Spotting During Perimenopause | Perimenopause Symptoms

What is Perimenopause?

Perimenopause is the few years before periods cease altogether (Menopause) at around 51. It lasts for 4-10 years, and most people experience at least a few symptoms.

The average age of menopause is 50, so that means most people go through perimenopause when they’re in their 40’s. Of course, it can happen earlier, or later than this.

Common Symptoms of Perimenopause

We’ll talk specifically about spotting during perimenopause, but some of the other common perimenopausal symptoms include:

• Weight gain
• Irregular periods
• Bloating
• Night sweats
• Issues with sleep
• Irritability
• Headaches from changing hormones
• Hot flashes
• Mood swings, including depression
• Other

Of these, perhaps the two most common (and well-known) ones are weight gain and hot flashes.

Of the symptoms in this list, irregular periods during perimenopause is perhaps the most common one. You may have periods that are lighter, heavier, shorter, or longer. You may experience spotting instead of a period, or spotting outside your normal menstruation time. Just about anything can happen!

These symptoms are caused by changing hormones. Learn more about that here: Perimenopausal Facts and FAQs. 

Want to know what the stages of perimenopause are, and where you’re at in that? Learn more here:

Stages of Perimenopause

What Causes Spotting During Perimenopause?

There are a number of reasons why you might experience spotting at this stage of your life. We’ll talk about some of the most common ones here:

#1: Changing Hormone Levels

The most normal cause of spotting before menopause occurs because of changing hormone levels. Although estrogen levels remain relatively stable, progesterone begins to dip during Perimenopause. This can lead to a number or changes, including perimenopausal spotting, missed periods, etc.

#2: Hormone Replacement Therapy Dosage

Another possible cause of spotting is if you’re on Hormone Replacement Therapy (HRT) and your medication isn’t properly regulated. The key is to use the lowest effective dose possible. If you’re on hormone replacement therapy and are having irregular periods, including spotting, see your doctor.

#3: Fibroids or Polyps

Finally, abnormalities with your endometrial lining, as well as polyps can cause irregular bleeding. This can look like spotting between periods, but it isn’t really related to your cycle at all.

#4: Endometrial Atrophy

This condition may cause abnormal bleeding during perimenopause, including mid-cycle. However, it most commonly happens to people during menopause.

It’s when the walls of the endometrium become very thin due to low levels of estrogen (this happens when you approach menopause).

#5: Endometrial Hyperplasia

Endometrial hyperplasia most commonly happens to people during menopause, although it can happen to people in perimenopause as well.

This condition may cause irregular bleeding, but the most common thing is very heavy bleeding. It’s when the uterine linking thickens and is often caused by excessive estrogen along with a lack of progesterone.

#6: Pregnancy

It is indeed possible to become pregnant during perimenopause. If you still have a period, you can still get pregnant so please use protection if this is not what you want.

During pregnancy, you may experience some light spotting around the same time you’d normally get your period. This doesn’t happen to everyone though, so please check in with your doctor.

Learn more about if you can become pregnant during perimenopause here.

#7: Birth Control Pill

Are you on birth control, but have forgotten to take your dose? This may result in some spotting.

#8: Infection, Irritation or STI

There are a number of reasons why you may experience spotting that are not really related to your menstrual cycle. For example, an infection may result in spotting, as well as an irritated vaginal, cervix or uterus. Did you recently get a pap test, or have rough sex for example?

Some STI’s may also result in spotting.

#9: Extreme Diet or Exercise

At any age, you may experience very light periods that resemble spotting, or skip periods if you severely restrict your food intake, or exercise very heavily. This occurs because your body is more focused on survival than it is on the less important things like producing reproductive hormones that regulate your cycle.

For optimal health, strike a healthy balance with this stuff.

#10: Vaginal Dryness

During the transition years leading up to menopause, you may notice that your vagina starts to become dryer. This happens because of changing levels of reproductive hormones. Because of this, you may notice some spotting, especially if you’re recently had penetrative sex.

When to See my Doctor about Perimenopausal Spotting?

It’s normal that your periods will become more and more irregular as your approach menopause. However, it’s worth consulting your doctor if things seem not quite right.

There are some serious conditions that can lead to heavy bleeding, spotting, bleeding after sex, etc. These conditions can include cancer, polyps, endometrial hyperplasia and endometrial atrophy.

In addition, if you’re on hormone replacement therapy (HRT), you may experience spotting if you’re not on the correct dose. Please see your doctor to adjust the medication.

How is Abnormal Bleeding During Perimenopause Diagnosed?

If you’re experiencing abnormal bleeding during menopause, please see your doctor immediately.

However, spotting, or other abormal bleeding during perimenopause is more common. It’s sometimes serious, but sometimes not. Check in with your doctor to rule out the more serious stuff. Also be sure to keep track of your period because this information can be very helpful for health care provider.

Here are some of the tests to expect that can help diagnose abnormal bleeding.

Endometrial Biopsy

A small amount of tissue is taking from the lining of the uterus. It’s sent to a lab where it’s examined under a microscope.

Transvaginal Ultrasound

A device is inserted into the vagina that emits sound waves. It’s used to create pictures of the organs in the pelvis.

Sonohysterography

Fluid is injected into the uterus and an ultrasound of the pelvic region is done.

Hysteroscopy

A small tube with a camera is inserted through the vagina and cervix opening. It allows the inside of the uterus to be seen.

Dilation and Curettage (D&C)

D&C is when the opening of the cervix is enlarged and tissue is scraped or suctioned from the lining of the uterus. The tissue is sent to the lab to be examined closely.

Perimenopause Spotting Instead of Period

If you have spotting during perimenopause instead of your period (it’s at the correct time of your menstrual cycle), is it normal?

