Why does genitourinary syndrome of menopause cause bleeding after sex?

After menopause, reduced oestrogen can affect the moisture, thickness, elasticity, and blood supply of vaginal and vulval tissues. The lining may become more delicate and less able to tolerate friction. Sex can then cause tiny surface splits or irritation, with light bleeding noticed during or soon afterwards. Dryness, burning, soreness, urinary urgency, or recurrent urinary discomfort may occur alongside it. Bleeding after sex has other possible causes, including cervical changes, infection, polyps, or medicines, so it should not be attributed to menopause without an assessment.

Arrange a medical review for bleeding after sex, even if it is light or happens only once. Until then, pause activity that causes pain or bleeding and use a suitable vaginal lubricant if you resume sex. A clinician can check the vagina and cervix, consider infection testing, and discuss regular vaginal moisturiser or local hormonal treatment when appropriate. Tell them about medicines, including blood thinners, and any dryness, discharge, or pelvic symptoms.

Seek urgent help for heavy or ongoing bleeding, dizziness, fainting, severe pelvic pain, fever, or feeling acutely unwell. Contact a clinician promptly for repeated episodes, bleeding after menopause, unusual discharge, or bleeding without sexual contact. These features need assessment to identify the source and choose appropriate care.

Could dryness explain the bleeding, or should my cervix and vagina be checked? Do I need infection testing or another investigation? Which lubricant, moisturiser, or local treatment is suitable for me? What symptoms should prompt faster review?