Causes of spotting during menopause

During the transition to menopause, changing hormone patterns can make bleeding irregular. Once periods have stopped, even a small pink, red, or brown mark should be checked rather than assumed to be a period.

Possible explanations include fragile vaginal or cervical tissue linked with lower oestrogen, polyps, inflammation or infection, and bleeding related to hormone therapy. Changes in the womb lining can also cause bleeding; some are benign, while others require treatment.

Blood may come from the vagina, cervix, womb, urinary tract, or rectum, and it is not always easy to identify the source at home. Vaginal dryness may make tissue more likely to bleed after sex or an examination, but that pattern still deserves discussion with a clinician.

Arrange a medical appointment and note when the spotting began, its colour and amount, whether it followed sex, and whether there is pelvic pain, unusual discharge, urinary bleeding, or bowel bleeding. Bring a list of medicines and hormone products, including vaginal preparations.

Assessment may include a pelvic examination and, depending on the findings, imaging or a sample from the womb lining. These checks identify where the blood is coming from and guide treatment toward the cause.

Seek urgent care for heavy bleeding, fainting, marked dizziness, severe pelvic or abdominal pain, or weakness that is rapidly worsening. Contact a clinician promptly for any new bleeding after menopause, repeated spotting, bleeding after sex, or blood-stained discharge.

Ask which examination can confirm the source of the blood, whether your medicines or hormone therapy could contribute, and whether imaging or sampling of the womb lining is appropriate. You can also ask what change in bleeding should trigger urgent care while you await results.