What causes spotting in menopause?

After menopause, the vaginal and womb tissues may become thinner and more easily irritated. Vaginal dryness can lead to light bleeding after sex or friction. Polyps, infection, hormone treatment, and pelvic organ prolapse can also contribute. Less commonly, bleeding can be linked with a condition affecting the lining of the womb or cervix.

Any bleeding after periods have stopped deserves a clinical review, even when it is a small smear and happens once. Menopause symptoms such as hot flushes, night sweats, mood changes, or low sex drive do not explain away bleeding. A clinician may ask about medicines and examine the vagina and cervix.

Book an appointment with a GP or gynaecology service and describe when the bleeding occurred, how much there was, whether sex preceded it, and whether you have pain or discharge. Bring a list of medicines, including hormone treatments and blood thinners. Use a pad if bleeding recurs so you can observe it.

The review may include an internal examination, an ultrasound, or a sample from the womb lining. The appropriate tests depend on your history and examination. Do not insert products into the vagina before an examination unless your clinician advises this.

Seek urgent help if bleeding becomes heavy, you feel faint or weak, you develop severe pelvic pain, fever, or rapidly worsening symptoms. Otherwise, arrange a routine but timely appointment for any postmenopausal spotting or bleeding.

Ask what may be causing the bleeding, whether vaginal dryness or a medicine could contribute, which tests you recommend, and what changes should prompt urgent review.