Hi, It s possible that the spotting you are experiencing after receiving a cortisone injection in your shoulder may be related to hormonal changes caused by the cortisone. Cortisone is a type of corticosteroid medication that can have systemic effects on the body, including altering hormone levels. Corticosteroids can have a variety of effects on the body s endocrine system, including changes in the production and release of certain hormones, such as cortisol and estrogen. In women, corticosteroids may increase estrogen levels, which can cause changes in the menstrual cycle, including irregular bleeding or spotting. However, it s also possible that the spotting you are experiencing may be unrelated to the cortisone injection. Other potential causes of postmenopausal bleeding include hormonal imbalances, vaginal atrophy, cervical or endometrial polyps, or even certain types of cancer. It s important to discuss any abnormal vaginal bleeding with your healthcare provider to determine the underlying cause and appropriate treatment. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Diwashish Biswas, Internal Medicine Specialist