Spotting during the perimenopause is usually harmless. In the years before your last period your hormones swing a lot. Then you sometimes lose a little blood between periods.
It is common. An American study followed 1,320 women through the menopause transition. Two in three had at least three episodes of spotting lasting six days or more.
One line always counts, though: have you gone a year without a period? Then any bleeding is a reason to see your GP.
What is spotting in the perimenopause?
Spotting is light bleeding outside your normal period. A few drops, pink or brown discharge, just enough for a panty liner. Doctors also call it intermenstrual bleeding.
The menopause transition starts with the perimenopause: the years in which your cycle becomes irregular. Your ovaries then do not ovulate every month. A cycle without ovulation is called anovulatory. When the transition comes differs per woman, but it usually starts in your mid-forties.
Without ovulation you make no progesterone. Oestrogen then lets the lining of your womb grow without the brake progesterone normally provides. That lining then sheds at unpredictable moments. That is spotting.
Is spotting during the perimenopause normal?
Yes, for most women it is part of it. According to the Dutch GP guideline on vaginal bleeding, cycles just before the menopause are often anovulatory. Irregular bleeding fits that picture.
The largest study of bleeding patterns in the menopause transition is SWAN. Women kept a daily menstrual calendar for up to ten years.
Two thirds reported at least three episodes of spotting lasting six days or more. More than three quarters had at least three periods of ten days or longer. Long, untidy bleeding is the rule in this phase rather than the exception.
Brown spotting is usually old blood. It sat a little longer in your womb or vagina before coming out. That is not an alarm signal in itself.
How long does spotting last in the perimenopause?
One episode of spotting usually lasts a few days. In SWAN, runs of six days or longer happened a few times for most women.
The phase of irregular bleeding itself can last years. Researchers split it into two steps. In the early phase your cycle length varies by more than seven days. In the late phase you skip periods, with gaps of sixty days or more.
How long may spotting last? There is no hard limit. Daily bleeding that goes on for weeks is not something to sit out, though. Discuss that with your GP.
The twelve-month line
You are officially in the menopause once you have gone twelve months without a period. Bleeding after that is called postmenopausal bleeding. It is no longer spotting.
Did your period come back after six months? Then you were still in the perimenopause. Gaps of six months happen in the late phase. The twelve-month count starts again.
Say you are 49 and your last period was in February. In September you bleed again. That is seven months later, so still perimenopause.
Did that bleeding only come in March of the following year? Then thirteen months had passed. That is postmenopausal bleeding, and you call your GP.
So after twelve months it is different. Then you have any bleeding checked, even a little. Why is in postmenopausal bleeding.
Normal or get it checked?
This table lists the situations women in the perimenopause most often wonder about. The right-hand column is not a diagnosis, but a direction.
| What you notice | Often fits | What you do |
|---|---|---|
| Cycle gets shorter or longer, sometimes a month skipped | Perimenopause | Track it on a menstrual calendar |
| Brown or pink spotting before or after your period | Hormone swings, old blood | Track it |
| Spotting in the first months of hormone therapy or a new IUD | Getting used to the hormones | If it persists, discuss it with your GP |
| Bleeding after sex | A contact bleed, for example from the cervix | Have your GP look at it |
| Very heavy bleeding, leaking through, large clots | Heavy menstrual bleeding | GP, who can also look at your iron |
| Spotting with lower abdominal pain, fever or unusual discharge | Sometimes an infection | GP |
| Bleeding after twelve months without a period | Postmenopausal bleeding | Always your GP |
Unsure about a row? That is reason enough to call your GP.
What causes spotting?
In the perimenopause the most common cause is ovulation dropping away. But there are other causes, and a few have nothing to do with the menopause.
- Hormonal contraception. A hormonal IUD, implant or pill often causes irregular bleeding, especially in the first three months. More in IUD bleeding.
- Hormone therapy. Irregular bleeding is a known side effect, especially in the first months.
- Polyps and fibroids. These are common and often harmless. Ultrasound in women without symptoms found a polyp in 10% and a fibroid in 13%. Read uterine polyp.
- An infection, such as chlamydia. That can happen after forty too.
