A period 18 months after menopause

Menopause is reached after twelve months without a menstrual period. Bleeding after that point can come from thinning or irritation of the vaginal or uterine lining, a cervical or uterine polyp, infection, hormone treatment or another medication. [Genitourinary Syndrome of Menopause](/conditions/genitourinary-syndrome-of-menopause/) may cause dryness and fragile tissue. [Pelvic Organ Prolapse](/conditions/pelvic-organ-prolapse/) can cause rubbing or surface bleeding.

Most causes are treatable, but bleeding can sometimes signal abnormal changes in the lining of the uterus, cervix or vagina. The amount of blood does not show the cause. Even pink or brown spotting should be reported, including bleeding that happens once and stops.

Contact a gynaecology or primary-care service promptly and describe when the bleeding began, how long it lasted, its colour and whether it followed sex. Mention hormone therapy, vaginal products, blood-thinning medicines, pelvic pain, discharge or urinary symptoms. Do not wait for another episode before seeking advice.

Assessment may include an examination of the vulva, vagina and cervix, an ultrasound to look at the womb lining, and sometimes a sample of tissue. Treatment depends on the finding. Supportive care for dryness may be discussed, but it should not replace checking new bleeding.

Seek urgent help for heavy bleeding, clots with weakness, faintness, severe abdominal or pelvic pain, fever, or dizziness. If bleeding is light but recurrent, arrange prompt review rather than using the absence of pain as reassurance. Emergency symptoms can reflect blood loss, infection or another acute pelvic problem.

Ask what may be causing the bleeding, which examination or scan is appropriate, and whether any medicine could contribute. Ask how quickly results are expected, whether a tissue sample is needed, and what bleeding or pain should prompt emergency care. Share any ongoing [Vaginal Dryness](/symptoms/vaginal-dryness/) or other menopause symptoms.