Bleeding after menopause — one rule

If a year or more has passed since your last period and bleeding or spotting from the genital tract appears — book a doctor's appointment at the earliest available date. The rule covers every situation: bleeding that is small, one-off, painless, or already over.

Why does it matter, if most often nothing serious is going on? Because you cannot tell by looking. In most women the cause turns out to be harmless — for example thinning of the lining related to lower hormone levels, or a benign polyp. But bleeding after menopause can also be a symptom of a more serious disease, and only a doctor, after examining you, can tell one from the other. A prompt assessment allows the cause to be found early — when the options for dealing with it are greatest.

What not to do: do not wait "to see if it happens again". Do not put bleeding down to age, exertion or stress. Do not postpone the appointment to observe or note something first — notes can help the conversation, but they are not needed for it; you can come with nothing.

If you take menopausal hormone therapy: with some regimens a monthly bleed is planned — your doctor tells you what to expect. Report bleeding other than the planned one (unexpected, heavy, prolonged) to your doctor. Do not stop the therapy yourself.

What the appointment may look like: the doctor will ask about the circumstances, examine you, and often order a transvaginal ultrasound; sometimes further tests are needed — the clinic will tell you how they proceed.

Urgent help: if bleeding is heavy, or comes with severe pain, dizziness or feeling unwell — seek help urgently rather than waiting for a routine slot.

Sources: [1] NHS — Post-menopausal bleeding; [2] NHS clinic patient leaflets (Devon, Gloucestershire).