- Your thyroid. A slow thyroid can disturb ovulation.
- A pregnancy. As long as you still have periods, it is possible. See menopause or pregnant.
Rarely, an abnormality of the womb lining is behind it. That is exactly why your GP wants to take a look when in doubt. Not because it is likely, but because it can be ruled out.
Spotting on hormone therapy
Starting hormone therapy for hot flushes? Then some irregular bleeding in the first months is not strange. Your body has to get used to the new hormones.
Does it keep coming back after those first months, or start only later? Then discuss it with the doctor who prescribed it. After the menopause, the Dutch GP guideline sees irregular bleeding on hormone therapy as reason to investigate.
Which forms exist and what the side effects are is in menopause hormone therapy.
What does a blood test say about spotting?
We are honest about this: a blood test does not explain spotting. No blood value tells you whether your bleeding is harmless. That remains work for your GP, sometimes with an ultrasound.
What a blood test can do is give you a factual picture of your hormones. In the perimenopause FSH and oestradiol swing a lot. One result is therefore a snapshot, not a date for your menopause.
From age 45, the Dutch GP guideline does not need an FSH test to diagnose the menopause. The GP looks at your age and your cycle.
Are you younger, or do you want to know anyway? The menopause check measures FSH, oestradiol, TSH and free T4. The last two are your thyroid values, because your thyroid can also disturb your cycle. What FSH tells you is in the FSH test guide.
Losing a lot of blood? Then your iron levels matter more than your hormones. Heavy bleeding can lead to anaemia. See anaemia from heavy periods.
What can you do yourself?
Our view: a well-kept menstrual calendar tells your GP more than a single hormone result. The Dutch GP guideline recommends that calendar too.
- Note every day with bleeding: how much, what colour, and whether it followed sex.
- Note your hot flushes and your sleep as well. That shows the pattern.
- Wondering whether you are pregnant? Take a pregnancy test first.
- Recognise something from the right-hand column of the table? Do not wait, call your GP.
- Want a factual starting point? Have your hormones and thyroid measured and discuss the result.
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
Further reading
- Perimenopause: symptoms, age and when to test
- Heavy periods: causes and when to test
- Bleeding after the menopause: why you always get it checked
Sources
- NHG-Standaard Vaginaal bloedverlies, the Dutch GP guideline on vaginal bleeding, richtlijnen.nhg.org (consulted 2026)
- NHG-Standaard De overgang (2022), the Dutch GP guideline on the menopause, richtlijnen.nhg.org
- Paramsothy P, et al. Bleeding patterns during the menopausal transition in the multi-ethnic Study of Women's Health Across the Nation (SWAN). BJOG, 2014. PMID 24735184
- Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10. J Clin Endocrinol Metab, 2012. PMID 22344196
- Burger HG, et al. A review of hormonal changes during the menopausal transition. Hum Reprod Update, 2007. PMID 17630397
Frequently asked questions
How long does spotting last in the perimenopause?
One episode usually lasts a few days. In a large study, two in three women had repeated spotting of six days or longer. The phase of irregular bleeding itself can last years.
Is spotting during the perimenopause normal?
Usually, yes. In the perimenopause you do not ovulate every month. Then the lining of your womb sheds irregularly. Bleeding after twelve months without a period always needs a check.
How long may spotting last?
There is no hard limit. Daily bleeding that goes on for weeks is something to discuss with your GP. So is bleeding after sex or very heavy bleeding.
What causes spotting?
In the perimenopause mostly cycles without ovulation. Other causes are hormonal contraception, hormone therapy, polyps, fibroids, an infection, your thyroid or a pregnancy.
My period came back after six months. Is that normal?
Yes, that can happen in the late perimenopause. You are only in the menopause after twelve months without a period. After such a bleed the count starts again.
Is brown spotting normal in the perimenopause?
Brown spotting is usually old blood that sat a little longer in your womb or vagina. In itself it is not an alarm signal. If it comes after twelve months without a period, have it checked.
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Lunarahealth
Dr. Naimi, BIG-registered physician, oversees the medical standards behind our content and assessments. Read our medical policy
