Menstrual cycle restarting after menopause

Menopause is reached after periods have stopped for a sustained time. Later bleeding can come from thinning or irritation of vaginal or womb tissues, polyps, hormone treatment or another condition. Pelvic organ prolapse can also cause tissue irritation and spotting. These possibilities cannot be distinguished safely by the amount of blood alone.

Bleeding does not automatically mean cancer, but conditions affecting the womb lining need to be ruled out. Symptoms such as vaginal dryness, hot flushes, night sweats or mood changes may continue around menopause, but they do not explain away new bleeding.

Contact a GP or gynaecology service and describe the colour, amount, duration and source of the blood. Mention hormone therapy, vaginal products, medicines, pain, discharge and any previous pelvic procedures. Assessment may include an examination and imaging or sampling of the womb lining, depending on your history and findings. Do not wait for a second episode before asking for advice.

Arrange prompt medical review for any bleeding after menopause. Seek urgent help if bleeding is heavy, you feel faint or weak, have severe pelvic pain, fever or shortness of breath, or cannot keep fluids down. Emergency symptoms can reflect significant blood loss or another acute problem.

Ask where the bleeding may be coming from, whether your medicines or vaginal tissues could contribute, and which examination or scan is appropriate. Ask when results will be available and what symptoms should prompt urgent review while you wait.