Spotting mid-cycle during menopause

During the menopause transition, periods may become less predictable and bleeding can be lighter, heavier, shorter or farther apart. Spotting may occur alongside other symptoms such as [Hot Flushes](/symptoms/hot-flushes/), night sweats, mood changes or vaginal dryness. Hormonal change is one possible explanation, but it should not be assumed without considering the full history.

Bleeding after twelve months without a period is considered postmenopausal bleeding and needs prompt clinical review, even if it is light. A clinician may examine the vagina and cervix and decide whether further tests are appropriate. [Periods Stopped](/symptoms/periods-stopped/) provides related information about this transition.

Track each episode, including colour, amount, duration, cycle timing and whether pain or sex preceded it. Note hormone therapy, contraception, vaginal products and medicines. Arrange an appointment for a new, repeated or postmenopausal episode. Do not use leftover hormones or change prescribed treatment without discussing the bleeding with your clinician.

Seek urgent care for heavy bleeding, severe pelvic pain, faintness, marked weakness, fever or rapidly worsening symptoms. Contact a healthcare professional promptly for any bleeding after periods have stopped, bleeding after sex, or bleeding that keeps returning. Urgency is based on the bleeding and associated symptoms, not on whether other menopause symptoms are present.

Ask whether the bleeding fits the menopause transition, whether an examination or scan is needed, how hormone therapy may affect it, and which symptoms should lead you to urgent care.