What causes bleeding after menopause?

After menopause, the vaginal and womb tissues may become thinner and more fragile. Genitourinary Syndrome of Menopause can cause dryness, irritation and bleeding, including after sex. Endometrial Polyps can bleed, while Endometrial Hyperplasia means the womb lining has become thicker than expected. Less commonly, bleeding presents with cervical, vaginal or womb cancers, including Uterine Sarcoma. Bleeding may be spotting or a heavier flow, and its amount does not reliably identify the cause. Even a single episode should be assessed.

Contact a clinician or postmenopausal bleeding service promptly and record when the bleeding occurred, its amount, whether it followed sex, and any pain, discharge or urinary symptoms. Bring a list of medicines, including hormone therapy and blood thinners. Assessment may include an examination, ultrasound and sometimes a sample of the womb lining. Treatment depends on the finding; surgery such as Radical Hysterectomy is used only for selected diagnoses.

Seek emergency care for heavy bleeding, faintness, severe weakness, severe pelvic pain, fever or shortness of breath. Otherwise, arrange prompt medical review for any bleeding after menopause, including pink or brown discharge and bleeding after sex. Do not wait for another episode to occur.

What examination or scan should I have first? Could my medicines or vaginal symptoms explain the bleeding? Will I need a womb-lining sample, and when should I expect results?