Urinary Tract Infection (UTI): This is the most likely diagnosis given the symptoms of UTI. The spotting could be related to the UTI itself or a separate gynecological issue, but the primary complaint suggests a UTI.

Vaginal Atrophy: Common in postmenopausal women, vaginal atrophy can cause spotting and may also lead to symptoms that mimic a UTI, such as dysuria and frequency, due to the thinning and drying of the vaginal walls.
Endometrial Polyps or Hyperplasia: These conditions can cause spotting and, in some cases, may be associated with urinary symptoms if there is significant bleeding or if the polyps/hyperplasia are large enough to exert pressure on the bladder.
Pelvic Inflammatory Disease (PID): Although less common in postmenopausal women, PID can occur and cause a range of symptoms including pelvic pain, spotting, and urinary symptoms.

Endometrial Cancer: This is a critical diagnosis not to miss. Postmenopausal bleeding or spotting is a key symptom, and while urinary symptoms are not typical, advanced cancer could potentially cause urinary symptoms due to local spread.
Ovarian Cancer: Similar to endometrial cancer, ovarian cancer can present with non-specific symptoms, including abdominal discomfort that might be confused with urinary symptoms, and postmenopausal bleeding.
Renal or Bladder Cancer: These cancers can present with hematuria (blood in the urine), which might be mistaken for spotting, and other urinary symptoms.

Tuberculosis of the Genitourinary Tract: This can cause chronic urinary symptoms and, in some cases, genital bleeding. It's rare in many parts of the world but should be considered in patients with risk factors or exposure history.
Schistosomiasis: In endemic areas, this parasitic infection can cause urinary and genital symptoms, including hematuria and, potentially, spotting in women. It's a rare consideration in most clinical settings but important in travelers or immigrants from endemic areas.