Bleeding from the cervix after menopause

It can be difficult to identify the exact source without an examination because blood from the vagina or womb passes through the same area.

After menopause, vaginal and cervical tissues may become thinner and drier, making them easier to irritate during sex or an examination. Cervical polyps, inflammation, infection, changes in the womb lining and medicines that affect bleeding are other possibilities. Cervical or womb cancer can also present with postmenopausal bleeding, but bleeding does not establish that diagnosis.

A clinician may inspect the vulva, vagina and cervix with a speculum. They may recommend cervical sampling if due, an ultrasound to examine the womb lining, or a small tissue sample depending on the findings.

Contact a gynaecology or primary-care service promptly. Write down the first and most recent episodes, the amount and colour of blood, whether bleeding followed sex, and any discharge, dryness, pelvic pressure or pain. Include hormone therapy, tamoxifen, blood-thinning medicines and recent cervical screening in your history.

Use a pad to monitor the flow and avoid inserting products into the vagina while actively bleeding unless a clinician has advised otherwise. Continue prescribed medicines until the prescriber tells you to change them.

Go to urgent care if the flow becomes heavy, you pass large clots, or bleeding occurs with severe pelvic pain, fainting, pronounced dizziness, breathlessness, fever or weakness. Emergency help is appropriate if you collapse or cannot stand safely.

Without those warning signs, arrange a prompt appointment rather than waiting to see whether another episode occurs.

Consider asking whether the cervix is definitely the source, what the examination showed, whether cervical or womb-lining tests are needed, and how you will receive results. If dryness is present, ask whether local treatment is suitable after the bleeding has been assessed.