Spotting during perimenopause: Is it normal?

Understanding perimenopause

If you’re around your early to mid-40s and notice spotting, you may think that it’s a sign that you’re entering menopause, but perimenopause and menopause are often confused. Perimenopause refers to the years leading up to menopause when you notice symptoms of the hormonal changes happening in your body. It often starts between the ages of 45 and 55 and lasts about two to eight years [1]. In everyday conversation, you may hear people chatting about their menopause symptoms when they’re actually referring to perimenopause, technically.

This natural part of aging is when your periods start to become irregular, leading up to a full “pause,” or halt of periods, at menopause. Your body’s levels of the female sex hormones estrogen and progesterone also start to drop during this time, which may cause irregular periods, spotting, and other common perimenopause symptoms including:

• Fatigue
• Hot flashes
• Hair loss
• Joint and muscle discomfort
• Mood swings
• Night sweats
• Pain during sex
• Weight gain [1]

Everyone’s journey through perimenopause and menopause is unique, and some will have more intense symptoms while others may have mild symptoms or none at all. Either way, you’ve only reached menopause when you have not had a period or spotting for a full year, at which point your symptoms should subside. The average age of menopause in the United States population is 52 [1].

What does perimenopause spotting look like?

Many of these transitional symptoms are disruptive, including spotting during perimenopause. But what exactly does perimenopause spotting look and feel like? 

Spotting is when you experience very light vaginal bleeding, or see a small amount of blood when you wipe or in your underwear. It’s usually not enough blood to cover a full pad or tampon, which would be classified as vaginal bleeding. Sometimes it’s mixed with discharge, turning a pinkish color. It may also feel like regular discharge [2].

What causes spotting during perimenopause?

The gradual hormonal shifts and drops that happen during perimenopause are thought to cause symptoms like spotting. As we’ve mentioned, levels of estrogen and progesterone drop over the course of several years,, causing irregularities and hormone-related symptoms like those listed above [1].

Aside from normal hormonal fluctuations, causes of spotting during perimenopause may also include:

• Early pregnancy: Yes, you can still get pregnant during perimenopause. It’s only when you’ve reached menopause that you can no longer become pregnant.
• Ovulation bleeding: Although you are likely to get some cycles without ovulation, most of us will still ovulate even towards the end of perimenopause [3]
• Withdrawal bleeding from hormonal birth control: If you’re using hormonal birth control during perimenopause, you may still notice withdrawal bleeds and spotting.

The hormonal fluctuations that happen during perimenopause make it harder to predict when your period will come and whether or not spotting is the start of an early (or late) period or just an isolated symptom. Tracking these events with Natural Cycles over time can help you see patterns emerging and determine whether the bleeding is irregular or on track with your body’s natural rhythms. For example, since Natural Cycles can detect ovulation, it could help you see if you’re having cycles without ovulation, which would imply that any spotting you’re experiencing would be related to hormonal imbalances rather than routine menstruation.

. Additionally, you can not only see how the length of your menstrual cycle phases changes throughout perimenopause but also pinpoint which phase you're in when spotting occurs. Since ovulation detection is at the heart of the app, it allows you to better understand if any spotting is happening before, during, or after ovulation — giving you insight into hormonal fluctuations and helping you differentiate between irregular bleeding and a normal period. 

What you can do to manage perimenopause bleeding

If you’re one of the women experiencing spotting during perimenopause, you’re not alone. One study found over 66% of women who logged their cycles during perimenopause experienced spotting for at least 6 days per cycle [4].

Luckily, there are period products available that can help you stay comfortable and manage perimenopausal spotting. In most drug stores, you’ll find pantiliners that come in many different lengths, shapes, and materials and are placed into your underwear like a pad. You can try a few of these out to see which one feels best for you and your lifestyle.

Abnormal bleeding during perimenopause

If you have abnormal bleeding (heavier than spotting) during perimenopause, it’s worth speaking with your healthcare provider about all of your symptoms and history to get a better sense of what’s happening in your body. Some much less common causes of abnormal bleeding during perimenopause include:

• Small growths inside the uterus such as fibroids or polyps
• Some sexually transmitted infections such as chlamydia
• Vaginal dryness
• Side effects of a medication like hormonal birth control
• Cuts or irritation after sex
• Cervical cancer [2,5]

These conditions do require medical attention, but they’re not necessarily cause for alarm. Most are manageable with medication and/or lifestyle changes 

When to see a doctor

Again, if you have bleeding during perimenopause that is heavier than just spotting, it’s best to make an appointment with your healthcare provider. They can do a full assessment, chart a course to recovery, or refer you to specialists if needed. It’s especially important to see your healthcare provider if:

• Your periods are happening very frequently
• Your periods last more than one week
• You have heavy vaginal bleeding
• You see spotting or bleeding after sex or in between periods
• You start bleeding again after not having a period or bleeding for over one year [1]

Most of the time, spotting during perimenopause is not unusual and can be a manageable part of aging, but if it’s affecting your daily quality of life, it deserves medical attention. As with all things to do with your reproductive health, if you have questions or concerns, it’s always a good idea to book an appointment and discuss with your healthcare provider or with your OBGYN.

Track your perimenopause symptoms with Natural Cycles

Keeping track of your symptoms like perimenopausal spotting can help you have constructive conversations with your healthcare provider while keeping you informed about the changes and cycles happening during perimenopause and beyond. See if working with a tool like Natural Cycles can support you during this transitional time.