Spotting after two years of menopause

After menopause, lower oestrogen can make vaginal and cervical tissue thinner and drier, so minor irritation may cause spotting. Polyps, inflammation, medicines and pelvic organ prolapse can also contribute. Less commonly, changes in the womb lining or cancer need to be ruled out; the amount of blood does not reliably show the cause.

Other menopause symptoms such as hot flushes, night sweats, mood changes, low sex drive or vaginal dryness may provide useful context, but they do not explain away postmenopausal bleeding. Periods stopped is a normal menopause change; bleeding after that change is different.

Contact a healthcare professional and describe when the bleeding began, its colour and amount, whether it followed sex, and whether you use hormone therapy or blood-thinning medicine. An assessment may include a pelvic examination, cervical screening review and tests of the vagina or womb lining.

Seek urgent care for heavy bleeding, severe pelvic pain, faintness, dizziness, fever or marked weakness. Otherwise, arrange a timely appointment rather than waiting for another episode, because postmenopausal bleeding needs a clear explanation.

Ask what examinations are appropriate, whether medicines or dryness could contribute, and whether the womb lining needs assessment. Bring your menopause history, medication list, previous screening details and information about pain or discharge.