Bleeding, Fibroids and Menopause

Fibroids often shrink after menopause as hormone levels fall, so a previous fibroid diagnosis should not be assumed to explain new bleeding. Blood may arise from fragile vaginal tissue, the cervix, a polyp or the uterine lining. A clinician needs to locate the source and decide whether the lining should be investigated.

Postmenopausal bleeding includes spotting, pink or brown discharge, and a heavier flow after periods have stopped. Vaginal dryness can cause light bleeding after friction, while a fibroid that projects into the uterine cavity can be associated with bleeding. Changes in the uterine lining can present in the same way, and symptoms alone cannot distinguish these causes.

Your clinician may review hormone treatment and other medicines, perform a pelvic examination, and arrange an ultrasound to assess the uterus and lining. Depending on the findings, a sample from the uterine lining or a closer look inside the uterus may be recommended.

Book a medical appointment promptly rather than waiting for another episode. Record when the bleeding began, whether it followed sex, its colour and amount, and any pelvic pressure, pain, discharge or urinary symptoms. Bring details of previous fibroid scans, procedures, hormone therapy and blood-thinning medicines.

Use a pad if bleeding is active so the amount can be observed. Do not restart leftover hormone tablets or use vaginal remedies to treat the bleeding before the source has been assessed.

Seek urgent help if bleeding is heavy or rapidly worsening, or if you develop severe pelvic pain, fainting, marked dizziness, weakness, fever or foul-smelling discharge. Light bleeding without these warning signs still warrants a prompt appointment because postmenopausal bleeding should be evaluated.

Ask whether the bleeding appears vaginal, cervical or uterine; whether the fibroids have changed; and whether the uterine lining needs sampling. Request clear instructions about follow-up, including when results should be available and which recurring symptoms need earlier review.