Many women experience this problem at some point in their lives. It is defined as bleeding from the vagina that is not part of your monthly periods or bleeding that occurs during monthly periods but is heavier than usual.

This is because it may be a sign of a problem within the vagina, uterus (womb) or ovaries. This includes irregular or excessively heavy menstrual bleeding, and any vaginal bleeding in a woman who has passed menopause.

It should be noted that in teenage girls, the first few periods can be irregular and of varying degree of heaviness, and this is not abnormal. Around the time of menopause, menstrual bleeding often becomes irregular, and again this is not abnormal.

HRT (hormone replacement therapy) may also cause harmless bleeding in postmenopausal women who have stopped having periods.

What causes abnormal vaginal bleeding and who is at risk? Abnormal vaginal bleeding may occur between the normal menstrual bleeds (intermenstrual bleeding) or it may take the form of unusually heavy menstrual bleeding (menorrhagia). In postmenopausal women, it may develop after a number of years without any vaginal bleeding.

It's important to understand exactly what is causing the bleeding and where it’s coming from (uterus, vagina, or some other organ or tissue) and to make decisions about how to control or stop the bleeding.

Periods differ from woman to woman and from month to month. A period can last from three to 10 days, and occur every three to six weeks. This pattern can vary with age, stress, diet, exercise and inherited factors. The flow can also vary. Around 40ml (two tablespoons) of fluid is lost, which the body quickly replaces.

It is common for women to suffer some cramping pain with their period. This is felt just below the navel and may spread into the legs or lower back. It can be felt as a dull ache or sharp twinge. During a period, it is also common to feel bloated and heavy, get more pimples, feel tense and emotional, and have sore breasts and greasier hair.

Irregular vaginal bleeding is a possible sign or symptom of a range of causes. For others, the cause depends on their age and the site of bleeding. Once pregnancy has been ruled out, some of the known causes include:

In more than half the women with bleeding, the cause of the irregular bleeding is not found. For these women the most likely reason is a change in hormonal activity. This is described as 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. African American women tend to have more episodes.

When the complex 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. Thus, you may 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 (including trauma, lesions, or diseases) have been looked for and determined not to be the cause of the bleeding.

Diagnosing abnormal bleeding involves a number of tests. Your healthcare provider will take a careful medical history. You will be asked questions about the following issues and other general questions regarding your health:

The doctor will also perform a complete physical, including a thorough pelvic exam. The exam includes careful inspection of your external genitalia, urethra, and anal area.

The vaginal walls and cervix or birth canal are inspected for the presence of any lesions or retained foreign objects. Sometimes a tampon or other object is left in the vagina and can cause bleeding.

While the doctor is examining your vagina and cervix, the doctor may take cultures (fluid samples) to test for sexually transmitted diseases such as gonorrhea and chlamydia.

The doctor may also take cells from the cervix that will be examined for cancer. This is a Pap smear.

It is also important for the doctor to place his or her hand into your vagina and sometimes your rectum to detect the shape of your uterus and ovaries as well as to feel for any masses that may be present.

Tests that may be performed with abnormal uterine bleeding include the following:

Fortunately, most heavy bleeding can now be easily treated without major surgery.

Since an endometrial ablation destroys the lining of the uterus, endometrial ablation is not for anyone, especially those who desire to keep her fertility. Women who have a malignancy or pre-malignant condition of the uterus are not candidates for ablation. Women who have severe pelvic pain, unless the pain is coming from an intracavitary myoma, may be better served by alternative treatments. Although pregnancy is unlikely after ablation, serious complications could arise. It is essential for a woman to use reliable contraception after an endometrial ablation.

One of the reasons women get hysterectomies is to control heavy menstrual bleeding. This is the only procedure that guarantees permanent elimination of any bleeding.

Hysterectomy is the removal of the uterus. The operation can be done in three ways:

The type of hysterectomy a woman has is dependent on a range of factors, including the nature of her problem and her medical history. Any decision to undergo hysterectomy, other than pre-cancer or cancer changes needs to be carefully discussed. Sometimes it is wise to seek a second opinion and to review options for other treatments.

See your health care provider for any abnormal vaginal bleeding. It is not always necessary to go to a hospital emergency department for this problem. An office visit to a gynaecologist (a doctor who specialises in female reproductive organs) is usually sufficient if you are bleeding but do not have any other symptoms.

Be certain to record when the bleeding occurs during the month. Also, try to determine if the bleeding is vaginal or anal. Don't be frightened - most irregular vaginal bleeding has a benign cause. If you're having heavy vaginal bleeding - saturating a pad an hour for more than a couple of hours - seek prompt medical attention.

If you're taking birth control pills or are on hormone therapy, consult your doctor and follow the instructions he or she gives you. This may be as simple as taking more pills, but you may need to change medicines completely.

If you are having abnormal vaginal bleeding with other symptoms, such as lightheadedness, severe abdominal pain, or fevers, or if you're pregnant and experience vaginal bleeding, you should be evaluated as soon as possible. This includes being seen in an emergency department.

The outcome depends on the cause of the problem, but abnormal vaginal bleeding rarely results from a serious condition and can usually be treated successfully.