Causes of bleeding after menopause

Possible sources include fragile vaginal or uterine lining after lower oestrogen levels, cervical or uterine polyps, thickening of the uterine lining, infection, medicine effects, or bleeding from the urinary tract or rectum. Cancer of the uterus, cervix, vagina, or vulva is a less common but important possibility that must be excluded.

After menopause, the ovaries no longer release eggs in a monthly cycle and menstrual periods have ended. Pink, red, or brown spotting afterward is therefore described as postmenopausal bleeding, not a resumed period.

Bleeding can begin after sex because dry, thin vaginal tissue is easily irritated. Hormone therapy can also produce bleeding patterns, particularly after starting or changing treatment, but the prescriber still needs to assess unexpected bleeding. The colour or small amount cannot reliably show where it came from.

Book a medical appointment and note when the bleeding started, its amount, whether it followed sex, and any pain, discharge, urinary symptoms, or bowel symptoms. Bring a list of hormone therapy, tamoxifen, blood thinners, supplements, and other medicines.

Assessment may include examination of the vulva, vagina, and cervix, followed by pelvic ultrasound or a sample from the uterine lining when indicated. If you are unsure whether blood came from the vagina, urine, or rectum, say so; the clinician can investigate each potential source.

Seek urgent care for heavy or rapidly increasing bleeding, fainting, marked dizziness, shortness of breath, severe pelvic or abdominal pain, or feeling acutely unwell. Do not drive yourself if you feel faint.

Without emergency signs, contact a clinician promptly rather than waiting for another episode. Recurrent spotting, bleeding after sex, watery or blood-stained discharge, pelvic pressure, or unexplained pain should all be mentioned because they influence the examination and tests.

Ask which part of the genital or urinary tract may be bleeding, whether your medicines could contribute, what the examination and ultrasound are looking for, and whether a uterine-lining sample is needed. Clarify when results will be available and which symptoms should prompt emergency care while waiting.