There are a lot of symptoms associated with perimenopause. Irregular periods, hot flashes, night sweats, straight-up rage, decreased fertility, changes in sexual function — the list goes on. What’s challenging about the large number of potential symptoms is it can be hard to differentiate between harmless perimenopause signs and when you need to see the doctor.
First, let’s clarify what perimenopause is: It’s when the female body begins transitioning to menopause, which is when menstruation permanently stops. While bleeding during perimenopause is normal, bleeding after menopause is not at all normal. If you’re experiencing any type of bleeding — spotting or otherwise — and you've already gone through menopause, you should see your healthcare provider ASAP.
One of the reasons why there are so many symptoms associated with perimenopause is because your body is experiencing some major upheavals. Specifically, the estrogen (aka the main female hormone) levels are unevenly rising and falling. This can result in longer or shorter menstrual cycles and even cycles where you don’t ovulate.
Perimenopause can also feel like a never-ending slog: Some women experience perimenopausal changes as early as their mid-30s, while others could begin perimenopause anytime throughout their 40s. Menopause occurs once you’ve gone through 12 consecutive months without a period. The average age for U.S. women reaching menopause is 51.
But the most annoying part of perimenopause has to be its mercurial symptoms, like, say, spotting. Is that pesky in-between-your-cycle blood normal once you hit your 40s? Or could it be a sign of something more serious? Rescripted spoke with Dorothy Bestoyong, DO, an OB/GYN based in Orlando, Florida to help us better understand perimenopause spotting.
Why am I spotting during perimenopause?
Spotting is when you experience small amounts of blood between your periods, like, say, in your underwear, or when you wipe with toilet paper, and it’s usually not cause for worry. In fact, irregular periods are one of the first tell-tale signs that you’ve entered perimenopause. Dr. Bestoyong confirms that spotting, which falls into the “irregular periods” category, can occur during perimenopause, highlighting a potential for more consistent spotting if you’re experiencing lighter periods. She also verifies that spotting can happen even if you’re on birth control, even though “typically spotting when you’re on contraception is not an issue.” But if you’re experiencing first-time spotting while on birth control, or are curious about why you’re spotting all of a sudden, definitely make an appointment with your physician. “If there’s any concern over irregular bleeding, it’s always a good idea to get evaluated,” says Dr. Bestoyong.
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Could the spotting be something serious?
While spotting is a common occurrence, and may not mean anything other than you’re in perimenopause, this particular symptom could also be a sign of endometrial cancer. This is a type of cancer that begins as a growth of cells in the lining of the uterus, called the endometrium. It’s also the most common type of cancer of the female reproductive system. One of the first symptoms is irregular vaginal bleeding, which can include spotting.
So if you’re experiencing spotting, the first thing you want to do is “rule out endometrial cancer/malignancies,” says Dr. Bestoyong. “It’s important to get a pelvic exam and an ultrasound to evaluate whether it’s originating from the uterus, cervix or vagina.” If necessary, your doctor will also perform an endometrial biopsy, where they remove a tissue sample from the lining of the uterus and send it to a lab for testing.
Ultimately, spotting may just be a sign of more hormone fluctuations during perimenopause. But, since it’s one of the main symptoms of endometrial cancer, it’s also a powerful warning signal: It’s because of this visible symptom that endometrial cancer is often found at an early stage.
However, if you’re postmenopausal and experiencing any sort of bleeding (spotting or heavier), it’s imperative you see your healthcare provider ASAP.
When in doubt, contact your doctor
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Since the potential reasons behind your perimenopausal spotting can run the gamut, the best course of action is to make an appointment with your healthcare provider. The answer may be as simple as natural body changes, but it could also mean something else is going on. You won’t know until your physician does a full workup, which can typically include a personal and family health history, as well as “a pelvic exam, an ultrasound, endometrial biopsy — if indicated — and possibly a Pap smear screening,” says Dr. Bestoyong.
The important thing is not to ignore something as innocuous as spotting, because it’s always better to rule out any potentially serious conditions at the outset. But if, by chance, your spotting does reveal a more consequential diagnosis, your healthcare provider will advise a treatment plan. Endometrial cancer, for example, is usually treated with surgery.
There’s no doubt spotting is cumbersome, but it will feel far less irritating once you know why it’s happening — even if it’s just due to good ol’ perimenopause. So make that appointment with your doctor today.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram, BlueSky, or Threads.
