When to worry about bleeding after sex with genitourinary syndrome of menopause

Lower oestrogen can make vaginal and urinary tissues thinner, drier, and easier to irritate. Friction during sex may then cause tiny surface cracks and spotting. Burning, dryness, soreness, urinary urgency, or discomfort with penetration can occur alongside the bleeding. These features can fit genitourinary syndrome of menopause, yet they do not explain every cause of bleeding.

Bleeding can also come from the cervix, an infection, a polyp, medication effects, or another condition. A clinician may examine the vagina and cervix and decide whether tests are needed.

Arrange a medical appointment if the bleeding returns, happens after more than one sexual encounter, or appears after menopause. Note when it occurred, how much blood you saw, whether penetration was painful, and whether you have discharge, pelvic pain, or urinary symptoms.

Until you are assessed, pause any activity that causes bleeding or pain. A suitable lubricant may reduce friction, while a clinician can discuss moisturisers or local treatment if tissue dryness is contributing. Do not self-treat persistent bleeding without an examination.

Seek urgent medical help for heavy or ongoing bleeding, faintness, severe pelvic or abdominal pain, fever, unusual discharge with feeling unwell, or possible pregnancy with pain or bleeding. If bleeding is light but keeps recurring, contact a gynaecology service promptly rather than waiting for it to settle on its own.

Ask whether the examination supports genitourinary syndrome of menopause, whether cervical screening is up to date, and whether an infection or polyp should be excluded. You can also ask which lubricant or vaginal treatment is appropriate and how soon you should return if bleeding continues.