Bleeding after 2 years of menopause

Bleeding can come from delicate vaginal tissue, a cervical or womb polyp, changes in the womb lining, infection, medicines, or another gynaecological condition. An examination is needed because appearance alone cannot identify the source.

After menopause, vaginal dryness and thinning can make tissue fragile enough to bleed after sex or minor irritation. Bleeding may also arise from the cervix, uterus, urinary tract, or rectum, so first check where the blood appears to come from.

Some causes are benign, but postmenopausal bleeding can be a presentation of disease in the womb or cervix. The need for assessment is based on the bleeding itself, not on its volume or whether pain is present.

Arrange a medical appointment soon. Record when the bleeding started, whether it was spotting or a flow, any clots, pain, discharge, bleeding after sex, and whether it has recurred. Bring a list of medicines, including hormone therapy and blood-thinning medicines.

A clinician may examine the vagina and cervix and may recommend imaging or a sample from the womb lining. Do not stop prescribed medicine without clinical advice. Use a pad rather than inserting a tampon while the source is unclear.

Seek urgent care if bleeding is heavy, you feel faint or weak, you have severe pelvic or abdominal pain, or you are soaking pads rapidly. Fever, foul-smelling discharge, or feeling acutely unwell also warrants prompt assessment.

Light spotting without these warning signs still needs a timely appointment. Contact the clinic again if bleeding returns, becomes heavier, or new symptoms appear while you are waiting.

Ask which part of the genital or urinary tract seems to be bleeding, whether your medicines could contribute, and which examination or test is appropriate. You can also ask what symptoms should bring you back sooner and how you will receive results.