Perimenopause Periods and Spotting—What’s Normal?

Every woman experiences perimenopause periods and spotting differently. For some, it may be a pleasant surprise that periods are starting to subside.

For others, it might be a very unwanted puberty-like event, but what's normal? What should you expect with perimenopause periods? How do you know if you’re experiencing perimenopause spotting or something else?

This article will look at perimenopause periods and some of the most common symptoms that you might experience.

How Perimenopause Affects Your Period

Perimenopause and menopause are not the same things. Instead, they are different stages of the same process of change in your body.

Menopause is the point when women stop having menstrual periods. During this period, the uterus lining is thinned out, so it can no longer sustain a full-term pregnancy. The average age of menopause is 51 years old, but it can vary based on a woman's age. Many women don't even know they are having menopause until they experience symptoms like hot flashes or night sweats.

Perimenopause is a transitional phase between your reproductive and postreproductive years and can last up to 10 years. 

During this time, your ovaries stop producing eggs and generate fewer hormones, causing changes in your body's natural balance of hormones. In addition, you may also experience changes like:

• How often you have your period (every 21 days instead of 28 days) or how heavy your periods are (heavy or light)
• An increase in vaginal dryness and an increased risk of sexually transmitted infections (STIs)
• Sexual desire, arousal, and satisfaction with sex
• Hormone levels that affect your menstrual cycle and fertility levels
• How your body responds to stress (also known as stress hormone levels)

How Often Do You Get Your Period During Perimenopause?

You may still bleed during perimenopause, but it may not be as severe as before menopause. During this period, some women experience irregular bleeding and spotting (menorrhagia), while others experience more regular periods. 

The perimenopause period comes with fluctuating hormones for many women. It can be stressful for those already experiencing symptoms such as hot flashes, night sweats, mood swings, irritability, or anxiety.

Some women will continue to experience their periods with less frequency than before. Others may have them every few weeks or even months. Some women may also experience irregular bleeding during perimenopause.

How Many Days Can a Perimenopause Period Last?

The cycle of perimenopause periods may last longer than it did before. The exact days might vary, but it's usually between 21 and 35. The average is about 31 days.

Typically, the average period lasts two to seven days. However, during perimenopause, your period may last longer. Many women with perimenopause have periods that last longer than three days. Some may even bleed for seven or more days each month.

The main reason your periods are longer during perimenopause is a drop in estrogen levels. Estrogen helps keep your uterine lining healthy so that it can be shed each month during menstruation. 

However, when there is a higher level of estrogen compared to progesterone levels, the uterine lining builds up. During your period, this lining sheds. When you have a period, the build-up may cause a heavier flow.

What Do Perimenopause Periods Feel Like?

It is hard to describe what a perimenopause period feels like because it is different for everyone. The common sign to look for is irregularity. 

If you are over 40 and you’re experiencing irregular bleeding, then you may be having perimenopause periods. However, you’ll want to consult your physician to rule out other causes.

Many things from infections to your diet can impact your period, so your doctor will conduct an examination and a few tests to eliminate other causes.

Here are the most common symptoms and changes you might experience with perimenopause periods.

• Heavy/light bleeding: You may notice heavier bleeding than usual during this time—or lighter than normal—and sometimes both.
• Hormonal changes: Hormones fluctuate during perimenopause, causing many women to experience hot flashes and other physical changes such as mood swings and irritability.
• Irregular menstrual cycles: You may have more than one period in a month or skip your period altogether for several months, which can be alarming if you're not expecting it.
• Changes in libido: You may experience a decrease in sexual desire or interest, which can be frustrating and cause stress for both partners.
• Vaginal dryness: You may experience less vaginal lubrication when sexually aroused during perimenopause. This can make sex uncomfortable and painful, especially if you don't use a water-based lubricant.
• Other symptoms: Some women also experience headaches, dizziness, and insomnia during perimenopause.

As your body's estrogen and progesterone production decrease, you enter the perimenopause spotting stage. As these two hormones decrease, your body will start producing more FSH (follicle-stimulating hormone) and LH (luteinizing hormone). These two hormones are responsible for ovulation, so when there's too much LH in your system, it can cause an egg to grow in one of your ovaries too quickly, which causes perimenopause spotting.

Spotting During Perimenopause and Menopause

If you notice a drop of blood on your underwear after you've gone to the bathroom and it’s not during your menstrual cycle, it’s known as spotting. It's also sometimes called intermenstrual bleeding. Spotting is often light enough that you'll barely notice it, and it may go away after a few days or weeks.

