Bleeding during menopause: what to know

During perimenopause, hormone changes can make periods irregular, lighter, heavier, closer together, or farther apart. Once someone has had no period for a full year, any vaginal bleeding is considered postmenopausal bleeding, even if it is only spotting or happens once.

Causes include thinning or inflammation of vaginal or womb tissues, polyps, fibroids, medication effects, and hormone treatment. Less commonly, bleeding can be related to a serious womb or cervical condition. Bleeding alone cannot determine the cause.

Record the colour, amount, duration, and whether bleeding follows sex. Note medicines, hormone therapy, pelvic symptoms, and when your last natural period occurred. Arrange a medical appointment for bleeding after menopause or for new, persistent, or troublesome bleeding during the transition. Assessment may include an examination, imaging, or a sample of womb lining.

Seek urgent care if bleeding is heavy, you feel faint or unusually weak, or you have severe pelvic pain, fever, or shortness of breath. Contact a clinician promptly for repeated spotting, bleeding after sex, or bleeding with a new pelvic lump or pressure. Do not wait for another episode if you have already reached menopause.

Have I reached menopause or am I still in the transition? What could explain this bleeding, and which examination or scan is appropriate? Could my medicines or hormone treatment contribute? What changes should prompt urgent review?