Blood spotting after menopause: what to know

Postmenopausal bleeding can come from fragile vaginal tissue, a polyp, changes in the cervix or womb lining, infection, or another condition. An examination is needed to identify where the blood came from; its colour or small volume cannot establish the cause.

After menopause, lower oestrogen can make vaginal and vulval tissue thinner, drier, and easier to irritate. Bleeding may also arise from endometrial polyps, the cervix, or the womb lining. Womb cancer can present with postmenopausal spotting, but the symptom alone does not show that cancer is present.

Blood can sometimes come from the urine or rectum rather than the vagina. Note whether it appeared on underwear, toilet paper, or after passing urine or stool, and tell the clinician if the source is uncertain.

Arrange a gynaecology appointment promptly. Record when the spotting began, whether it followed sex, any pelvic discomfort or discharge, and all medicines or hormones you use. Do not stop a prescribed blood thinner or hormone treatment unless the prescriber tells you to.

Assessment may include a pelvic and speculum examination. Depending on the findings, the clinician may suggest an ultrasound to view the womb lining or take a small tissue sample. These checks distinguish surface irritation from changes that need targeted treatment.

Seek urgent medical care if bleeding becomes heavy, you feel faint or unusually weak, you have severe pelvic or abdominal pain, or you develop fever with feeling unwell. These features warrant rapid assessment regardless of the eventual cause.

Light spotting without those warning signs still deserves a prompt appointment. Do not wait for it to recur before arranging an evaluation.

Ask which part of the genital tract appears to be bleeding, whether an ultrasound or tissue sample is appropriate, and how medicines or vaginal dryness may contribute. Also ask how and when results will be shared, what symptoms should trigger urgent help, and what follow-up is needed if the bleeding returns.