What Spotting Between Periods Really Means in Perimenopause

Like an overeager prom date holding a wilting corsage, your period decided to show up a little early this month. Which is weird but not unheard of as things have been a little wonky lately. But now it’s done and you’ve packed your period paraphernalia away. You’ve even gone so far as to wear your A-list underwear.

And then, wham, you notice blood when wiping, and of course, you’re all stuffing toilet paper and running out to cadge a tampon from a co-worker. 

We’d like to say that there’s no need to pull out the pads and tampons again. But we can’t because what happens next is a bit unpredictable: During perimenopause, at some point, it’s likely you’ll notice some spotting when wiping. This could signal a few days of that same type of spotting, another entire period, or nothing more at all until your next full period, weeks or a month or more away. 

When your period decides to show up without calling first, it may be relatively normal for you, lighter than normal, or it may be a once-in-100-years weather event. 

“The normal in perimenopause is not going to be uniform,” says Nathan Goodyear, M.D., an integrative physician and medical director of Brio-Medical in Scottsdale, AZ. “The bleeding associated with perimenopause can vary from light to normal to heavy,” he says. Can you feel the magic?

And while irregular periods (which include spotting) are the most common change to your cycle, what exactly to expect varies so much from person to person.

About the Experts

Nathan Goodyear, M.D., is the medical director of Brio-Medical, a holistic, integrative cancer healing center in Scottsdale, AZ. In addition to being board-certified in obstetrics and gynecology, Dr. Goodyear is a Fellow in Functional and Regenerative Medicine.

Jerilynn Prior, M.D., is a professor of endocrinology at the University of British Columbia, in Vancouver, Canada who focuses on, among other things, the menstrual cycle and the study and treatment of vasomotor symptoms. 

Is Spotting During Perimenopause Normal?

Yes, spotting during perimenopause is 100% normal, if annoying. During perimenopause (the average length of perimenopause is four years) you’re likely to experience a range of symptoms. They almost certainly include changes to your periods as well as some spotting. 

During perimenopause, you can also have spotting instead of a period, which may look to you like a super-light period. In fact, more than 90 percent of women experience at least one episode of spotting. Some 78 percent have at least three episodes during perimenopause, according to the Study of Women’s Health Across the Nation (SWAN) (1).

Why spotting during perimenopause happens 

Why does anything happen during perimenopause? Changes to your periods are thanks to wild hormone fluctuations that continually rise and fall until your final period and, a year after that, the start of menopause. 

As estrogen does this crazy up-and-down dance and progesterone steadily falls, your more regular ovulation and menstruation patterns become out of sync. “As a result, the normal signaling patterns which dominate and control the follicular and luteal phases of the menstrual cycle are absent,” says Goodyear. 

In other words, before perimenopause, the uterine lining would thicken after ovulation, in prep for a fertilized egg to hunker down in there and grow into a fetus. But during perimenopause, because ovulation is wonky, your uterine lining can continue to get thicker. This can result in random spotting before your period, after your period, or mid-cycle—and then a gusher when you do get your period, says Goodyear.

What Normal Spotting Might Look Like

If you’re spotting, you may notice a bit of blood in your underwear, or when you wipe. It could be bright red or dark brown (a sign that the blood has been hanging out for a while). There can also be an increase in vaginal discharge during perimenopause. (Any time it smells bad or fishy or looks yellow or grey, this could signal infection and you should talk to your doctor.)

Other Period Changes During Perimenopause 

Some women’s perimenopause periods are like the least appealing Choose Your Own Adventure book ever written:

• You might skip a period, then have it return exactly two months later like it owes you no explanation.
• You might have one every three weeks like clockwork. 
• Or you might switch between the two.
• You might have no period at all for months, and think you’re on the fast track to Menopause City, where all women are worry-free and wear white pants. And then, boom, you have a few more months of periods like there wasn’t a break at all. 
• Your periods could get super heavy (think: a Super Plus heavy every hour or so.) 
• They could be very light until they fade out altogether.

You get the idea: It’s anything goes and it’s different for different women, says Goodyear, all because your hormones are having relationship issues after a long time together. In short, expect the unexpected.

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How to Predict Unpredictable Periods 

You might want to keep a journal (or download an app) to track your periods and instances of spotting. Note when they start, how long they last, and how heavy they are. That way you’ll have info to share with your doctor so she can reassure you that things are normal, or check things out if she’s not sure.

And remember how in middle school you carried an emergency pad or tampon? It’s a good time to try that again, just in case. To avoid leaks and stains, wearing panty liners or period underwear will keep you covered.

When Should I Worry About Spotting During Perimenopause? 

For the most part, spotting is nothing to think twice about.

That said, there is a chance that spotting can indicate another issue. If you’re not perimenopausal, or are in early perimenopause, irregular periods and spotting can flag a thyroid disorder. When your thyroid hormones are out of whack, it affects your other hormones, resulting in irregular periods, according to the U.S. Office of Women’s Health.

What About Heavy Bleeding During Perimenopause

We’re talking really heavy, like 80 ml or more of blood lost during a period, according to the American College of Obstetrics and Gynecology (ACOG). Because measuring feels like a bad idea, consider it heavy if you are filling a tampon or pad in an hour, for several hours, if you need to wake in the night to change your pad or tampon, and/or it lasts longer than seven days.

“Heavy flow is a common symptom of perimenopause,” says Jerilynn Prior, M.D., a professor of endocrinology at the University of British Columbia, in Vancouver, Canada. Heavy bleeding  (also called menorrhagia) is most likely NBD—the uterine lining can get extra thick because you’re not shedding it regularly, and that means a lot of blood. 

Even if it doesn’t indicate a medical issue, the volume of blood loss can be dangerous. Why? It can lead to iron deficiency. Just to be safe, bring up heavy bleeding with your doctor.

Another reason to chat with your OB/GYN? Heavy bleeding can indicate uterine fibroids, which are common benign growths. It could also—in rare cases—be a sign of uterine cancer, says the Cleveland Clinic.

Spotting During Menopause, However, Is Not Normal

You’ve hit menopause once perimenopause has ended. In other words, you’ve gone a full year without a period. If you have bleeding or spotting during menopause, your next move is to call your doctor. 

That’s because spotting during menopause is not normal. Abnormal bleeding can be caused by a range of issues including uterine polyps and endometrial hyperplasia (a condition where the lining of the uterus grows too thick), according to ACOG.

But the reason for postmenopausal bleeding doctors really want to rule out is endometrial cancer (a cancer that starts in the uterus). For many women with this type of cancer, bleeding is the only symptom, according to the Mayo Clinic.

If you have abnormal bleeding after menopause, your doctor will likely recommend testing to determine its cause. This could include a pelvic ultrasound, an endometrial biopsy, or another procedure.

That said, once in a while, a woman will have a surprise period (that’s just a period) even after a year of no periods, sometimes triggered by hormone replacement treatment. “About 10 percent of women in menopause will have another flow,” says Prior. “It’s really important to pay attention to whether you felt different before it started, if you experienced sore breasts, bloating, or other PMS-like symptoms,” she says. These flashback symptoms can help your doctor to determine if it was just another delayed period, a side effect of hormone therapy, for example, or if the bleeding is related to a more serious issue.