Irregular bleeding during menopause: what to know

During the transition into menopause, hormone changes can make periods irregular, lighter, heavier, or separated by longer gaps. Once periods have stopped, bleeding is not treated as a normal period returning. Causes can include thinning or inflammation of the vaginal or womb lining, polyps, medication effects, or other conditions that need checking. Vaginal dryness may lead to small amounts of bleeding after sex, while pelvic organ prolapse can cause pressure or tissue changes; neither should be assumed without an examination. Other menopause symptoms include hot flushes, night sweats, mood changes, and low sex drive.

Write down the date, amount, colour, triggers, and whether bleeding followed sex. Bring a list of medicines, hormone treatments, and relevant medical history. A clinician may examine the vagina and cervix, arrange imaging, or take a sample from the womb lining based on your symptoms. Use pads if you need to monitor flow, and seek advice before changing prescribed hormone treatment.

Book a medical assessment for any bleeding after a sustained period without periods, even if it happens once or is only spotting. Seek urgent help for heavy bleeding with dizziness, faintness, severe pain, weakness, or breathlessness. Contact a clinician promptly for bleeding that recurs, follows sex, or comes with unusual discharge, pelvic pressure, or new pain. Assessment helps distinguish common lining changes from conditions needing treatment.

Ask: Does my bleeding count as postmenopausal bleeding? Could dryness, prolapse, medication, or the womb lining be involved? Do I need an examination, scan, or tissue sample? Should I continue my current hormone treatment? Which symptoms should prompt urgent help?