Menopause and abnormal bleeding: what to know

Before periods have fully stopped, hormone fluctuations can change the timing, flow and length of cycles. A skipped period may be followed by bleeding that is lighter, heavier or different from your usual pattern. Vaginal dryness can also cause spotting after sex. Bleeding is not automatically caused by menopause, however. Polyps, fibroids, infection, medicines, pregnancy-related causes and changes in the womb lining can also be involved.

Menopause is reached after a full year without a period. Any vaginal bleeding after that point needs clinical review, even if it is light or happens once. A clinician may ask about the bleeding pattern, medicines and pregnancy possibility, and may offer an examination or further assessment.

Write down when bleeding starts and stops, how heavy it is, whether clots or pain occur, and whether it follows sex. Use products that let you judge the amount comfortably and keep hydrated if bleeding is more than usual. Book a medical appointment for bleeding after menopause, repeated spotting, bleeding between periods or a change that persists. Do not stop prescribed hormones or blood-thinning medicine without advice.

Seek urgent help if bleeding is heavy enough to make you feel faint or weak, if you have severe pelvic pain, or if you may be pregnant and have pain or bleeding. Fever, foul-smelling discharge or feeling acutely unwell also needs prompt assessment. Emergency care is appropriate for collapse, severe dizziness or bleeding that is rapidly worsening.

Could my medicine, contraception or vaginal dryness explain the spotting? Do I need an examination or tests? How should I record bleeding? What amount of bleeding or pain should trigger urgent care?