What should you know about menses after menopause?

Menopause is reached after a sustained period without menstrual periods. Bleeding after that point is postmenopausal bleeding, not a return of a normal cycle. Causes can include thinning and irritation of vaginal or cervical tissues, polyps, hormone medicines, and changes in the lining of the womb. Less commonly, it can be linked with cancer, so the symptom should not be self-diagnosed.

Bleeding may be spotting, pink or brown discharge, or a heavier flow. Pain, vaginal dryness, unusual discharge, urinary symptoms, or a feeling of pressure may provide useful clues, but their absence does not remove the need for assessment.

Contact a doctor or gynaecology service and describe when the bleeding occurred, how much there was, whether it followed sex, and whether you use hormone therapy or blood-thinning medicine. Keep a note of colour, clots, pain, and other symptoms. Assessment may include an examination, imaging, or a sample from the womb lining, depending on your history.

Do not wait for another episode before making contact. Avoid inserting products or having sex if these worsen pain or bleeding, and follow the clinician's advice about medicines rather than stopping prescribed treatment on your own.

Seek urgent care for heavy bleeding, faintness, severe or worsening pelvic pain, weakness, shortness of breath, fever, or feeling seriously unwell. If bleeding is light and you feel well, arrange a prompt routine assessment rather than treating it as a normal period.

Ask what examinations or tests you may need, whether your medicines or vaginal symptoms could contribute, when results will be available, and which changes should prompt urgent help. Take a list of medicines and the date of your last natural period.