Menopause and breakthrough bleeding: what should you know?

During the menopause transition, ovulation and the uterine lining can become less predictable. Hormonal contraception, hormone treatment, missed doses, vaginal dryness, infection or irritation can also cause spotting. Endometrial polyps and other uterine conditions are possible explanations, so the pattern matters more than the label.

Bleeding is considered postmenopausal when it occurs after periods have stopped for a sustained interval. It is not expected simply because menopause has occurred and should be checked, even if it is light or happens once. A clinician may ask about contraception, medicines, sexual activity, pain and the appearance and timing of the blood.

Record when the bleeding began, how long it lasted, whether it followed sex, and whether you had pain, discharge or dizziness. Note contraception and hormone medicines, including missed or recently changed doses. Arrange a medical appointment for bleeding that recurs, follows sex, occurs after menopause or is not explained by your usual treatment.

Do not insert products or take extra hormones to stop the bleeding without advice. A clinician may examine the vagina and cervix and decide whether further assessment is needed based on your history.

Seek urgent care for heavy bleeding with faintness, severe weakness, shortness of breath, severe pelvic pain, fever, or possible pregnancy. Get prompt medical advice for bleeding with foul-smelling discharge or pelvic pain, because infection such as chlamydia can sometimes affect the reproductive tract.

Could my contraception or hormone treatment explain this bleeding? Do I need an examination or assessment of the uterine lining? What should I do if it happens again, becomes heavier or follows sex?