Causes, Care & Confidence:
Bleeding After Sex In Menopause

Noticing blood after intimacy during menopause can be unsettling – especially if it’s unexpected. In medical terms, any vaginal bleeding that occurs 12 months or more after your last period is considered postmenopausal bleeding, and it’s something worth paying attention to. Most causes are not serious, but it’s always a signal to check in with your GP.

What Counts as Postmenopausal Bleeding – and What Doesn’t

• Postmenopausal bleeding refers to any vaginal bleeding, spotting, or pink/brown discharge that happens after menopause has been confirmed (no periods for a whole year).
• Light streaks on toilet tissue, bleeding after sex, or occasional pink discharge still count – even if it seems minor.
• Bleeding before you’ve gone 12 months without a period is considered perimenopausal bleeding and may be related to irregular cycles.

Many women wonder if a “tiny amount” is worth mentioning. The answer is yes – simply because your body is communicating a change.

Why It Matters to Pay Attention

• While vaginal dryness or tissue thinning are common, bleeding can sometimes be linked to infections, polyps, or, less commonly, cancers of the womb, cervix, or vagina.
• According to NHS guidance, postmenopausal bleeding should always be investigated, even if you feel otherwise well.
• Early detection often means simpler, less invasive treatment.

Think of it like a warning light on your car dashboard – you wouldn’t ignore it just because the car still drives smoothly.

Bleeding after sex during menopause is not automatically a sign of something serious, but it is your cue to seek professional advice. The next step is understanding why it might happen – and which causes are most common.

Once menopause has set in, your hormone levels – especially oestrogen – drop. That hormonal shift changes the way the vaginal and cervical tissues behave, which means the skin is thinner, drier, and more fragile than before. When those tissues are more delicate, even gentle friction during sex can sometimes cause spotting. But that’s only one piece of the puzzle.

Vaginal Atrophy (Atrophic Vaginitis) – The Most Common Culprit

• Low oestrogen levels reduce blood flow and collagen in vaginal tissue, making it less elastic.
• This can lead to dryness, itching, and a feeling like the skin is almost papery.
• During intercourse, this dryness increases friction, which can cause microtears and light bleeding.
• NHS-approved treatments include local oestrogen creams or pessaries to restore moisture and resilience.

Cervical or Vaginal Infections – Often Overlooked

• Bacterial vaginosis, thrush, and sexually transmitted infections can still occur post menopause.
• Infections can inflame delicate tissues, leading to bleeding during or after sex.
• Routine swabs at your GP or sexual health clinic can identify and treat these quickly.

Polyps, Fibroids, and Benign Growths – Irritation-Prone

• Non-cancerous growths in the womb or cervix can become irritated during sex.
• They often cause irregular bleeding at other times too, not just post-intercourse.
• Removal is usually quick and done under local anaesthetic.

Cancer of the Cervix, Womb, or Vagina – Rare but Serious

• While less common, postmenopausal bleeding can be an early sign of gynaecological cancer.
• The NHS cervical screening programme and prompt investigation of symptoms improve early detection.
• Statistically, the majority of postmenopausal bleeding cases are not cancer, but it’s the reason we don’t ignore the symptom.

In summary, Many causes of bleeding after sex in menopause are treatable and non-serious, but the only way to know for sure is to get checked. Knowing the possibilities can make that first GP conversation less daunting.

Finding blood after intimacy can make your mind race – but taking a calm, step-by-step approach will help you get the answers you need. The key is to document what you see, notice any other symptoms, and seek medical advice promptly rather than waiting to see if it happens again.

First Steps at Home – Record, Don’t Panic

• Make a note of when the bleeding happened, how much there was, and its colour (bright red, pink, brown).
• Note any accompanying symptoms like discomfort, dryness, itching, or pelvic pain.
• Avoid guessing the cause or self-medicating with over-the-counter creams unless advised by your GP.
• If possible, avoid intercourse again until you’ve been checked – this helps avoid further irritation.

When to See Your GP Urgently – Red Flags to Know

• Heavy bleeding (soaking pads/tampons) or large clots.
• Bleeding that occurs multiple times or gets worse.
• Persistent pelvic or abdominal pain.
• Feeling unwell alongside bleeding, such as fever or dizziness.

The NHS recommends that any postmenopausal bleeding, even once, should be assessed. If you call your GP and mention “postmenopausal bleeding”, they’ll usually book you in promptly – sometimes within the two-week cancer referral pathway for fast checks.

What to Expect at the Appointment – No Surprises

• Discussion of your symptoms and relevant medical history.
• Physical examination, which may include a gentle speculum check (similar to a smear test).
• Possible swabs to rule out infections.
• Ultrasound scan to examine the womb lining and ovaries.
• If needed, a biopsy of the endometrium (womb lining) – often quick, done in-clinic, with mild cramping.

Your GP will explain each step and ensure you consent before proceeding. Most women find that these tests are over much quicker than expected.

Acting quickly helps rule out anything serious and puts you on the right treatment path sooner. The sooner you call your GP, the sooner you can either put your mind at rest or start managing the cause effectively.

