Bleeding disorder
Women with a bleeding disorder may be prone to more excessive bleeding. A hematologic work-up should discover the cause. Other
On occasion an ovarian cyst can rupture and give rise to internal hemorrhage. This may occur during ovulation or as a result of endometriosis. If the pregnancy test is positive, consider pregnancy related bleeding (see obstetrical hemorrhage), including miscarriage and ectopic pregnancy. Diagnosis
A history will establish if the condition is acute or chronic, and if external circumstances are involved. A gynecologic examination is usually complemented by a gynecologic ultrasonography. A blood count determines the degree of anemia and may point out bleeding problems. The pregnancy test is important, particularly as bleeding in early pregnancy presents as gynecological hemorrhage and ectopic pregnancy can be fatal. Diagnosis is broadly classified into supportive and definitive investigations:

Supportive
Complete blood count to assess degree of anemia. Ultrasonography to rule out uterine lesions, PID. Definitive
Pregnancy test for those who are not yet post menopausal mandatory. Speculum examination to take samples for pap smear. Dilation and curettage to get samples for histology and also control the bleeding if associated with abortion. Colposcopy. Definition
Menstruation occurs typically monthly, lasts 3–7 days, and involves up to 80 ml blood. Bleeding in excess of this norm in a nonpregnant woman constitutes gynecologic hemorrhage. In addition, early pregnancy bleeding has sometimes been included as gynecologic hemorrhage, namely bleeding from a miscarriage or an ectopic pregnancy, while it actually represents obstetrical bleeding. However, from a practical view, early pregnancy bleeding is usually handled like a gynecological hemorrhage.
First aid
Gynecologic hemorrhage needs  to be evaluated as soon as possible by a physician. The amount and duration of bleeding will dictate whether a bleeding event is an emergency event. Treatment
Treatment depends on diagnosis and may include hormonal therapy, iv fluids, blood transfusion, and/or  a dilation and curettage. Internal bleeding requires laparoscopy or abdominal surgery, in rare and extreme cases a hysterectomy is performed. See also
Medical emergency
Istihadha


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