Menstruation post menopause

Menopause is reached after twelve months without a period. Later bleeding can come from thinning or irritation of the vaginal or womb tissues, polyps, hormone treatment, infection or medicines. It can also be linked to thickening of the womb lining or, less commonly, a cancer affecting the womb or cervix. The appearance may vary from a pink smear to brown discharge or a heavier bleed, and even a single episode matters.

Vaginal dryness, pelvic pressure and other menopause symptoms may occur at the same time, but they do not explain away post-menopause bleeding. A clinician may examine the vagina and cervix and arrange imaging or sampling based on the history and findings.

Arrange an appointment promptly, even if the bleeding stops. Note when it happened, how much there was, whether it followed sex, and any pain or discharge. List hormone treatments, blood-thinning medicines and other medicines. Do not restart or stop prescribed treatment without advice. Use a pad if needed so you can observe the amount.

Seek urgent help for heavy bleeding, faintness, severe pelvic pain, weakness, breathlessness or a fever. Contact a clinician promptly for repeated spotting, bleeding after sex, watery or unpleasant-smelling discharge, or a new pelvic mass or pressure. Do not wait for another episode before arranging assessment.

What could be causing this bleeding? Do I need an examination, ultrasound or womb-lining sample? Could my medicines or hormone treatment contribute, and what symptoms should prompt urgent help?