Bleeding after menopause: what you need to know

Bleeding may come from fragile vaginal tissue, a cervical or uterine growth, infection, medication, or another cause. An examination helps identify where the blood started and whether treatment is needed.

After periods have stopped because of menopause, new spotting is not considered a menstrual period. Lower oestrogen can make the vaginal lining thin, dry, and easier to injure, especially during sex. Polyps and changes in the lining of the womb can also bleed.

Less commonly, cancers of the cervix, womb, vagina, or vulva can present with postmenopausal bleeding. The symptom alone cannot distinguish these conditions, so prompt assessment matters rather than trying to judge the cause from colour or amount.

Arrange a medical appointment promptly. Note when the bleeding began, whether it followed sex, its colour and amount, and any pain, discharge, urinary symptoms, or vaginal dryness. Bring a list of medicines, including hormone treatment and blood-thinning medication.

The clinician may examine the vulva, vagina, and cervix. Depending on the findings, assessment can include pelvic ultrasound, cervical testing, or sampling the womb lining. Do not stop prescribed medication unless the prescribing clinician advises it.

Seek urgent medical care if bleeding is heavy, you feel faint or unusually weak, or you have severe pelvic or abdominal pain. Fever, foul-smelling discharge, confusion, chest pain, or breathing difficulty also warrants urgent assessment.

Light spotting without these warning signs still needs a prompt appointment. Its urgency comes from being unexpected after menopause, not from an assumption about which condition caused it.

Ask which part of the genital tract appears to be bleeding, whether your medicines could contribute, and which examination or test is appropriate. You can also ask how to manage dryness safely, when results will be available, and what change in bleeding should trigger urgent care.