Vaginal bleeding after menopause

Pink or brown discharge can contain blood and should be reported in the same way as fresh red spotting.

Lower oestrogen levels can leave the vaginal lining thin, dry and vulnerable to friction. Other causes include polyps, inflammation, infection, changes in the womb lining, or medicines that alter bleeding. Pelvic organ prolapse can expose tissue to rubbing and soreness. Cancer of the cervix, vagina or womb is another possible presentation, so the symptom requires assessment rather than self-diagnosis.

The visit may involve an external and speculum examination to locate the blood. Ultrasound, cervical testing or a sample from the womb lining may follow when the history or examination indicates it.

Book a prompt appointment and describe the problem as postmenopausal bleeding. Keep a brief record of spotting, stained discharge, clots, pelvic discomfort, vaginal dryness and whether sex preceded the episode. Tell the clinician when natural periods ended and whether you use hormone therapy.

List medicines that may affect bleeding and do not alter their dose without medical guidance. A pad can help you observe the amount and colour while avoiding irritation from inserted menstrual products.

Seek urgent assessment for rapidly increasing flow, repeated passage of large clots, severe abdominal or pelvic pain, fever, faintness, breathlessness or unusual weakness. Call emergency services for collapse, confusion or difficulty remaining upright.

Light bleeding without these features still needs a timely clinical appointment; the small amount does not reveal the cause.

Ask where the bleeding originated, which tests fit the examination findings, and when results will be available. If the tissue looks dry or irritated, ask when treatment for vaginal dryness can begin and what should prompt you to return sooner.