Bright red bleeding after menopause

Bright red blood is usually fresh blood, but colour alone cannot identify where it came from or why it occurred. Possible sources include fragile vaginal or vulval tissue after menopause, the cervix, or the lining of the womb. Polyps and thickening of the womb lining can present with postmenopausal bleeding. Womb, cervical, and vaginal cancers can also present this way, so examination is needed rather than diagnosis by appearance.

Blood noticed in underwear or on toilet paper may instead come from the urine or bowel. A clinician can help establish the source. Medicines, vaginal products, recent sex, pelvic procedures, and any hormone treatment are useful context, but they do not remove the need to report the episode.

Contact a gynaecology service or primary care clinician promptly. Record the date, amount, colour, clots, pain, discharge, and any repeat bleeding. Bring a current medicine list, including hormone therapy, blood-thinning medicines, and non-prescription products.

Assessment may include questions about your bleeding, a pelvic examination, imaging of the womb lining, or collection of a tissue sample. The appropriate tests depend on your history and findings. Do not stop prescribed medicine without advice; the clinician who assesses you can explain whether any treatment needs adjusting.

Seek urgent care if bleeding is heavy, rapidly increasing, soaking pads, or accompanied by large clots. Severe pelvic or abdominal pain, fainting, marked dizziness, weakness, shortness of breath, confusion, or clammy skin also warrants urgent assessment.

A small episode without these warning signs still needs a medical appointment. Urgency is based on the bleeding and how unwell you feel, not on whether a particular cause seems common.

Ask which part of the genital tract appears to be bleeding, whether the womb lining needs imaging or sampling, and how you will receive results. Clarify what changes should trigger urgent care while you wait and whether any prescribed hormones or blood-thinning medicines require clinician-led adjustment.