Spotting after one year of menopause

Spotting may appear as pink, red or brown discharge, and bleeding can occur after sex or without an obvious trigger. It is not considered a return of ordinary periods once menopause has been established.

After menopause, lower oestrogen levels can make the vaginal and uterine lining thinner and more delicate. Dry tissue may bleed after friction, including sexual activity. Other possible causes include a cervical or uterine polyp, inflammation, infection, some medicines, or thickening of the uterine lining. Less commonly, bleeding can be a presentation of cancer of the uterus, cervix or vagina, so the symptom should not be self-diagnosed.

Bleeding can sometimes come from the urinary tract or rectum rather than the vagina. A clinician can help identify the source and decide which examination or test is appropriate.

Arrange an appointment with a gynaecologist or another healthcare professional promptly. Record when the spotting began, how long it lasted, its colour and amount, whether it followed sex, and any pain or unusual discharge. Bring a list of medicines, including hormone therapy and blood thinners.

Assessment may include a history, pelvic examination and an examination of the cervix. Depending on the findings, the clinician may arrange an ultrasound, a sample of the uterine lining, or other tests. Do not use vaginal products or stop prescribed medicines unless your clinician advises you to.

Seek urgent medical help if bleeding becomes heavy, you feel faint or weak, you develop severe or worsening pelvic pain, or you have fever with a foul-smelling discharge. Seek prompt advice for repeated spotting, bleeding after sex, or any bleeding accompanied by unexplained weight loss or a change in bladder or bowel habits.

If the bleeding is light and has stopped, still arrange a clinical assessment rather than waiting to see whether it returns. Keep using any prescribed treatment as directed while you seek advice.

You could ask: What might be causing the spotting? Does my medication or hormone therapy affect the assessment? Which examination or scan do you recommend? Would I need a tissue sample? What symptoms should lead me to seek urgent help?