Bleeding During the Menopause Transition

While cycles are winding down, flow can become irregular. Once menstrual periods have stopped for a full year, later vaginal bleeding—including spotting or brown discharge—is postmenopausal bleeding rather than a returning period.

During perimenopause, fluctuating ovulation can alter the spacing, length and heaviness of menstrual bleeding. Even then, very heavy flow, bleeding after sex or a marked new pattern should be discussed with a clinician.

After menopause, fragile vaginal tissue is one possible source, particularly when dryness causes friction. Polyps, inflammation and changes affecting the cervix or womb lining can also present with bleeding. Appearance alone cannot separate these causes.

Write down the date, amount, colour and duration of bleeding, whether it followed sex, and any pelvic pain or unusual discharge. Include the date of your last natural period and the names of hormone or blood-thinning medicines.

Book a medical assessment for any bleeding after menopause or troublesome changes during the transition. Depending on your history, the clinician may examine the vagina and cervix and arrange imaging or sampling of the womb lining. Continue prescribed treatment unless your prescriber advises a change.

Attend urgent care if blood loss is heavy, you feel faint, weak or short of breath, or pain is severe. Fever with pelvic pain or offensive discharge can signal infection and should be assessed promptly.

Light postmenopausal spotting is not usually an emergency when you otherwise feel well, but it still warrants a timely appointment. Do not wait for it to happen again before making contact.

Ask whether your timing fits perimenopausal menstrual change or postmenopausal bleeding, which tests could locate the source, whether medicines may influence the pattern, and what symptoms should bring you back sooner.