Post-menopausal cramping and spotting

After menopause, any vaginal bleeding or pink, brown, or red discharge deserves a clinical review, even when it happens once or seems minor. Dry, fragile vaginal or uterine lining can bleed, and polyps or fibroids may contribute to spotting and cramps. Infection, including Chlamydia, is another possible cause depending on symptoms and exposure.

Less commonly, bleeding can be a presentation of womb cancer, cervical cancer, or cervical dysplasia. This does not mean bleeding confirms cancer; examination is needed to identify the cause.

Contact a GP or gynaecology service and describe when the bleeding began, its colour and amount, whether cramps are constant, and whether you use hormone therapy or blood thinners. Bring a list of medicines and note pain, discharge, urinary symptoms, or bowel changes.

Assessment may include a pelvic examination, cervical screening when appropriate, swabs, ultrasound, or a sample of the womb lining. The right tests depend on your history and examination. Do not use leftover treatment to mask symptoms before advice.

Seek urgent care for heavy bleeding, severe or rapidly worsening pain, fainting, marked weakness, fever, or a swollen and tender abdomen. Emergency help is appropriate if you feel unable to stand, become confused, or have symptoms of significant blood loss. Otherwise, arrange a prompt non-emergency appointment rather than waiting for another episode.

Ask which examination and tests are appropriate, whether medicines could contribute, how to manage dryness or discomfort, and when results or follow-up should be expected.