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

Lower oestrogen after menopause can make the vaginal and urinary tissues thinner, drier and easier to irritate. Genitourinary Syndrome of Menopause may therefore lead to spotting after sex, a small amount of blood on toilet tissue, burning, soreness or urinary discomfort. Bleeding can come from the vagina, cervix, uterus or nearby urinary tissues, so its source cannot be confirmed by symptoms alone.

Arrange an appointment with a doctor or gynaecology service, including if the bleeding happened only once or was light. Note when it began, how much you saw, whether it followed sex, and whether you use hormone therapy or blood-thinning medicine. An examination may identify tissue irritation; the clinician may also recommend tests to check the cervix or lining of the uterus.

Seek urgent medical help if bleeding is heavy, does not settle, or comes with faintness, severe pelvic pain, fever, marked weakness or shortness of breath. Contact a clinician promptly for repeated spotting, bleeding after sex, new discharge or worsening pelvic pressure. These signs do not identify one cause, but they should not be watched indefinitely.

Ask what may be causing the bleeding, whether the vaginal tissues appear fragile, which examination or tests are appropriate, and how to use local treatments safely if genitourinary symptoms are present. Ask when to return if spotting happens again.