Blood staining after menopause: what you should know

Make a medical appointment rather than waiting to see whether it returns. Bleeding after menopause has several possible causes, and an examination is needed to identify where the blood came from.

After menopause, the tissues of the vagina and the lining of the womb can become thinner and more fragile as oestrogen levels fall. This may lead to light spotting, particularly with dryness, friction or sexual activity. Other possible explanations include a cervical or womb polyp, inflammation, infection, changes in the womb lining, or bleeding related to medication or hormone treatment.

Cancer of the womb, cervix or vagina can also present with postmenopausal bleeding, so the symptom should not be dismissed. Blood seen on underwear or toilet tissue may instead come from the urinary tract, rectum or irritated external skin; a clinician can help locate the source.

Contact a gynaecologist, family doctor or primary-care clinic promptly. Note when the staining began, its colour and amount, whether it followed sex, and whether there is pelvic pain, unusual discharge, urinary discomfort or bleeding from the bowel. Bring a list of medicines, including blood thinners and any hormone treatment, but do not stop prescribed medicine without clinical advice.

Assessment may include questions about your bleeding and medical history, an examination of the vulva, vagina and cervix, and tests chosen for your findings. A pelvic ultrasound may be used to view the womb lining. In some cases, the clinician may recommend looking inside the womb or taking a small tissue sample to clarify the cause.

Seek urgent medical care if the bleeding is heavy, rapidly increasing, soaking through pads, or accompanied by severe pelvic or abdominal pain. Immediate help is also appropriate if you feel faint, dizzy, unusually weak, short of breath, confused, or develop cold and clammy skin.

Without these emergency features, arrange a prompt appointment for any new postmenopausal stain or spotting. The need for assessment is based on the symptom itself, not on whether the blood is bright red, brown, pink or present only once.

You may wish to ask: Where does the bleeding appear to be coming from? Which examination or test is appropriate for me? Could vaginal dryness, a medicine or hormone treatment be contributing? What symptoms should send me to urgent care while I wait? When and how will I receive the results, and what follow-up will be needed?