Unexpected bleeding after menopause: what to know

Unexpected bleeding after menopause should be checked by a clinician, even when it is light or happens only once. Menopause means bleeding has stopped for a sustained period, so new blood from the vagina, cervix or womb needs a clear explanation.

Common explanations include thin, delicate vaginal or womb tissues related to low oestrogen, inflammation, and benign growths such as endometrial polyps. Genitourinary syndrome of menopause can cause dryness, irritation and bleeding, particularly after sex. Endometrial hyperplasia is another womb-lining change that needs assessment. Bleeding can also be a presentation of womb cancer, cervical cancer or vaginal cancer; this symptom does not establish which condition is present.

A clinician may ask about the timing, amount, colour, pain, sexual activity and medicines such as hormone therapy or blood thinners. Assessment can include an examination, pregnancy testing when relevant, ultrasound and sampling of the womb lining.

Arrange a medical appointment promptly and record when the bleeding started, whether it followed intercourse, and any pelvic pain or discharge. Bring a list of medicines and note whether menopause followed natural changes, surgery or treatment. Do not use vaginal products to mask bleeding before an examination unless a clinician advises them. The tests chosen depend on your history and examination findings; a camera examination of the womb or a tissue sample may be recommended.

Seek urgent medical help if bleeding is heavy or persistent, you feel faint or weak, or you have severe pelvic pain, fever, or a foul-smelling discharge. These features can signal significant blood loss or infection and should not wait for a routine appointment. Any new bleeding after menopause still warrants follow-up even if it stops.

Ask what source of bleeding is most likely, which examination or scan is needed, and whether the womb lining should be sampled. Ask how your medicines or hormone treatment could contribute, when results will be available, and what symptoms should prompt faster care.