Bleeding after intercourse following menopause

The amount of blood cannot identify its cause. A timely examination can locate the source and guide any tests or treatment needed.

After menopause, lower oestrogen can leave vaginal tissue dry, thin and prone to small surface injuries from friction. Other possibilities include inflammation, cervical or uterine polyps, infection, skin conditions or changes within the cervix or womb.

Cervical and endometrial cancers can present with postmenopausal bleeding, so assessment is necessary; the symptom alone does not show what the cause is. Blood may also come from the urinary tract or rectum and be mistaken for vaginal bleeding.

Note when the bleeding occurred, its colour and amount, whether there was pain, dryness or discharge, and whether it has happened before. Bring a current medicine list, including hormones and blood-thinning medicines.

The clinician may examine the vulva, vagina and cervix. Depending on the findings, they may recommend imaging, a sample from the womb lining, cervical testing or another focused test. You can request an explanation, a chaperone and a pause at any point.

Seek urgent medical help if bleeding is heavy, you feel faint or weak, pain is severe, or you have breathing difficulty. Fever, worsening pelvic pain or foul-smelling discharge also warrants prompt clinical advice.

If the spotting has stopped and you otherwise feel well, still arrange a medical appointment rather than waiting for another episode.

Ask where the bleeding appears to come from, which tests are recommended, how and when results will arrive, what can make intercourse more comfortable, and what follow-up is needed if bleeding returns.