Reasons to bleed after menopause

Low oestrogen can make vaginal and cervical tissues thinner, drier, and more likely to bleed after friction. A polyp, infection, or pelvic organ prolapse can also cause spotting. Medicines and hormone therapy may alter bleeding patterns. Less commonly, bleeding reflects a problem in the lining of the womb or cervix, so even a small episode deserves review. Bleeding is different from hot flushes, night sweats, or other symptoms associated with menopause and should not be dismissed as a routine menopause symptom.

Contact a GP or gynaecology service and describe when the bleeding started, how much there was, whether it followed sex, and whether you have pain or discharge. Bring a list of medicines and hormone treatments. Assessment may include an examination, an ultrasound, or a sample from the womb lining. Do not insert products into the vagina before an appointment unless advised. Vaginal dryness can be treated, but the cause of bleeding should be established first.

Seek urgent care for heavy bleeding, dizziness, faintness, severe lower abdominal pain, fever, or feeling very unwell. Prompt assessment is also needed for repeated bleeding, bleeding after sex, or a new watery or foul-smelling discharge. If you have symptoms of [Pelvic Organ Prolapse](/conditions/pelvic-organ-prolapse/), mention pressure, a bulge, or difficulty emptying your bladder.

Ask what source of bleeding is most likely after the examination, whether the womb lining needs imaging or sampling, and whether a medicine could be contributing. Discuss treatment for dryness or irritation only after serious causes have been considered. Ask when to return if bleeding happens again.