In post-menopausal women, increased leucorrhoea with burning and itching of the vulva may be accompanied by painful itching, possibly due to atrophic vaginitis. Vaginal examination reveals atrophic changes in the vagina, with congestion of the mucosa, scattered small bleeding spots or punctate bleeding spots, and sometimes broken skin. In post-menopausal cases, bloody leucorrhoea is more likely to be due to lesions of the cervix or endometrium, requiring cervical smear, ultrasound and, if necessary, colposcopy or hysteroscopy.