Spotting During Perimenopause: What is Normal

Spotting during perimenopause is a symptom you should never ignore. Read on to find out why.

At midlife, women transition from their reproductive years to the natural end of monthly menstrual cycles. This transition — called perimenopause — usually begins in the 40s and ends by the early 50s, although any age from the late 30s to 60 can be normal.

Perimenopause symptoms can last anywhere from 1 to 10 years. During this time, the ovaries function erratically and hormonal fluctuations may bring about a range of changes. Hormones estrogen and progesterone are then in flux, which means your levels will fluctuate from month to month.

These shifts can be erratic, affecting ovulation and the rest of your cycle. You may notice anything from spotting between periods to different bleeding patterns.

The changes in cycles

Some women breeze through the transition. For many others, the hormonal changes create a range of mild discomforts. And for about 20 percent of women, the hormones fluctuate wildly and unpredictably. For this group, perimenopause can be enormously disruptive both physically and emotionally.

The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate).

The hormonal ups and downs of perimenopause can be the cause of almost any imaginable bleeding pattern. When estrogen is lower, the uterine lining gets thinner, causing the flow to be lighter or to last fewer days. And when estrogen is high in relation to progesterone (sometimes connected with irregular ovulation), bleeding can be heavier and periods may last longer.

One common menstrual change in early perimenopause is shorter cycles, usually averaging two or three days less than usual but sometimes lasting only two or three weeks.

It can feel as though you’re starting a period when the last one has barely ended. In later perimenopause, you may skip a period entirely, only to have it followed by an especially heavy one. Occasionally, menstrual periods will be skipped for several months, then return as regular as clockwork.

Why spotting happens

According to experts, perimenopausal changes in hormone levels interfere with ovulation. If ovulation does not occur, the ovary will continue making estrogen, causing the endometrium to keep thickening. This often leads to a late menstrual period followed by irregular bleeding and spotting.

If you notice some blood on your underwear between periods that doesn’t require the use of a pad or tampon, it’s likely spotting. Spotting usually results from your body’s changing hormones and endometrium build-up.

Many women spot before their period starts or as it ends. Mid-cycle spotting around ovulation is also common.

If you’re regularly spotting every two weeks, it may be a sign of hormonal imbalance. You may want to speak with your healthcare provider.

Consider keeping a diary to track your periods. Include information such as: when they start, how long they last, how heavy they are, and any in-between spotting. You can also log this information in an app.

Worried about leaks and stains? Consider wearing panty liners every day. Our panty liners are pH friendly to skin, toxin-free, fragrance-free, and non-chlorine bleached. They have a super soft cotton cover sheet so you won’t feel any discomfort.

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What you can do

Some women seek medical attention for their perimenopausal symptoms. But others either tolerate the changes or simply don't experience symptoms severe enough to need attention. Because symptoms may be subtle and come on gradually, you may not realize at first that they're all connected to the same thing — rising and falling levels of estrogen and progesterone.

Health care providers who are well informed about perimenopause can be important partners in thinking through the options.

The American College of Obstetricians and Gynecologists noted that certain herbs, including soy and black cohosh, may help with some perimenopause symptoms. Always talk to a doctor before trying new remedies, including these supplements, which are available over-the-counter.

At the onset of perimenopause, a person may wish to schedule regular doctor visits for preventive healthcare.

Around perimenopause, doctors may recommend certain health screenings that sometimes include colonoscopy, mammogram, and blood tests.

You should not hesitate to seek a doctor's care and advice to deal with disruptive perimenopausal symptoms.

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