Bleeding if you are in menopause

This includes a pink stain, brown discharge, spotting after sex or a flow resembling a period.

Menopause-related thinning and dryness can make vaginal tissue fragile. Polyps, inflammation, cervical changes, thickening of the womb lining, hormone treatment and medicines that affect clotting can also be involved. Cancer of the cervix, vagina or womb may present with bleeding after menopause, but the bleeding pattern cannot determine the diagnosis.

An assessment aims to locate the source and inspect the tissue. It may include a speculum examination, pelvic ultrasound, cervical testing or sampling of the womb lining, selected according to your history and initial findings.

Request a prompt appointment and say clearly that the bleeding began after menopause. Note the amount, colour, duration, clots and relationship to sex. Add any pelvic pain, pressure, discharge, urinary symptoms or dryness, and record when the last natural menstrual period occurred.

Bring details of hormone therapy and medicines that influence bleeding. Keep taking prescribed treatment unless its prescriber advises a change. If there is uncertainty about whether blood came from the vagina, bladder or rectum, tell the clinician rather than trying to decide alone.

Attend urgent care for heavy or rapidly increasing bleeding, large clots, severe pelvic or abdominal pain, fever, faintness, pronounced dizziness, breathlessness or marked weakness. Call emergency services if you collapse, become confused or cannot remain standing.

If bleeding is only a small stain and you otherwise feel well, it still warrants prompt assessment, but emergency care is generally guided by the warning signs above.

Ask what structure appears to have bled, which conditions the proposed tests are checking for, and when follow-up will occur. Discuss whether hormone therapy or another medicine could contribute and whether any adjustment should wait until results are known.