Menopause and spot bleeding

During the transition before menopause, hormone shifts can make the uterine lining shed unpredictably, causing light marks on underwear or toilet paper. Vaginal dryness, irritation, contraception, polyps, fibroids, infection, and changes in the cervix can also cause bleeding. Once you have gone a full year without a period, any vaginal bleeding is considered postmenopausal bleeding and should not be assumed to be a routine menopause symptom. Most causes are treatable, but examination is needed to identify the source.

Note when the spotting occurred, its colour and amount, whether it followed sex, and any pain, discharge, or urinary symptoms. Record the date of your last period and list medicines, including hormonal contraception or hormone therapy. Arrange a non-urgent appointment for new, repeated, or unexplained spotting. Avoid inserting products or having sex if they clearly worsen irritation until you have advice, and do not change prescribed hormones without discussing it.

Seek urgent help if bleeding becomes heavy, you feel faint or weak, develop severe pelvic pain, have fever, or may be pregnant. Contact a clinician promptly for any bleeding after periods have stopped, even if it is light or happens once. The evaluation may include a pelvic examination and, depending on your symptoms, imaging or a sample from the uterine lining.

Am I still in the menopause transition, or have my periods stopped completely? Could dryness, medication, contraception, or a cervical or uterine cause explain this? Do I need an examination or further tests? What symptoms should prompt faster care?