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Is Spotting Normal During Perimenopause and Menopause?

By the time most women reach their early fifties, they’ll enter menopause. It’s the time of life that officially starts when you haven’t had a menstrual period for at least a year. Some women make the transition relatively easily, while others—a majority, in fact—will experience a few uncomfortable symptoms such as hot flashes, difficulty sleeping, and changes in their mood. In most cases, these changes are perfectly normal and treatable.

However, spotting during menopause, and the time leading up to it, is a symptom you should never ignore.

“Any abnormal bleeding or spotting in perimenopause or menopause should be evaluated by your gynecologist,” said John J. Fitzgerald III, DO, a gynecologist at Abington-Jefferson Health. “Most of the causes are benign, but some may evolve into more serious health issues, such as cancer, if left untreated.”

Spotting During Perimenopause and Menopause

Perimenopause, which means around menopause, is the time leading up to menopause. It can last for as long as a decade, during which time you’ll experience changes in your menstrual cycle.

“Perimenopausal women continue to make estrogen; however, the other hormone made by the ovaries, progesterone, declines,” said Dr. Fitzgerald. “These hormonal changes can cause the endometrium to grow and produce excess tissue, increasing the chances for developing polyps.”

Polyps are usually benign and grow in the tissue that lines the uterus. They can cause irregular and heavy bleeding. If they occur on the cervix, they can cause bleeding after sex.

Other common causes of bleeding during menopause are endometrial hyperplasia and endometrial atrophy.

“Endometrial hyperplasia is a thickening of the glands that line the uterus,” said Dr. Fitzgerald. “It can potentially cause abnormal bleeding and if left untreated, it can progress to uterine cancer. It’s important to catch it early while it’s most treatable.”

Endometrial atrophy happens when estrogen levels dip, which causes the endometrium to thin. This can also lead to abnormal bleeding.

“Women who are on hormone therapy during perimenopause and menopause may also experience spotting or abnormal bleeding if their medication is not properly regulated,” said Dr. Fitzgerald. “If this happens, talk to your doctor so your medication can be adjusted appropriately.”

How Your Doctor Diagnoses and Treats Spotting

Your doctor will ask about your family history and also perform a physical exam. You may also have several other tests to help figure out why you are spotting. These may include:

  • Endometrial biopsy: Using a tube inserted through your cervix, the doctor will collect a sample of the endometrium for examination. The sample is usually collected in your doctor’s office.
  • “D&C”: Similar to an endometrial biopsy, a dilation and curettage collects a sample of the endometrial lining for examination; typically, more tissue is collected and the test is done in a hospital with anesthesia.
  • Sonohysterography: Fluid is injected into the uterus, which is examined using an ultrasound to look for abnormal contours.
  • Hysteroscopy: A thin tube with a camera is inserted through the cervix, which allows your doctor to view your uterus directly.
  • Transvaginal ultrasound: The doctor uses sound waves to create images of the pelvic organs.

“Treatment options for spotting and abnormal bleeding ultimately depend on the cause, but may include medication to regulate hormone levels or surgery to remove polyps or endometrial lining,” said Dr. Fitzgerald. “If you experience abnormal bleeding, heavy bleeding, or bleeding that occurs more frequently than expected during your menstrual cycle, get a checkup with your gynecologist.”

For a referral to an Abington - Jefferson Health gynecologist, please call 215-481-MEDI (6334) or search our online directory.

Page last reviewed: November 1, 2017
Page last updated: November 1, 2017

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