Once your GP or specialist has identified the cause, treatment can often be surprisingly straightforward – sometimes as simple as a topical cream or switching to a gentler lubricant. The aim is always twofold: address the underlying cause and restore your comfort and confidence during intimacy.

Hormone-Based Treatments – Restoring Vaginal Health

• Local oestrogen therapy (creams, pessaries, or vaginal rings) replenishes moisture, elasticity, and blood flow to the vaginal tissues.
• Works directly where it’s needed with minimal systemic absorption.
• NHS-approved and widely available, with benefits often noticeable within a few weeks.
• Particularly effective for vaginal atrophy and dryness-related bleeding.

Non-Hormonal Approaches – Simple, Everyday Support

• Vaginal moisturisers help maintain tissue hydration between sexual activity.
• Water-based or silicone-based lubricants reduce friction during sex – choose products free from glycerin and parabens if you’re prone to irritation.
• Lifestyle factors such as staying hydrated and avoiding harsh soaps can also make a noticeable difference.

Treating Underlying Conditions – Targeted Interventions

• Infections – treated with antibiotics, antifungals, or antivirals depending on the cause.
• Polyps or fibroids – usually removed with a minor procedure, often as a day case.
• Cancer-related causes – managed through NHS cancer care pathways, with early detection improving treatment outcomes.

The right treatment depends entirely on the cause, but most women find their symptoms improve quickly once they start the correct therapy. The important part is not delaying that first conversation with your GP.

While you can’t completely guarantee it won’t happen again, there’s a lot you can do to keep your vaginal tissues healthy and less prone to bleeding. Think of it like skin care – consistent, gentle maintenance often pays off.

Regular Sexual Health Check-Ins – Stay Ahead of Changes

• Attend your NHS cervical screening when invited – even postmenopause.
• Speak openly with your GP about any new symptoms, however small.
• Consider an annual well-woman check to monitor overall gynaecological health.

Everyday Vaginal Health Tips – Small Habits, Big Impact

• Use a pH-balanced, fragrance-free cleanser or just warm water for intimate washing.
• Stay hydrated – vaginal tissues, like skin, need moisture from within.
• If you’re prone to dryness, apply a vaginal moisturiser regularly (not just before sex).

Knowing Your Body's Signals – Early Action Wins

• Pay attention to changes in discharge, spotting, or discomfort.
• Keep a discreet symptom diary – a few notes in your phone can help spot patterns.
• Address dryness early with lubricants or oestrogen therapy before microtears develop.

Prevention isn’t about perfection – it’s about making small, sustainable choices that keep your tissues stronger and more comfortable over time. That way, you’re more likely to enjoy intimacy without worry.

Bleeding after sex during menopause isn’t just a physical symptom – it can ripple into your emotions, your self-image, and your relationship dynamics. For some women, the first thought isn’t “What’s causing this?” but “What will my partner think?” That’s a heavy load to carry on top of the uncertainty.

Navigating Conversations with Your Partner – Reducing Awkwardness

• Be honest but matter-of-fact – a calm “This sometimes happens in menopause, and I’m getting it checked” sets the tone.
• Avoid letting it become a silent, unspoken worry that makes intimacy feel tense.
• If needed, share NHS resources or articles so your partner understands the medical side too.

Managing Anxiety Around Intimacy – Taking Pressure Off

• It’s normal to feel cautious or even avoid sex for a while after bleeding.
• Consider gradual reintroduction, starting with non-penetrative intimacy.
• Mind-body approaches like mindfulness or breathing exercises can reduce tension during intimacy, making bleeding less likely.

Finding Support – You’re Not the Only One

• Peer groups – online menopause forums or local support circles – can offer real-life reassurance.
• Talking to a menopause specialist or counsellor can help you navigate both the physical and emotional effects.
• Remember: one in four postmenopausal women will experience some form of bleeding, yet it’s rarely spoken about openly.

Addressing the emotional side is just as important as the medical investigation. By talking openly and seeking the proper support, you protect not only your physical health but also your confidence and connection.

Bleeding after sex in menopause can feel like an unwelcome interruption – a mix of worry, awkwardness, and a dash of “why now?”. But as you’ve seen, it’s often the body’s way of asking for a bit of extra care, not a sign to panic. Understanding the possible causes, knowing when to seek help, and being aware of the treatments available gives you back a sense of control.

The real takeaway? You don’t have to navigate this quietly or alone. From simple moisturisers to targeted hormone therapies, and from open conversations with your partner to timely GP check-ups, there are clear, compassionate steps forward. Acting early not only protects your health but also preserves your confidence and comfort in intimacy – which is just as important.

If you’ve noticed any bleeding, even once, take it as your cue to check in with a trusted healthcare professional. And if you’re looking to feel more informed before that appointment, explore our Menopause Symptom Tracker or browse our related resources on vaginal health and hormone therapy. Small actions today can make all the difference in how you feel tomorrow – both in body and in mind.