Abnormal bleeding after menopause

Bleeding can come from fragile vaginal or womb lining, a polyp or another non-cancerous cause. It is also a presentation of womb, cervical or vaginal cancer, so a clinician needs to identify where the blood came from rather than judging the cause by its amount.

Lower oestrogen levels can make vaginal and urinary tissues thin, dry and easily irritated. Polyps can bleed from the cervix or womb, while thickening of the womb lining may also cause spotting or a heavier flow. Medicines, including hormone treatment and blood-thinning medicines, can influence bleeding but should not be assumed to be the sole explanation.

Blood noticed on underwear or toilet tissue may instead come from the urinary tract or rectum. A careful history and examination help locate the source and guide the right tests.

Contact a gynaecology or primary-care service without waiting for another episode. Record when the bleeding began, its colour and amount, any pelvic pain or discharge, and all medicines or hormones you use. Do not stop prescribed medicine unless the prescriber advises it.

Evaluation may include examination of the vulva, vagina and cervix, pelvic ultrasound and sampling of the womb lining. The clinician selects tests according to the suspected source, examination findings and medical history.

Seek urgent medical care if bleeding is heavy or you feel faint, weak, short of breath or confused. Severe pelvic or abdominal pain, fever, or passing large clots also warrants rapid assessment. If the bleeding is light and you otherwise feel well, it still needs a prompt appointment rather than being watched indefinitely.

Ask which structure appears to be bleeding, whether the womb lining needs imaging or a sample, and how you will receive the results. You can also ask what to do if bleeding recurs after reassuring tests and whether vaginal dryness, hormones or other medicines could be contributing.