What should you know about female spotting blood after menopause?

After menopause, low oestrogen can make vaginal and vulval tissues thin, dry, and easier to irritate. A polyp, infection, pelvic organ prolapse, or medicine can also contribute. Bleeding may come from the vagina, cervix, or womb lining, and its appearance does not show the source. Womb cancer and other important conditions can sometimes present with postmenopausal bleeding, so the symptom needs evaluation even when it is light or happens once. Menopause symptoms such as hot flushes, night sweats, mood changes, low sex drive, or vaginal dryness may provide useful context but do not explain bleeding without assessment.

Contact a gynaecology or primary-care service and describe when the bleeding occurred, its amount and colour, whether it followed sex, and any pain, discharge, urinary change, or hormone treatment. The clinician may examine the vagina and cervix and arrange an ultrasound or other investigation. Do not wait for the bleeding to recur before seeking advice. Bring a list of medicines and note whether periods have stopped, including whether the change followed surgery or hormone treatment.

Seek urgent help if bleeding is heavy or accompanied by dizziness, fainting, severe abdominal or pelvic pain, fever, or marked weakness. Otherwise, arrange prompt non-emergency review for any spotting, pink discharge, or fresh blood after menopause.

Where might the blood be coming from? Do I need an examination, ultrasound, or sampling of the womb lining? Could dryness, prolapse, hormone treatment, or another medicine be contributing?