Dark spotting after menopause

After menopause, the vaginal and uterine tissues may become thinner and more easily irritated. Vaginal dryness, sex, a minor injury, cervical changes, polyps or pelvic organ prolapse can cause spotting. Some medicines and hormone treatments can also affect bleeding. Less commonly, bleeding can be related to changes in the womb lining, so colour, small amount or lack of pain does not rule out a condition needing treatment. Hot flushes, night sweats, mood changes or low sex drive may occur around menopause, but they do not explain away postmenopausal bleeding.

Contact a GP or gynaecology service and explain when menopause occurred, whether spotting followed sex, and whether you use hormone therapy or blood-thinning medicine. Note the amount, colour, duration, pain, discharge and any recurrence. Assessment may include an examination of the vagina and cervix, followed by an ultrasound or sampling of the womb lining when indicated. Do not assume the bleeding is simply vaginal dryness or wait for it to become heavier before arranging review.

Seek urgent help if bleeding becomes heavy, you feel faint or very weak, or you develop severe pelvic pain, fever or a rapidly worsening condition. Otherwise, arrange a prompt routine assessment for any bleeding after menopause, including pink or brown discharge or spotting that stops on its own.

Ask where the blood may be coming from and whether your medicines or hormone treatment matter. Do you need a pelvic examination, ultrasound or womb-lining sample? Could vaginal dryness be contributing, and what treatment is suitable? When should you return if spotting recurs?