Do You Still Have Periods After Menopause?

Menopause is reached after 12 consecutive months without a menstrual period when there is no other explanation. Before that point, during perimenopause, bleeding can become irregular, lighter, heavier or more widely spaced.

Bleeding after established menopause is called postmenopausal bleeding rather than a period. It may appear as fresh blood, light spotting, or pink or brown discharge, and it can happen only once or recur.

Possible causes include thinning and dryness of vaginal or uterine tissues, cervical or uterine polyps, infection, changes in the uterine lining, and effects of hormone therapy or some medicines. Cancer of the uterus or cervix is another possible cause, so the source should be checked even when the amount is small or there is no pain.

Arrange a prompt appointment with a gynaecologist or primary-care clinician for any bleeding after menopause. Note when it began, its colour and amount, whether it followed sex, and whether you have discharge, pelvic discomfort or urinary symptoms. Bring a list of medicines and supplements, including hormone therapy and blood-thinning medicines.

Assessment may include questions about the bleeding, a pelvic examination, an ultrasound of the uterus, or a sample from the uterine lining. The tests chosen depend on your symptoms, health history and examination. Do not stop prescribed hormone therapy or blood-thinning medicine on your own; the prescriber can advise whether it needs adjustment.

Contact a clinician promptly after any postmenopausal spotting or bleeding, including a single episode or blood noticed only after sex. Seek urgent medical help if bleeding is heavy, or if it occurs with fainting, marked dizziness, shortness of breath, severe pelvic or abdominal pain, fever, or feeling acutely unwell.

If an earlier assessment found no serious cause but the bleeding returns or continues, arrange another review. A new or persistent episode deserves reassessment rather than being assumed to have the same cause.

You may wish to ask where the bleeding seems to be coming from, which examinations or tests are appropriate, and how quickly they should be arranged. Also ask whether a medicine or hormone regimen could be contributing, what changes would require urgent help, and what follow-up is needed if the bleeding happens again.