Menopause break-through bleeding: what to know

During perimenopause, ovulation may become less predictable, so bleeding can arrive between periods or look different from your previous pattern. Vaginal dryness or irritation can also lead to light bleeding, particularly after sex. Polyps, fibroids, changes in the cervix, medicines, and problems involving the womb lining are other possibilities a clinician may consider.

If you have gone through twelve months without a period, any new vaginal bleeding is postmenopausal bleeding, even when it is only spotting. The colour or amount cannot identify the cause on its own. Menopause can also bring hot flushes, night sweats, mood changes, low sex drive, and vaginal dryness; these symptoms do not explain away new bleeding.

Make a note of when the bleeding began, how long it lasted, whether it followed sex, and whether you had pain, discharge, dizziness, or urinary symptoms. Record medicines, hormone treatment, contraception, and any recent procedure. Arrange a medical review if bleeding is new, recurrent, or occurs after menopause. The assessment may include questions, an examination, and tests chosen for your symptoms.

Until you are reviewed, use a pad if you need to monitor the amount and avoid inserting anything into the vagina if that worsens bleeding or pain. Do not stop prescribed hormone treatment or other medicines without advice.

Seek urgent medical help if bleeding is heavy or rapidly increasing, or if it comes with fainting, severe weakness, severe abdominal or pelvic pain, fever, or shortness of breath. Contact a clinician promptly for any bleeding after menopause, repeated episodes, bleeding after sex, or bleeding with unusual discharge or pelvic pressure.

You could ask: What might explain this bleeding in my situation? Do I need an examination or further tests? Could vaginal dryness, a medicine, or hormone treatment be contributing? What changes should make me seek urgent help?