Menopause and intermittent bleeding: what to know

As ovarian hormone levels fluctuate, the lining of the womb may not thicken and shed on a predictable schedule. You may notice spotting, bleeding between periods, or a gap followed by bleeding. Vaginal dryness can also make light bleeding after sex more likely. Other causes include cervical or womb changes, some medicines, infection, fibroids, polyps, or pelvic organ prolapse. These possibilities cannot be separated by the pattern alone.

Menopause is reached after twelve months without a period. Any bleeding after that point is postmenopausal bleeding, even if it is a small amount or happens once.

Record when the bleeding starts, how long it lasts, whether it is spotting or a flow, and whether it follows sex. Note pelvic pain, unusual discharge, dizziness, or medicines such as hormone treatment or blood thinners. Arrange a clinician appointment for repeated, unexplained, or postmenopausal bleeding. An assessment may include an examination and tests chosen from your history.

Seek urgent medical help if bleeding is heavy or continuous, you feel faint or weak, you have severe pelvic pain, or you may be pregnant. Contact a clinician promptly for bleeding after menopause, bleeding after sex that keeps returning, or bleeding with foul-smelling discharge or fever.

Ask what stage of menopause your pattern suggests, whether your medicines could contribute, which examination or tests are appropriate, and how to manage vaginal dryness if sex triggers spotting.