What is “normal” during the years before menopause are irregular periods. They often become further apart, and may also be lighter. So, what resembles spotting instead of your period during perimenopause may be a normal thing. It can actually be considered a sign that you’re about to enter into menopause.

Perimenopause spotting instead of period? Not to worry. It’s actually quite a normal thing as you begin to approach menopause.

Bleeding Between Periods During Perimenopause?

Some people may experience bleeding in between periods in the years leading up to menopause. This is a little bit tricky because spotting or bleeding can sometimes be caused by changing hormones during this time period. And perimenopause is all about changing hormones!

However, spotting or bleeding outside of your normal menstruation time can also be an indication of other things as well, including pregnancy (implanation bleeding), or even some more serious conditions.

If you experience bleeding in-between periods, it’s recommended that you check in with your doctor to rule out the more serious problems.

Learn more here: Spotting and Perimenopause. 

I’m Spotting at the Same Time Each Month

If you’re spotting at the same time of your menstrual cycle each month, it may be a sign of a (perhaps serious?) hormonal imbalance of some kind. You can check in with your doctor to find out if hormone replacement therapy may be right for you.

What About Spotting During Menopause?

Menopause spotting: is this something to worry about, or not really a big deal?

If you’ve had no periods for a year, you’re officially in menopause. So, you don’t have a menstrual cycle during menopause.

However, if you start to have your period again, or experience some spotting during menopause, this is a serious cause for concern. Please see your doctor immediately. It can be one of the signs of cervical or uterine cancer, and early detection is key for these illnesses.

So, can you have spotting during menopause? Not really. The way it works is that once you have a period, even after an absence of a few months, you’re actually in perimenopause. The clock resets and the countdown to 12 months without a period starts again.

Bleeding During Menopause Causes

Some of the reasons why you may experience post-menopausal spotting include the following:

• Cancer of the uterus, cervix or vagina
• Thinning of the tissues of the uterus or vagina, which can lead to bleeding
• Fibroids or polyps
• Endometriosis
• Certain medications
• Pelvic trauma
• Bleeding from the urethra or rectum

As you can see, the reasons behind menopause spotting can be serious and a visit to the doctor is always required for bleeding during menopause!

Learn more about Menopause Spotting

What is Metrorrhagia?

The official definition of Metrorrhagia is irregular uterine bleeding that happens outside of the normal period time. It may, or may not be related to menstruation.

There are various treatment options for Metrorrhagia that depend on the underlying condition causing it. There are also some serious medical conditions that can cause this, including cancer, so it’s important to check with your doctor about this.

You can learn more here: Metrorrhagia FAQs.

Menstrual Cycle Changes: Are they Normal?

Keep Track of your Menstrual Cycle

One thing that can be extremely helpful for your doctor is to have a record of your menstrual cycle. This is vital for them to recognize any irregularities.

When did you begin spotting, and when did it end?

How heavy was it?

When did you begin menstruating, and for how long?

Are there Medical Treatment for Pre-Menopausal Spotting?

If you’re experiencing this, you may want to know about the possibility of medical treatments for Perimenopausal Symptoms. The answer is that it depends on the underlying cause.

If it’s HRT, then your doctor will adjust the dose.

If it’s fluctuating hormones, your doctor may suggest medication to regulate their levels.

Perhaps it’s related to polyps or the endometrial lining? Your doctor may suggest surgery to remove them.

As you can see, the treatment your doctor recommends depends heavily on the underlying cause of spotting before menopause. That’s why it’s important to check in with them about it.

What About Supplements to Treat Spotting in Perimenopause?

If you’d prefer not to do hormone replacement therapy, you may want to know if there are any supplements that help to regulate hormone levels?

There are. However, results are mixed and the studies are kind of inconclusive, at best. Many of them actually show no real effect at all. If you do want to try them, ask your doctor for their advice, or check in with a naturopath for their recommendations.

How Can I Deal with Spotting During Perimenopause? 

If you’re spotting during perimenopause, it can be a bit of a hassle. That’s why we recommend getting yourself some comfortable options to deal with it!

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Spotting between cycles can be a little bit annoying to deal with. However, there are two options that we recommend: period panties and reusable cloth pads.

Both of them are eco-friendly, affordable and better for our bodies than disposable products.

Learn More about Period Panties

Menstrual underwear make an excellent choice if you have very light spotting throughout your cycle. Most people find that they’re more comfortable than disposable pantyliners.

The reason why we love them is because many brands of pads contain trace amounts of toxic chemicals in them. However, with period panties, you can have a toxin free period experience. This is particularly important if you’re going to be using them for much of the month.

The other reason why you might consider period panties is because you’ll save money over the medium to long-term if you’re using them all the time. Just buy 4-5 pairs and you’ll be covered for all your spotting needs for years.

What are the Best Period Panties?

Check out some of our picks for the best period panties:

The Best Menstrual Underwear for Spotting

Or, check out our favourites in the chart below:

Learn More about Reusable Cloth Pads for Perimenopause Spotting

The next option you might want to consider for spotting during perimenopause are reusable cloth pads. They’re pretty similar to disposable sanitary pads, but they’re made from natural materials. The best thing is that they can be used for 5-10 years.

Like disposables, washable menstrual pads come in a range of absorbencies. For spotting, you might want to consider panty liners.

They’re eco-friendly, very comfortable, hypoallergenic, and will save you a lot of money compared to disposables if you use them all the time. They’re also great for vaginal discharge, along with spotting.

Find out the Best Reusable Cloth Pantyliners

For some of our top picks, you’ll want to check out:

The Best Reusable Pantyliners

Spotting During Perimenopause: Have your Say!

Have you experienced Perimenopause spotting? How did you deal with it? Leave a comment below and share your thoughts with us.