Bleeding after the menopause

Any bleeding after more than twelve months without a period counts. It does not have to be heavy: a trace, once, is enough to justify the appointment.

During the transition to menopause it is different — there, irregular cycles are expected, and what makes sense is to mention them if they are very heavy or very frequent. The "more than a year" rule is what separates the two situations.

In most cases the cause is benign, and an assessment is the right way to confirm that. It can be endometrial atrophy, a polyp, an effect of medication — common and treatable situations.

Even so, it is one of the signals the British guidelines place on a fast referral pathway, because in a minority of cases it corresponds to something that is resolved far better when found early. Assessing quickly is what allows reassurance to come quickly, almost always.

This varies from person to person and it is the doctor who decides, but it helps to know that the usual path starts with a conversation and a gynaecological examination, and often includes an ultrasound to look at the endometrium.

There is nothing you need to arrange beforehand. What helps is noting when it happened, how often, and what medication you are taking — hormone therapy in particular, if that applies.

There is one answer that comes up a lot and does not serve: