Menstrual spotting after menopause: what to know

Spotting can arise from delicate, dry tissues in the vagina or womb, irritation after sex, inflammation, polyps, or changes in the womb lining. Some medicines and hormone treatments can also contribute. Pelvic organ prolapse may cause rubbing or surface irritation. These possibilities can look alike, so the amount or colour of spotting does not establish the cause.

Less common but significant causes include changes affecting the cervix or womb lining. This is why a small smear of blood deserves a clinical review rather than being treated as a late period. Tell the clinician whether the spotting is repeated, follows intercourse, or comes with discharge, pelvic pressure, or pain.

Arrange an appointment promptly and note the first and last day of spotting, its colour, whether it marked underwear or needed a pad, and any trigger such as sex or an examination. Bring a list of medicines, hormone products, and relevant medical history.

A clinician may inspect the vagina and cervix and may arrange an ultrasound or a sample from the womb lining. The choice depends on your symptoms and examination. Avoid assuming that a previous normal check explains new bleeding; report each new episode.

Get urgent medical help for bleeding that becomes heavy, dizziness or fainting, severe pelvic or abdominal pain, fever, or feeling acutely unwell. Use emergency services if weakness or breathlessness accompanies the bleeding.

Could dryness, irritation, a polyp, medicine, or a womb or cervical problem be involved? What examination and tests are appropriate? Should I change any products or medicines? How should I respond if the spotting returns?