Causes of bleeding after menopause

Possible causes include fragile vaginal or womb-lining tissue after oestrogen levels fall, cervical or womb polyps, thickening of the womb lining, and unscheduled bleeding related to hormone therapy. Less commonly, bleeding can be a presentation of cancer affecting the womb, cervix, vagina or ovaries.

Postmenopausal bleeding includes red blood, brown or pink discharge, and spotting from the vagina after periods have stopped because of menopause. Blood can also come from the urinary tract, bowel, vulva or irritated vaginal tissue, so an examination helps identify its source.

Lower oestrogen can make vaginal tissue thin, dry and prone to bleeding, including after sex. Polyps are small growths that may bleed. A thickened womb lining may be linked to hormone exposure and sometimes contains abnormal cells, which is why the cause cannot be identified from appearance alone.

Arrange a prompt appointment with a gynaecologist or primary-care clinician. Record when the bleeding began, its colour and amount, whether it followed sex, and whether you have pelvic pain or unusual discharge. Bring a list of medicines, including hormone therapy, tamoxifen and blood thinners; do not stop prescribed medicine without clinical advice.

Assessment may include examination of the vulva, vagina and cervix, followed by a vaginal ultrasound to inspect the womb lining. Depending on the findings, the clinician may recommend hysteroscopy, which uses a narrow camera to view the womb, and a small tissue sample for laboratory examination.

Contact a clinician promptly for any bleeding after menopause, including a single spot or blood-stained discharge, because examination is needed to exclude important causes. Seek urgent medical help if bleeding is heavy, you feel faint or weak, you have severe pelvic or abdominal pain, or you develop breathing difficulty.

Ask which possible source of bleeding the examination suggests, whether your medicines could contribute, what the ultrasound will assess, and whether a hysteroscopy or biopsy is appropriate. You can also ask how and when results will be shared, and what changes should prompt earlier review while you wait.