What bleeding after menopause can mean

After menopause, lower oestrogen levels can make vaginal and vulval tissue thinner, drier, and more prone to bleeding after friction. Other causes include polyps on the cervix or inside the womb and overgrowth of the womb lining, called endometrial hyperplasia. Bleeding can also relate to hormone treatment or another medicine.

Postmenopausal bleeding is a presentation of womb cancer and can occur with cervical or vaginal cancer. This direction matters: the symptom needs investigation, but it does not by itself diagnose cancer. Occasionally, blood from the bladder or bowel is mistaken for vaginal blood, so locating the source is part of the assessment.

Arrange medical review even if the bleeding was only spotting, stopped quickly, or has not returned. Write down when it occurred, its colour and amount, whether there were clots, and any pelvic pain, unusual discharge, urinary symptoms, bowel symptoms, or bleeding after sex.

The clinician may examine the vulva, vagina, and cervix, then recommend imaging to measure and inspect the womb lining. A sample of lining tissue or a closer look inside the womb may be advised according to the findings. Bring details of hormone therapy, blood-thinning medicines, and prior gynaecological procedures.

Go for urgent assessment if bleeding becomes heavy, fills pads rapidly, contains large clots, or occurs with severe abdominal or pelvic pain. Fainting, significant dizziness, confusion, shortness of breath, a racing heartbeat, or cold clammy skin can signal substantial blood loss or acute illness.

Without those features, arrange a prompt outpatient appointment rather than ignoring the symptom. If you cannot tell whether blood is vaginal, urinary, or rectal, report that uncertainty so the correct areas can be examined.

Ask what the examination suggests about the source, which test will evaluate the womb lining, and whether a tissue sample is recommended. It is also helpful to ask how medicines will be managed, when results will be available, and whom to contact if bleeding recurs before follow-up.