Causes of light spotting after menopause

Even a small pink, red or brown stain that happens once should be discussed with a clinician because the appearance or amount cannot identify its source.

Lower oestrogen levels after menopause can make the vaginal and urinary tissues thinner, drier and easier to irritate. Spotting may then occur after sex or an examination. Polyps on the cervix or inside the womb, inflammation and thickening of the womb lining are other possibilities.

Cancer of the womb lining, cervix, vagina or vulva can present with bleeding after menopause. This presentation does not determine the diagnosis, so an examination and appropriate tests are needed to separate benign causes from conditions requiring treatment.

Arrange an appointment even if the spotting has stopped. Note when it occurred, its colour and amount, whether it followed sex, and whether you have pelvic pain, discharge, urinary symptoms or vulval soreness. Bring a list of medicines, including menopausal hormone therapy, blood-thinning medicines and non-prescription products.

Assessment may include inspection of the vulva, vagina and cervix, followed by an ultrasound, sampling of the womb lining or another test if indicated by the findings.

Seek urgent medical help if bleeding becomes heavy, you feel faint or very weak, or you develop severe abdominal or pelvic pain. Fever, foul-smelling discharge or rapidly worsening pain also warrants prompt assessment. Otherwise, book a timely appointment for any postmenopausal spotting rather than waiting for it to recur.

Ask which area appears to be bleeding, whether the womb lining needs imaging or sampling, whether medicines could contribute, and what follow-up is needed if the first tests do not reveal a cause.