Bleeding after two years of menopause

Arrange an appointment even if the bleeding happened once, was only spotting, or has already stopped. Assessment is needed to identify where the blood came from and why it occurred.

After menopause, vaginal tissues can become thin and fragile, which may lead to spotting, including after sex. Polyps, changes in the uterine lining, infection, medicines, or hormone treatment can also cause bleeding. Less commonly, bleeding is a presentation of cancer of the womb, cervix, vagina, or vulva, so it should not be self-diagnosed.

Blood noticed on underwear or toilet paper may instead come from the urinary tract or bowel. A clinician can help distinguish the source.

Contact a gynaecologist or primary care doctor promptly. Note when the bleeding began, its colour and amount, whether it followed sex, and whether you have pelvic pain, unusual discharge, urinary symptoms, or bowel symptoms. Bring a list of medicines, including hormone therapy and blood-thinning medicine.

The clinician may examine the vulva, vagina, and cervix. Depending on the findings, evaluation can include pelvic ultrasound, examination of the cervix, or a sample from the uterine lining. These tests look for a cause rather than assuming that bleeding is a returning period.

Seek urgent medical care if bleeding is heavy or rapidly soaking pads, or if it occurs with fainting, marked dizziness, weakness, shortness of breath, severe pelvic or abdominal pain, fever, or feeling acutely unwell. Do not drive yourself if you feel faint.

Without those warning signs, the bleeding still warrants a prompt appointment; waiting for another episode can delay identification of a treatable cause.

Ask which part of the body appears to be bleeding, whether your medicines could contribute, what examination or tests are appropriate, and how results will be communicated. You can also ask what changes should prompt emergency care while you wait and whether any prescribed medicine should be continued.