Blood spotting in menopause: when to be checked

This includes a pink or brown stain, a small amount noticed once, bleeding after sex or flow resembling a period. How light the bleeding is does not determine whether it needs checking.

In perimenopause, ovulation becomes less predictable, so periods may arrive closer together, farther apart, or with spotting between them. A new pattern still merits discussion, particularly when bleeding is frequent, follows sex or is accompanied by pelvic symptoms.

After menopause, lower oestrogen can leave vaginal or uterine tissue thin and prone to bleeding. Polyps and thickening of the womb lining are other possibilities. Womb or cervical cancer can also present with postmenopausal bleeding, which is why an examination is needed rather than judging the cause by colour or volume.

Contact a primary care clinician or gynaecologist soon after any bleeding that occurs once menopause is established. Note the date, amount, colour, whether it followed sex and whether you have pain, discharge or vaginal dryness. Bring a list of medicines, including menopausal hormone therapy and blood-thinning treatment.

Assessment may involve an examination of the vagina and cervix, pelvic ultrasound and a sample from the womb lining. The exact sequence depends on your history and findings. Do not change hormone treatment on your own; the prescriber can explain whether the bleeding fits the expected pattern for that medicine.

Attend emergency care if the flow is heavy or rapidly worsening, or if it comes with fainting, severe weakness, breathing difficulty or intense pelvic or abdominal pain. These features need immediate attention regardless of the suspected source.

Without emergency symptoms, postmenopausal spotting still calls for prompt clinical review. Book an appointment even if the bleeding has stopped and do not wait for another episode before seeking advice.

Ask which part of the reproductive tract appears to be bleeding, what tests are recommended, how each test is performed and when to expect results. If dryness or discomfort is present, ask which local treatments are suitable while the bleeding is investigated.