Bleeding Long After Menopause

Arrange an appointment with a gynaecologist or primary care clinician without waiting for another episode. Causes range from fragile tissue and polyps to changes in the womb lining, cervix, vagina, or vulva that require treatment, including cancer.

After menopause, lower oestrogen levels can make vaginal or womb-lining tissue thin and prone to bleeding. Other possibilities include polyps, inflammation, changes in the womb lining, effects of hormone therapy or medicines, and cancer of the womb, cervix, vagina, or vulva. Blood may also come from the urinary tract or bowel and be mistaken for vaginal bleeding.

Bleeding can appear as red blood, brown discharge, pink staining, or spotting after sex. Its colour, amount, or lack of pain cannot safely identify the cause. A new episode after periods have been absent for a full year belongs in a medical assessment, including when you use hormone therapy.

Note when the bleeding started, how much there was, whether it followed sex, and whether you have pelvic pain, pressure, vaginal dryness, unusual discharge, urinary symptoms, or bowel bleeding. Bring a list of medicines, including hormone therapy, blood-thinning medicines, and treatments such as tamoxifen. Do not stop prescribed medicine unless the prescriber advises it.

The clinician may examine the vulva, vagina, and cervix. Further evaluation can include a transvaginal ultrasound, viewing the inside of the uterus with a thin camera, or sampling tissue from the womb lining. The findings and your medical history determine which tests are suitable. Mention if an internal examination is painful or difficult so the team can adapt the approach.

Request a prompt appointment for every episode of postmenopausal bleeding, including a small spot, blood-stained discharge, or bleeding that has stopped. Recurrent bleeding needs reassessment even if an earlier check did not find a concerning cause.

Go to an emergency department or call local emergency services if bleeding is heavy or you feel faint, severely dizzy, confused, short of breath, very weak, or cold and clammy. Urgency is based on active blood loss and how unwell you feel; it does not depend on whether the eventual cause is common or uncommon.

Ask which body site appears to be bleeding, what tests are recommended, how you will receive the results, and what symptoms should trigger faster help. If you take hormone therapy, ask whether the bleeding pattern is expected for that regimen and whether any change should wait until the evaluation is complete.