Cramps and spotting after menopause

After menopause, vaginal bleeding or spotting can come from dryness and fragile vaginal or cervical tissue, polyps, medication effects or other pelvic changes. Cramps may occur alongside these problems or have a separate cause, including pelvic organ prolapse. Most causes are not cancer, but bleeding can sometimes signal a condition that needs prompt treatment, so its amount does not determine its importance.

Tell the clinician whether the blood came from the vagina, urine or rectum, and describe colour, frequency, pain, discharge and any recent procedures. [Periods Stopped](/symptoms/periods-stopped/) provides related context.

Arrange a medical appointment soon and take a list of medicines, including hormone treatment and blood thinners. Do not insert products or douche before assessment. The clinician may examine the vagina and cervix and decide whether imaging or further testing is needed. Note each episode and any triggers such as sex or exertion.

Seek urgent care if bleeding is heavy or increasing, or if cramps come with dizziness, fainting, severe pain, fever, weakness or shortness of breath. Contact a clinician promptly for any new spotting, repeated bleeding, pelvic pressure, unusual discharge or pain during sex.

Where might the blood be coming from? Could dryness, a prolapse, a medicine or another pelvic condition explain it? Do I need an examination, scan or biopsy? What symptoms should make me seek urgent help?