than the level of the heart. Do not lay flat or put your head between your legs.
* After the bleeding has stopped, use the moisturizer or decongestant spray, such as Neo-Synephrine. Wet a piece of cotton with the Neo-Synephrine and place the cotton inside of your nose.
* Hold your nostrils together for five or so minutes.
* In some cases of prolonged bleeding, ice the forehead and bridge of the nose. The cold causes blood vessels to constrict, which limits and slows blood flow.
Preventing Repetitive Nosebleed
* Go home and rest with head elevated at 30 to 45 degrees.
* Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose.
* Do not strain during bowel movements. Use a stool softener (for example, docusate [Colace]).
* Do not strain or bend down to lift anything heavy.
* Try to keep your head higher than the level of your heart.
* Do not smoke.
* Stay a cool diet of soft, cool foods and beverages. No hot liquids for at least 24 hours.
* Do not take any medications that will thin the blood for example, aspirin, ibuprofen, clopidogrel bisulfate (Plavix) or warfarin (Coumadin). Do not stop taking any medications without first contacting your doctor.
* Your doctor may recommend some form of lubricating ointment for the inside of the nose.
* If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. A temporary remedy such as a nasal decongestant spray, for example, Afrin or Neo-Synephrine may be helpful. These types of sprays constrict blood vessels. (NOTE: If used for many days at a time, these can cause addiction so they are recommended for short-term use only. Do not use if the patient has high blood pressure.)
* Repeat the steps above on how to stop the common nosebleed. If bleeding persists, call the doctor and/or go to the nearest emergency department.
If a nosebleed is serious, or is not stopping, it is important that you see further medical attention. A nosebleed is considered dangerous, when the bleeding does not stop for more than 10 minutes. This is because, blood loss can become a serious problem and you may begin to feel weak or dizzy.
If nosebleeds are becoming common for you, there are more serious treatments that you can have your doctor perform. The doctor can stop a serious nosebleed by packing your nose with surgical gauze. Another treatment includes sealing the blood vessels inside of your nose through cauterizing (surgical burning).
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