Bleeding after sex during perimenopause

Fluctuating hormones can make periods less predictable and vaginal tissue drier or more easily irritated. Friction during sex may then cause a small surface tear or spotting. Genitourinary syndrome of menopause can present with dryness, burning, urinary discomfort, pain during sex, and bleeding from fragile tissue.

Not every episode is hormonal. Cervical inflammation from chlamydia can present with contact bleeding, while cervical dysplasia, cervical cancer, and vaginal cancer can also present with bleeding after sex. Examination is used to distinguish vaginal dryness from bleeding arising at the cervix or elsewhere.

Pause penetration until active bleeding and tenderness resolve. Try a generous amount of water-based lubricant when sex resumes, and avoid fragranced washes or douching that may worsen irritation. Keep a record of periods, spotting after sex, dryness, pain, discharge, urinary symptoms, and any hormone medicines.

Book a review for recurrent bleeding, persistent dryness, pain during sex, or a notable change in your usual bleeding pattern. The clinician may inspect vaginal and cervical tissue, assess for infection, review medicines and cervical screening, and discuss moisturisers or prescription treatment when tissue changes are contributing.

Seek urgent help if bleeding is heavy or accompanied by faintness, marked weakness, severe pelvic or abdominal pain, or fever. Contact a clinician promptly for repeated contact bleeding, bleeding between periods that is new for you, unusual discharge, or pelvic pain. Once you have reached menopause, any vaginal bleeding should be assessed rather than assumed to be part of hormonal change.

Ask whether the tissue looks dry or fragile, whether the cervix bleeds on contact, and whether infection testing is advisable. Discuss your cervical screening schedule, which lubricant or moisturiser ingredients may suit you, and whether local or systemic hormone treatment is appropriate given your medical history.