Spotting during perimenopause is common, especially if you're approaching menopause. It's not unusual for women to experience spotting every month. Usually, perimenopause spotting doesn't indicate a problem—it's just part of your body's changes as it adjusts to lower hormone levels.

What Does Perimenopause Spotting Look Like?

Perimenopause spotting can happen in a few different ways. You may have light bleeding or brown discharge at the start or end of your period, or you might have very light menstrual periods that are shorter than they used to be. Also, you might experience heavy bleeding and cramping during your periods. Some women experience a combination of all three types of spotting during perimenopause.

Bleeding between periods can happen when you're not ovulating regularly, which occurs when your body isn't producing enough estrogen to stimulate egg release every month. Some women undergoing menopause will experience more frequent spotting around ovulation, but this isn't always the case—it just depends on how quickly your body changes during this stage.

Perimenopause spotting can happen for many reasons. It's important to understand why you have this symptom to manage it effectively. The most common reason for perimenopause spotting is hormonal changes. Hormonal fluctuations can cause changes in the lining of your uterus, which may lead to bleeding when it's not supposed to be there—during a period or after sex (called postcoital bleeding).

Another reason for perimenopause spotting can be related to your lifestyle. For example, if you're not eating well or exercising regularly, your body will not get the nutrients it needs to stay healthy. Your body may also be reacting negatively to stress and anxiety—which can cause a fluctuation in hormone levels, resulting in bleeding at unusual times.

The bleeding can be light or heavy and may last for several days. It's impossible to predict when perimenopause spotting will happen, but it's common for women to experience it at some point during this stage.

Are Changes in Your Period Normal During Perimenopause?

Yes, changes in your period are normal during perimenopause. There are several changes in your period during perimenopause. 

Here's what to look for:

• Your period starts coming more often or less often than it used to.
• You notice changes in flow, like going from heavy to light or vice versa.
• Your period stops for a few months, then starts again.
• You have irregular bleeding throughout the month, not just during your regular cycle days.

Other Causes of Irregular Periods

In addition to perimenopause causes, irregular periods can be caused by several things, including lifestyle choices, certain medications, and health conditions.

Here are a few causes that you may want to consider:

• Stress: Stress is a common cause of irregular periods in women. If you have recently experienced any stressful life events—a death in the family or financial turmoil, for example—your menstrual cycle may be affected.
• Poor diet and exercise habits: A poor diet and lack of exercise can alter your hormone levels, leading to irregular periods.
• Smoking cigarettes or using tobacco products: Cigarettes contain nicotine and other harmful chemicals that can affect your reproductive system, causing irregular periods.
• Alcohol and coffee: Drinking too much alcohol or coffee may affect how well your body produces hormones that regulate your menstrual cycle—and drinking too much alcohol can also lead to dehydration.
• Premature ovarian failure: This is a condition where your ovaries stop working before age 40, which means you will have infrequent periods or none at all.
• Certain medication: Birth control pills and hormone therapy for menopause can cause changes in your menstrual cycle (as well as other side effects). Still, these changes usually go away after discontinuing the use of birth control pills and hormonal therapy altogether.
• Polycystic ovarian syndrome: This condition causes enlarged ovaries and cysts on them, irregular periods, and infertility. You can treat it with medication or surgery.
• Premenstrual dysphoric disorder: This mood disorder causes symptoms like anxiety, irritability, and depression two weeks before your period starts each month. It's diagnosed based on symptoms alone, so if you think this may affect you, talk with your doctor about what other tests might help get a diagnosis.

When to Worry About Perimenopausal Bleeding

Vaginal bleeding is common during perimenopause and can be in the form of spotting or light or heavy bleeding. The bleeding is known as perimenopausal bleeding and may last for several days. Perimenopausal bleeding is nothing to worry about if it's just spotting or light bleeding that lasts a couple of days. 

However, you should see your Ob-Gyn if you observe any of these signs:

• Bleeding that lasts more than two weeks
• You have heavy bleeding that requires you to wear a pad or tampon every hour.
• You experience pain during sex, urination, or bowel movements after the onset of perimenopause bleeding
• There's a sudden and heavy gushing of blood
• Pelvic pain, cramping, or pressure during your period
• Bleeding is accompanied by fever, chills, nausea, or vomiting
• Heavy bleeding that lasts for more than a week
• You're not having your period at all

Perimenopause periods are an inevitable part of a woman's life. It's wise to visit your gynecologist for regular checkups. During these visits, your doctor will help determine whether you are developing perimenopause-related conditions and how to manage them.