Bleeding or spotting after menopause: what to know

Bleeding can come from fragile vaginal tissue, the cervix or the womb lining, and an examination is needed to locate the source. Blood in urine or from the rectum can sometimes be mistaken for vaginal bleeding, so tell the clinician if the source is uncertain.

After menopause, lower oestrogen can leave vaginal tissue dry, thin and prone to bleeding after wiping, examination or sex. Vaginal dryness may also cause soreness, burning or discomfort with penetration. Other sources include changes on the cervix or within the womb. Assessment matters because some serious conditions also present with postmenopausal bleeding, and the colour or amount cannot reliably separate the causes.

Pelvic organ prolapse more often presents with pressure, heaviness or a vaginal bulge; exposed tissue may become irritated. A clinician can check for this and look for skin, vaginal or cervical changes during the same examination.

Contact a primary care or gynaecology service promptly rather than waiting for another episode. Record when the spotting began, colour, amount, duration, whether it followed sex, and any pain, discharge, urinary symptoms or bowel bleeding. List hormone treatments and medicines that affect bleeding, but continue prescribed medicine unless a clinician advises a change.

Evaluation may include an examination of the vulva, vagina and cervix, followed by tests selected for the suspected source. The clinician may discuss pelvic ultrasound or sampling the womb lining. If the first assessment is reassuring but bleeding returns, report the new episode for further review.

Seek urgent care for heavy bleeding, fainting, marked dizziness, breathlessness, chest discomfort, severe pelvic or abdominal pain, or rapidly worsening weakness. Fever with pelvic pain, unpleasant-smelling discharge or feeling acutely unwell also needs prompt attention. Light spotting without these signs still requires a timely appointment, but it is not automatically an emergency.

Ask where the blood appears to originate, what the examination shows, which tests are needed and when results will be discussed. You can also ask what to do if spotting recurs, whether dryness treatment is appropriate and whether any medicine needs review.