Menopausal bleeding after sex: what to know

Lower oestrogen after menopause can make vaginal tissue thinner, drier and more easily irritated. This genitourinary change may cause soreness, burning or small amounts of bleeding with penetration. Infection, including chlamydia, can also cause bleeding or discharge. A fragile area on the cervix, cervical dysplasia or a vaginal condition may be involved. Cervical cancer and vaginal cancer can present with bleeding, although bleeding alone cannot identify the cause.

Evaluation commonly includes questions about the bleeding, sexual symptoms, medicines and screening history, followed by an examination. Depending on findings, a clinician may recommend swabs, cervical assessment or a biopsy. A cone biopsy is one procedure used for selected cervical abnormalities, not a routine treatment for every episode.

Book an appointment even if the bleeding is light or happens once. Record when it occurred, whether it followed penetration, the amount, pain, discharge and any urinary symptoms. Avoid intercourse until soreness settles if it triggers bleeding, and use a suitable lubricant if dryness is present. Do not use leftover antibiotics or vaginal products without advice, because they can obscure symptoms or irritate tissue.

Seek prompt care for repeated bleeding, bleeding without sex, pelvic pain, offensive discharge, fever, dizziness or bleeding that becomes heavier. Emergency help is appropriate for heavy bleeding with faintness or severe pain. After menopause, any vaginal bleeding warrants clinical review, including blood noticed after wiping.

Ask which tissues may be bleeding, whether infection or cervical changes need testing, and whether vaginal moisturisers, local treatment or another option could help dryness. Ask when results will be available and what symptoms should prompt earlier contact.