Bleeding long after menopause

This includes a smear of blood, spotting, or pink or brown discharge. Many causes are treatable and non-cancerous, but bleeding can also be a presentation of womb, cervical or vaginal disease that benefits from early investigation.

Lower oestrogen after menopause can make vaginal or uterine tissue thinner and more fragile. Bleeding may also arise from a polyp, inflammation, infection, a thickened womb lining, trauma, or medicines that affect bleeding. Sometimes blood from the urine or rectum is mistaken for vaginal blood.

Womb cancer commonly presents with postmenopausal bleeding, but the symptom alone cannot establish its cause. A clinician needs to locate the bleeding and examine the cervix, vagina and womb lining as appropriate.

Arrange a medical appointment promptly rather than watching for another episode. Note the amount and colour, whether bleeding followed sex, whether you have pain or discharge, and whether you use hormone therapy, vaginal oestrogen, tamoxifen, anticoagulants or other regular medicines.

Assessment may involve a pelvic examination and a vaginal ultrasound to look at the womb lining. A hysteroscopy allows the clinician to view the inside of the womb, and a biopsy can sample tissue when needed. The recommended tests depend on your history and findings.

Every episode after menopause deserves prompt clinical assessment, including light spotting without pain. Tell the service if the bleeding is recurring, increasing, accompanied by pelvic pain, or mixed with an unusual watery or blood-stained discharge.

Go to emergency care if bleeding is heavy or you develop severe pain, fainting, pronounced dizziness, weakness, shortness of breath or confusion. These features may indicate significant blood loss or another acute problem.

Ask where the clinician thinks the blood originated, which tests are recommended, whether medicines could contribute, and when results should arrive. If a biopsy or hysteroscopy is proposed, ask what it involves, how discomfort is managed and whom to contact afterward.