Perimenopausal spotting: What's normal and what's not?

Spotting — the common term for light, non-period bleeding — is completely normal for most women, especially women entering perimenopause. Spotting is roughly defined as any vaginal bleeding that’s not caused by your period. You may notice spotting on toilet tissue when you go to the bathroom, or it may show up as small or light stains on your underwear. You can usually handle most cases of spotting with a thin pantyliner, if you need any protection at all, and it’s rare to need a tampon or full-sized pad.

You’ve probably experienced spotting at some point in your life, due to changes in hormone levels, pregnancy, or other factors, and you probably already know that some spotting is perfectly normal. But when is perimenopause spotting normal, and when is it something to be concerned about?

First, some spotting is very common during perimenopause due to changes in your body’s hormone levels. Many women will experience spotting before their periods begin or in the middle of their cycles, around ovulation. However, spotting can sometimes be the first disruption in your period that indicates the beginning of perimenopause. As your body’s estrogen levels shift, spotting is often an early symptom of the transition to menopause.

However, if you experience perimenopause bleeding for 3 weeks or more, or if you continue to see spotting and breakthrough bleeding at irregular times, it’s always a good idea to make an appointment with your doctor. Talk with your doctor about your perimenopausal heavy bleeding and see what the best course of action is for you and your health.

Is Perimenopause Spotting Normal?

Yes, perimenopausal spotting is completely normal. Many women experience irregular bleeding and spotting as the first indicator that they’re beginning perimenopause. If you aren’t experiencing perimenopausal heavy bleeding, it’s likely that your body is just adjusting to changes in hormone levels and the transition to menopause.

Perimenopause Periods vs. Pre-Perimenopause Periods — What’s the Difference?

How do periods during perimenopause differ from periods before perimenopause? Disruptions in your period during perimenopause are normal, and so is perimenopause bleeding between periods. Every woman has a different experience with perimenopause spotting, but there are some common symptoms that most women will encounter.

According to Dr. John J. Fitzgerald III, DO, a gynecologist at Ablington-Jefferson Health, “Perimenopausal women continue to make estrogen; however, the other hormone made by the ovaries, progesterone, declines [...] These hormonal changes can cause the endometrium to grow and produce excess tissue, increasing the chances for developing polyps.”

In other words, an imbalance between levels of estrogen and progesterone can result in your body building up some of the same endometrial lining that it would during your menstrual cycle. The uterus must then shed that lining, and because it’s not as thick as it would be during a typical reproductive cycle, the shedding results in light spotting and non-period bleeding.

Of course, many perimenopausal women still experience periods, especially in the beginning of the transition to menopause. And, as you begin perimenopause, your periods may change due to changes in your body’s hormone levels. So, what can you expect from perimenopause periods? And how do they differ from pre-perimenopause periods?

First, it’s important to understand that perimenopause is a transition period between your reproductive years and menopause. Menopause is defined as the time at which a woman’s menstrual periods have completely stopped for at least 12 months. Up until that point, while periods become more sporadic and unpredictable, perimenopausal women will still experience them — and may still become pregnant if they have intercourse when ovulating.

Most Common Changes in Perimenopause Periods

Now, let’s talk about the difference between perimenopause spotting, perimenopause periods, and pre-perimenopausal periods. During perimenopause, you will likely experience both menstrual periods and non-period perimenopause bleeding between periods. The most common changes in perimenopause periods include:

  • Irregularity: Your cycle may change as you enter perimenopause. It’s not uncommon for some women to have periods more frequently than every 28 days. And, at the same time, it’s also normal for some women to experience less frequent or more erratic cycles.

  • Changes in flow: A lot of women report significantly heavier or lighter periods than they’re normally accustomed to when entering perimenopause and the transition to menopause. You may find that you no longer need anything but a pantyliner during your perimenopause periods, or you may find yourself bleeding through tampons and pads more rapidly.

  • Varying duration: Perimenopause periods can often vary a great deal in length. You may experience longer periods that last up to a week, or you might only bleed for a couple of days. If you have uninterrupted, irregular bleeding, don’t hesitate to call your gynecologist to determine if it’s normal or if you need medical help.

  • No periods: Some women’s periods stop entirely almost immediately after transitioning to perimenopause. These women will still not be considered to be menopausal or post-menopausal until after they have gone at least 12 months without a period.

  • While these changes are normal, perimenopause heavy bleeding and continuous spotting can indicate a problem. If you experience perimenopause bleeding for 3 weeks or more, see your gynecologist as soon as possible. And, if your spotting is within the normal range, but still bothers you, you can always refer to natural alternatives to help balance out hormonal changes. A few lifestyle changes, like getting more exercise or eating a hormone-friendly diet, phytotherapy, or taking a natural hormone-balancing supplement could make all the difference.

    And, if you believe that a hormone imbalance is causing perimenopause spotting between periods, talk to your doctor about your options to balance your hormones.