Vaginal Bleeding After Menopause

Bleeding is not expected after menstrual periods have ended. Many causes are treatable, but an examination is needed because appearance alone cannot show where the blood came from or why it occurred.

Lower oestrogen levels can make the vaginal lining thin, dry, and prone to bleeding after friction. Polyps, inflammation, infection, changes in the womb lining, and effects of hormone treatment are other possibilities. Less commonly, postmenopausal bleeding is a presentation of cancer of the womb, cervix, vagina, or vulva, which is why checking every episode matters.

Blood noticed on underwear or toilet tissue may instead come from the bladder, bowel, vulval skin, or a sore area related to prolapse. A clinician can help locate the source.

Contact a gynaecology or primary care service promptly rather than waiting for another episode. Record the date, colour and amount, any clots, whether sex preceded it, and symptoms such as pelvic pain, discharge, itching, urinary changes, or bowel bleeding. Bring a list of medicines, including hormone therapy and medicines that affect clotting.

Assessment may involve examining the vulva, vagina, and cervix, followed by an ultrasound or a closer look at the womb lining when indicated. A small tissue sample may be recommended if the lining needs direct evaluation.

Go to urgent care for bleeding that is heavy, rapidly increasing, or accompanied by fainting, marked dizziness, breathing difficulty, severe pelvic or abdominal pain, weakness, or confusion. These symptoms can signal significant blood loss or another acute problem.

If bleeding is light and you otherwise feel well, it still warrants a prompt appointment. Do not wait for pain, because important causes of postmenopausal bleeding may not hurt.

You may want to ask whether the blood came from the vagina, cervix, womb, urinary tract, or bowel; which examination will clarify the source; whether your medicines could contribute; and how results will be communicated. Ask whom to contact if bleeding returns while you await testing.