Spotting after menopause: what it can mean

After menopause, bleeding is not treated as a normal period. Thinning and dryness of the vaginal or cervical tissues can make them easier to irritate, including during sex. Polyps, some medicines, hormone treatment, infection, or changes in the womb lining can also cause spotting. Pelvic organ prolapse may expose or irritate tissue. Less commonly, bleeding can be linked with a cancer of the womb or cervix, which is why the symptom needs evaluation rather than guesswork. Other menopause symptoms, such as hot flushes or night sweats, do not explain away post-menopausal bleeding.

Arrange an appointment with a GP or gynaecology clinician and describe the first day of bleeding, its colour, amount, recurrence and relationship to sex. Bring a list of medicines, hormone treatments and relevant medical history. The assessment may include an examination and, depending on your history, imaging or a sample from the womb lining. Avoid inserting products into the vagina before an examination unless advised. Keep using prescribed medicines as directed, but report bleeding that begins after a treatment change.

Seek urgent medical help if bleeding is heavy, you feel faint, have severe pelvic pain, develop fever, or feel suddenly unwell. Contact a clinician promptly for any repeat episode, bleeding after sex, unusual discharge, or new pressure or bulging in the vagina. The amount of blood does not reliably show the cause, so do not delay assessment because the spotting seems minor.

Ask what examinations are appropriate, whether vaginal dryness or a medicine could contribute, and whether you need a womb or cervical assessment. Tell the clinician about the date of your last period, hormone treatment, contraception history, pain, discharge and any earlier episodes.