Yes, you must see your doctor again. While it could simply be that you're still having a few periods, there are more worrying reasons for bleeding after the menopause which need to be ruled out.

Periods become erratic at the menopause

The menopause usually occurs between the ages of 45 and 54, on average between 50 and 51 (earlier in women who smoke and those who've had a hysterectomy).

Normally as a woman approaches the menopause she may notice that her periods become different, often lighter and shorter, signalling the changing hormone control mechanisms. But sometimes a woman finds her periods get longer and heavier before they finally stop.

Periods may become irregular, missing some months entirely. Once there have been no periods for 12 months, a woman is usually considered to have reached the menopause. So as you didn't have a period for 12 months before these recent bleeds, you have reached the menopause.

When bleeding is considered abnormal

Periods do become irregular, you may miss one here or there and then miss more and more. Even one period after 12 months without one could very occasionally be normal.

What isn't normal is irregular bleeding - that is, bleeding between periods, on and off throughout the monthly cycle, after sex, or after the menopause has properly begun.

As you realise, it's quite difficult to tell whether - in your case - you simply had an odd period as part of the menopause process, or whether your bleeding falls into the 'abnormal bleeding' category. As you have now had two episodes I think it definitely needs further investigation.

What could be causing the bleeding?

Several things can cause bleeding after the menopause, including vaginal infections, polyps, and, most worryingly, cancer of the womb (also known as endometrial cancer).

Although your doctor found nothing wrong, specialised tests are needed to check for these conditions. Your doctor may want to arrange for you to see a gynaecologist, who could arrange for tests such as an ultrasound scan, a biopsy of the lining of the womb, or a hysteroscopy (an internal telescope test which examines the inside of the womb).

If there is something serious causing you to bleed, the sooner it's treated the better the chances are of dealing with it effectively. Even if there's no abnormal cause for your bleeds, the sooner you find this out the sooner you can stop worrying.

This article was last medically reviewed by Dr Trisha Macnair in June 2008