Unexpected bleeding is always a concern for any woman at any age. Anything other than a normal menstrual period and even an abnormally heavy bleeding during your period can be cause for alarm.

It's important to understand what is causing the bleeding and where it's coming from and to make decisions about how to control or stop the bleeding.

A woman’s normal menstrual cycle involves a complex series of hormonal events. Various parts of your body coordinate with one another as an egg is released from an ovary. Either the egg is fertilized by a sperm and implants in the uterus, or the lining of your uterus is shed each month as your menstrual period. This shedding causes normal menstrual bleeding.

You may have your period for 2-7 days and have a normal volume of blood and fluid loss of about 5 tablespoons.

When bleeding is not caused by your menstrual cycle, it is called abnormal or dysfunctional uterine bleeding. This is the most common cause of abnormal vaginal bleeding during a woman’s childbearing years. Up to 10% of women may experience excessive bleeding at one time or another.

When the hormonal process that creates your menstrual period loses coordination and the hormones oestrogen and progesterone are out of balance, your body overproduces uterine blood flow. This may cause you to experience excessive vaginal bleeding. This bleeding is related to irregularities of your menstrual cycle without any evidence of disease.

The diagnosis of dysfunctional uterine bleeding is a diagnosis of exclusion, which means that all other causes for the bleeding have been looked for and determined not to be the cause of the bleeding.

Depending on your age, there are different reasons for you to have dysfunctional uterine bleeding.

Dysfunctional uterine bleeding is usually associated with an anovulatory cycle. Anovulation occurs when you have a menstrual cycle but do not produce an egg from one of your ovaries.

In some cases, dysfunctional uterine bleeding can occur with ovulation or the release of an egg from an ovary.

When you do not produce an egg, there is still stimulation of your uterus from the hormone estrogens. Progesterone, a very important hormone produced by a growing egg, is absent. Therefore, the uterus becomes unusually thick and enlarged until it reaches an abnormal size.

Irregular shedding of the uterine lining and heavy bleeding occurs. You then experience heavy, irregular vaginal bleeding. The most common cause of dysfunctional uterine bleeding if you are an adolescent is anovulation.

In women of childbearing age (18-40 years), the most common cause of abnormal uterine bleeding is pregnancy and its complications such as ectopic pregnancies or miscarriages. Anovulation can be a cause of bleeding in women of childbearing age.

Older women who are approaching menopause may also experience dysfunctional bleeding. If you have ovulation without the release of an egg, this occurs because you have fewer eggs available for release. Also, your ovaries are losing their ability to bring an egg to maturity.

Diseases of the female reproductive organs may also cause bleeding.

Cancer of the vagina, cervix, uterus, and ovaries is possible. Your gynaecologist will consider ovarian cysts, cervicitis, endometritis, fibroids, vaginal infections, and other conditions that can cause excessive bleeding.

Vaginal bleeding may be a concern for women older than age 50 years. The risk of cancer increases with age. Also, your vaginal walls may be dry from lack of oestrogen, which may cause bleeding during or after sexual intercourse.

Certain drugs may cause bleeding, especially if you take a drug that prevents your blood from clotting.

You may have experienced trauma that can cause bleeding. An IUD may cause bleeding Injury from sexual intercourse may happen.

For hormonal irregularities, effective treatments for dysfunctional uterine bleeding usually involve the use of prescription hormones such as birth control pills to help in the coordination of your menstrual cycle. A specialist such as a gynaecologist usually starts this type of treatment. Your GP should check for another cause of bleeding if you do not respond to hormonal treatment.

If other causes are found, different therapies might be needed, which may include minor surgical procedures to remove lesions that can cause abnormal bleeding.

Talk to your gynaecologist about the problem so that the cause can be found and treated as soon as possible.

The gynaecologist  will explain the risks and benefits of the best surgical treatment for you at the consultation after examination.

The uterus and the bladder are held in their normal positions just above the inside end of the vagina by a "hammock" made up of supportive muscles and ligaments. Wear and tear on these supportive structures in the pelvis can allow the bottom of the uterus, the rear of the bladder or both to sag through the muscle and ligament layers. When this happens, the uterus or bladder can create a bulge into the vagina. In severe cases, it is possible for the sagging uterus or bladder to work its way down far enough that the bulge can appear at the vagina's opening or even protrude from the opening. When the uterus sags downward, it is called uterine prolapse. When the bladder sags, it is called bladder prolapse, also known as a cystocele.

Various stresses can cause the pelvic muscles and ligaments to weaken and lead to uterine or bladder prolapse. The most significant stress on these muscles and ligaments is childbirth. Women who have had multiple pregnancies and vaginal delivery are more likely to develop prolapse. Obesity also can strain the pelvic muscles. Support problems in the pelvis become worse after menopause because the pelvic tissues depend on oestrogen to help them keep their tone, and oestrogen levels drop after menopause.

Some doctors estimate that half of all women have some degree of uterine or bladder prolapse in the years following childbirth. For most women, these conditions remain undiagnosed and untreated. Only 10% to 20% of women with pelvic prolapse seek medical evaluation for symptoms.
This can be corrected both surgically and non-surgically.

For mild cases, exercises known as Kegel exercises are a great way to increase your pelvic support. To perform Kegel exercises, you need to squeeze the pelvic floor muscles that you would use if you were trying to stop urinating when your bladder was only partly empty. Most doctors advise women with pelvic muscle weakness to tighten these muscles and hold them tight for a few seconds at a time. Repeat the exercise ten times in each session and do approximately four sessions each day. Over time, most women notice improvement in bladder control and may have less pain or fewer symptoms.

Other non-surgical treatment of these conditions involves placing an object (pessary) into the vagina to support surrounding structures. The gynaecologist fits a rubbery, ring-shaped device called a pessary into the upper portion of your vagina. Pessaries can help to prop up the uterus and bladder and prevent them from sagging into the vagina. They are removable so they can be washed periodically.

A prolapsed bladder or uterus may need to be corrected with surgery, which can be done through the vagina or the abdomen. The procedure that is chosen depends on the woman's age, severity of the symptoms, medical history, desire for future fertility and desire to be able to have sex. The goals are to restore normal anatomy, relieve symptoms, restore normal bowel and bladder function, and restore the ability to have sex. In some severe cases, surgical removal of the uterus (hysterectomy) is recommended.