Blood in urine after menopause: what to know

A pink, red or brown toilet appearance may come from the bladder, kidneys, urethra, vagina or rectum. After menopause, thinner vaginal and urinary tissues can cause irritation or spotting, but this cannot be safely distinguished from urinary bleeding by colour alone. Infection, stones, inflammation and medicines that affect clotting are among the possibilities. A urinary tract infection may cause burning, frequency or urgency. Blood can also occur without pain, so feeling well does not remove the need for a clinical review.

Arrange a medical appointment even if the bleeding happened once or has stopped. Tell the clinician whether you saw blood during urination, on toilet paper or on underwear, and mention burning, pain, clots, fever, medicines and smoking history. A clean urine sample may be examined for blood and infection. Depending on the findings, examination or further urinary-tract tests may be recommended. Do not self-treat with leftover antibiotics. Keep a note of colour, timing and associated symptoms.

Seek urgent care for heavy bleeding, clots that make urination difficult, inability to pass urine, severe side or abdominal pain, fever with chills, vomiting, dizziness or fainting. Contact a clinician promptly for any visible blood that returns or persists. A painless episode still needs evaluation because bladder conditions can present with bleeding before other symptoms appear.

How can we tell whether the blood came from urine or vaginal tissue? Do I need a urine culture or imaging? Could my medicines be contributing? Which changes mean I should seek urgent care? What follow-up is needed if the first urine test is normal?