Menopause and bleeding: what to know

As hormone levels change, periods may become closer together, farther apart, lighter, or heavier before they stop. Menopause is reached after twelve months without a period. Spotting or bleeding after that point is called postmenopausal bleeding and is not considered a returning period.

Possible causes include thinning of the vaginal or womb lining, cervical changes, polyps, some medicines, and hormone treatment. Less commonly, bleeding can be a sign of a womb-related cancer. A symptom does not identify its cause on its own, so assessment matters even when the bleeding is light or happens once.

Write down when the bleeding started, whether it was spotting or a flow, its colour, and any pain, discharge, or bleeding after sex. Include medicines and hormone treatments in your notes.

Arrange an appointment with a gynaecologist or other healthcare professional if you bleed after twelve months without periods. They may ask about your history and examine the vagina and cervix; an ultrasound or a sample of the womb lining may be suggested depending on your symptoms.

Seek urgent medical help if bleeding is heavy enough to soak pads quickly, you feel faint or unusually weak, or you have severe pelvic pain. If you are pregnant or could be pregnant, bleeding also needs prompt advice. Otherwise, book a timely assessment for any bleeding after menopause rather than waiting for it to settle.

Ask what may be causing the bleeding, whether you need an examination or ultrasound, and how to prepare for any womb-lining sample. You can also ask whether vaginal dryness or pelvic organ prolapse could be contributing and which treatments are suitable for your health history.