Perimenopause Spotting Between Periods: What Is Normal and When to Get Checked

What Is Spotting and Why Does It Happen in Perimenopause

Spotting refers to light bleeding or brownish discharge that occurs outside of your regular period. It is usually much lighter than a period, often just a few spots of blood on underwear or when you wipe. During perimenopause, spotting happens for several reasons. Fluctuating estrogen levels can cause the uterine lining to shed a little at unpredictable times rather than all at once during a period. Anovulatory cycles (where you do not ovulate) can result in an unstable lining that bleeds inconsistently. Cervical or uterine irritation can also cause light bleeding. In many cases, occasional light spotting in perimenopause is simply your body adjusting to hormonal changes, but it is not something to ignore without at least understanding what is causing it.

Types of Spotting and What They Suggest

The character of spotting can offer useful clues. Brown spotting, which is essentially old blood, is very common in perimenopause and is usually related to a delayed end to a period or a small amount of lining shedding outside your regular cycle. Pink or light red spotting in the middle of your cycle can be related to ovulation in some women, though this also becomes less predictable in perimenopause. Bright red bleeding between periods, especially if it comes on suddenly or lasts more than a day or two, is more worth investigating. Spotting that occurs consistently around the same point in your cycle, or that is accompanied by pain or unusual discharge, is also worth mentioning to your doctor. No single episode of light spotting is cause for panic, but a pattern of it deserves attention.

When Spotting Is a Red Flag

There are specific circumstances where spotting warrants prompt medical attention. Bleeding after sex (postcoital bleeding) is always worth investigating, as it can indicate cervical changes, a polyp, or occasionally cervical cancer. Any bleeding after you have already gone 12 months without a period (which would mean you are postmenopausal) should be reported to your doctor promptly, as postmenopausal bleeding has different causes and implications than perimenopausal spotting. Spotting that is accompanied by pelvic pain, pressure, or bloating that is new or worsening also needs evaluation. Heavy spotting that approaches period-level flow but is occurring at unusual times is another signal that something beyond normal hormonal fluctuation may be happening.

Conditions That Can Cause Spotting Alongside Perimenopause

Perimenopause is a common cause of spotting in your 40s, but it is not the only one, and some conditions that cause spotting are very treatable once identified. Cervical or endometrial polyps are small, usually benign growths that can bleed at irregular times and are easily removed. Fibroids can cause both heavy periods and between-period spotting. Cervicitis (inflammation or infection of the cervix) can cause spotting, especially after sex. Hormonal medications, including new or changed oral contraceptives, can cause breakthrough bleeding. Even a thyroid disorder or uncontrolled diabetes can affect the uterine lining and cause irregular bleeding. If you have started any new medication and notice new spotting, mention this to your prescriber.

What to Expect at the Doctor

Keeping Track of Spotting Over Time

Spotting is one of the harder symptoms to track because it is easy to dismiss in the moment and then forget about. But building a record over several months can be very useful. If you are using PeriPlan to log your symptoms, noting spotting episodes alongside your other cycle data gives you a clearer picture of whether it is truly occasional or more frequent than you realized. This kind of log also helps you have a more confident conversation with your doctor, because you can say with certainty when spotting started, how often it happens, and whether it tends to occur at a particular point in your cycle. That level of detail is hard to summon from memory alone, but it is exactly what makes a clinical assessment more effective.