Heavy bright-red bleeding after menopause

After menopause, bleeding can arise from thinning or irritation of vaginal tissues, polyps, a thickened womb lining, or less commonly a cancer affecting the womb, cervix or vagina. Bright-red colour indicates fresh blood but does not reveal the source. Most causes are not cancer, yet cancer needs to be considered and ruled out by appropriate assessment.

Bleeding may appear on underwear, toilet paper or after sex. Tell the clinician whether it was spotting or heavy, how long it lasted, and whether there is pain, discharge or urinary discomfort.

Arrange prompt review with a GP, gynaecologist or postmenopausal bleeding service, even if the bleeding has stopped. Use a pad to observe flow, note medicines such as hormone therapy or blood thinners, and bring details of prior procedures. Assessment may include an examination, ultrasound or sampling of the womb lining.

Seek emergency help if bleeding is heavy and ongoing, or if you feel faint, weak, breathless or confused. Severe pelvic pain, fever or feeling acutely unwell also warrants urgent care. Do not wait for a routine appointment when these symptoms occur.

Ask what may be causing the bleeding, which tests are recommended, how medicines affect the evaluation, and when results and follow-up will be available.