Bleeding after menopause

Contact your GP promptly in the UK, or your doctor or gynaecologist in the US or elsewhere, if you notice any bleeding after menopause. That includes a small amount, a single episode, spotting, or pink or brown discharge. Arrange a check even if you have no other symptoms.

Don’t wait for it to happen again. The NHS says bleeding after menopause can be a sign of cancer and needs assessment. There are other possible causes too. The appointment is to find out why you are bleeding.

What counts as bleeding after menopause

Menopause is usually recognised after 12 months without periods. Hormonal contraception can make this harder to recognise because it changes bleeding. If you are unsure whether menopause has happened, tell the clinician about your last natural period and any hormones you use.

Do not dismiss blood because it appeared after sex or because it looks like a little discharge. The NHS includes spotting and pink or brown discharge in its advice to get checked. Even uncertainty about whether it is blood is a reason to ask.

What can cause the bleeding

Lower oestrogen can cause thinning and inflammation of the vaginal lining or womb lining. Another possible cause is a cervical or womb polyp, a growth that is usually non-cancerous. The womb lining can also become thickened, a condition called endometrial hyperplasia.

Some forms of thickened womb lining can lead to womb cancer. Cancer itself can also cause bleeding, although the NHS describes it as a less common explanation. The amount of bleeding and when it happens cannot tell you the cause; you need an assessment.

How HRT changes the discussion

Sequential HRT can include planned withdrawal bleeding. Irregular bleeding or spotting can also occur when HRT is first started. Ask your prescriber what pattern is expected with your treatment, so you can describe any change clearly.

Advice has changed recently. NICE’s guidance, updated in April 2026, describes bleeding as a common side effect during the first 6 months of systemic HRT, or within 3 months of changing its preparation or amount. It advises prompt medical help for unscheduled bleeding beyond those timeframes.

These timeframes are not instructions to ignore bleeding. The British Menopause Society recommends earlier investigation for heavy or prolonged bleeding, regardless of when HRT began or changed. Assessment also takes account of personal risk factors and the bleeding pattern. Contact your prescriber promptly about those changes. For severe or very heavy bleeding, use the emergency or same-day advice below rather than waiting for that review.

Do not stop or change prescribed HRT without talking to your doctor. Bring the product names and dates of any changes to the appointment. The clinician can check whether you need a treatment change or more tests. Taking HRT does not automatically explain every episode of bleeding.

The UK referral pathway

The NHS says a GP should refer postmenopausal bleeding to a hospital or specialist clinic, and that the wait to see a specialist should be no more than 2 weeks. Ask how your referral will be arranged and whom to contact if you have not heard.

NICE’s suspected-cancer guidance recommends referral for people aged 55 and over with postmenopausal bleeding and consideration of referral under 55. It treats bleeding potentially associated with HRT separately, directing clinicians to the British Menopause Society guidance. Your GP decides which assessment route fits your circumstances.

What may happen at the appointment

Assessment may include an examination of the vagina and cervix and a vaginal ultrasound scan. A clinician may also suggest hysteroscopy, using a thin camera passed through the cervix to look inside the womb, and a biopsy, which takes a tissue sample for testing. You may not need all of these tests.

Ask what each proposed test is looking for, what it may feel like and what pain relief or support is available. Say if a previous examination was difficult. Before you leave, ask how you’ll get your results and who to contact with questions.

Treatment depends on the cause. Options described by the NHS include removing polyps, vaginal oestrogen for some tissue changes, and specialist treatment for changes in the womb lining or cancer. Your clinician can explain the options after assessment; do not choose a treatment based on how the bleeding looks.

Getting the check arranged

Call 999 now (UK) or 911 (US), or your local emergency number, if vaginal bleeding is severe, or heavy bleeding comes with feeling faint, passing out or confusion.

Contact your GP or NHS 111 today (UK), or your doctor or urgent care service (US or elsewhere), if bleeding is very heavy without those emergency symptoms.

In the US, MedlinePlus advises prompt assessment of unusual vaginal bleeding and contacting a healthcare provider for any bleeding after menopause. In the UK, contact your GP; elsewhere, use your local doctor. A brief description is enough to start: when it happened, what you noticed and whether you use HRT.

Keep the referral and follow-up details somewhere you can find them. Ask what to do if bleeding continues or changes while you are waiting, and who will review any further episodes. Do not wait to complete a diary before making contact.