Bleeding after menopause

If you notice any bleeding after menopause, contact your GP soon in the UK, or your doctor or gynaecologist in the US or elsewhere. That includes a small amount, bleeding that happens once, spotting, or pink or brown discharge. Get it checked 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 checking. There are other possible causes too. The appointment is to find out why you’re bleeding.

What counts as bleeding after menopause

Menopause is usually confirmed after 12 months without periods. Hormonal contraception can make this harder to tell, because it changes bleeding. If you’re not sure whether you’ve reached menopause, tell the clinician when your last natural period was and about any hormones you use.

Don’t ignore blood because it came after sex or looks like a little discharge. The NHS includes spotting and pink or brown discharge in its advice to get checked. Even if you’re not sure it’s blood, ask.

What can cause the bleeding

Lower oestrogen can make the lining of the vagina or womb thinner and inflamed. Another possible cause is a polyp in the cervix or womb. A polyp is a growth that is usually not cancer. The womb lining can also become thicker, which is called endometrial hyperplasia.

Some kinds of thickened womb lining can lead to womb cancer. Cancer itself can also cause bleeding, though the NHS says this is a less common reason. How much you bleed and when it happens can’t tell you the cause. You need a check.

How HRT changes the discussion

Sequential HRT (hormone replacement therapy taken in a cycle) can include a planned bleed, called a withdrawal bleed. You may also get irregular bleeding or spotting when you first start HRT. Ask your prescriber what pattern to expect with your treatment, so you can describe any change clearly.

This advice changed recently. NICE’s guidance, updated in April 2026, says bleeding is a common side effect in the first 6 months of systemic HRT (HRT that works through the whole body). It is also common within 3 months of changing the type or dose. NICE advises getting medical help soon for unplanned bleeding after those times.

These time limits don’t mean you should ignore bleeding. The British Menopause Society recommends checking heavy or long-lasting bleeding sooner, whenever HRT was started or changed. The check also looks at your own risk factors and your bleeding pattern. Contact your prescriber soon about these changes. For severe or very heavy bleeding, follow the emergency or same-day advice below rather than waiting for that review.

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

The UK referral pathway

The NHS says a GP should refer bleeding after menopause to a hospital or specialist clinic. It says the wait to see a specialist should be no more than 2 weeks. Ask how your referral will be arranged and who to contact if you haven’t heard.

NICE’s guidance on suspected cancer recommends referral for people aged 55 and over with bleeding after menopause. For people under 55, it says to consider referral. It deals separately with bleeding that may be linked to HRT, and points clinicians to the British Menopause Society guidance. Your GP decides which route suits you.

What may happen at the appointment

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

Ask what each test is looking for, what it may feel like and what pain relief or support is available. Say if an examination has been hard for you before. Before you leave, ask how you’ll get your results and who to contact with questions.

Treatment depends on the cause. The NHS describes options such as 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 the check. Don’t 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 getting unusual vaginal bleeding checked soon, and contacting a healthcare provider about any bleeding after menopause. In the UK, contact your GP. Elsewhere, see your local doctor. A short description is enough to start: when it happened, what you noticed and whether you use HRT.

Keep your referral and follow-up details somewhere easy to find. Ask what to do if the bleeding carries on or changes while you wait, and who will check any further episodes. Don’t wait until you’ve kept a diary before you get in touch.