Perimenopause Spotting: When to Worry and When It’s Normal

When you suddenly experience light bleeding between periods, it can be confusing and maybe even a little scary. 

If the light bleeding is perimenopause spotting, though, you likely don’t need to worry about it. This common symptom of perimenopause is caused by hormone changes, and while perimenopause spotting often isn’t cause for concern, it can definitely be frustrating and inconvenient!

Here’s everything you need to know about perimenopause spotting, including what causes it, and how to tell the difference between normal perimenopause spotting versus red flag perimenopause spotting.

What is perimenopause spotting?

During perimenopause, you might experience vaginal bleeding between periods. This is what’s known as perimenopause spotting, sometimes called breakthrough bleeding or intermenstrual bleeding.

Perimenopause spotting is generally light in both flow and color:

• Color: Light pink or light red
• Flow: Light enough that blood is only noticeable when wiping or as a faint spot on underwear, and lightweight sanitary products (like a panty liner) can easily handle stain or leak protection 

In many cases, having perimenopause spotting from time to time is normal and not cause for concern. Spotting often goes away by itself [1].

How common is perimenopause spotting?

“Just noticed spotting, do I need to panic?" In most cases, no. Light spotting between periods is common during perimenopause. We know that perimenopause spotting is a symptom of perimenopause, but it’s hard to estimate how common it is.

Some studies report that about 1 in 5 women experience perimenopause spotting between periods [1]. Other studies put the number even higher, at 66% of women – that is, around 3 out of 5 [2].

You may be more likely to experience perimenopause spotting more often if you have [2]:

• Long periods (10 or more days)
• Heavy periods

Why does spotting happen in perimenopause?

The short answer is: hormones. 

Your hormone levels shift during perimenopause, transitioning toward the hormone balance that you’ll have after menopause. These hormone changes are the reason why you may experience perimenopause spotting and period changes (alongside other perimenopause symptoms). 

In fact, irregular cycles, irregular periods, and perimenopause spotting are actually among the first signs of perimenopause.

How do hormone changes cause perimenopause spotting?

Estrogen and progesterone, two key reproductive hormones, rule your menstrual cycle. Both undergo a dramatic shift in perimenopause, declining significantly over time and fluctuating unpredictably as they go. 

These fluctuations throw off the balance between estrogen and progesterone, which impacts their ability to regulate your cycle. This can lead to irregular periods, irregular ovulation, and yes, perimenopause spotting.

Here are just a few ways that hormone fluctuations can cause perimenopause spotting: 

• Uterine lining (endometrium) changes: In a typical cycle, estrogen and progesterone trigger the uterine lining to thicken in preparation for pregnancy, then shed if pregnancy doesn’t occur. This shedding is your period. When estrogen and progesterone aren’t balanced, the uterine lining is less stable and more likely to shed irregularly, leading to perimenopause spotting, heavy periods, and irregular cycles.
• Irregular ovulation: Changing hormones make ovulation increasingly irregular in perimenopause. Irregular ovulation then impacts progesterone levels, since the processes around ovulation are part of what produces progesterone. That makes the uterine lining even more unstable and alters shedding and bleeding patterns, which you experience as perimenopause spotting [3].
• Irregular ovulation spotting: Some people experience spotting when they ovulate (which can happen pre-perimenopause, too), meaning your perimenopause spotting could be ovulation spotting. Since perimenopause ovulation is irregular, perimenopause ovulation spotting is irregular, too, and may take you by surprise at seemingly random, mid-cycle moments.

When does spotting start in perimenopause?

Spotting can begin at any point during perimenopause, but it most commonly starts in your early to mid-40s as one of the first signs of hormonal changes. That said, some women notice spotting as early as their late 30s, while others don't experience it until their late 40s or early 50s as they approach menopause. The truth is, there's no single "on schedule" timeline, perimenopause is highly individual, and spotting can appear early, late, or anywhere in between during the 4-10 year transition.

What matters more than when your spotting starts is how you're experiencing it. Normal perimenopause spotting should be light (panty liner only), occasional rather than daily, and light pink, red, or brown in color. If you're between 35-52 and suddenly experiencing spotting between periods, even if your cycles are still fairly regular, you're likely right on track with perimenopause. If you're concerned about your specific situation or timeline, tracking your symptoms and discussing them with your healthcare provider can give you personalized reassurance about where you are in your perimenopause journey.

Can medication cause perimenopause spotting?

Yes, perimenopause spotting can sometimes be related to medication, including:

• Hormonal medication commonly used to treat perimenopause symptoms, such as hormone replacement therapy (HRT) and hormonal birth control
• Non-hormonal medication, such as blood thinners [4]

What’s considered normal spotting during perimenopause?

Generally speaking, perimenopause spotting is normal when:

• Your spotting is very light
• You only notice spotting when wiping, or in faint stains on your underwear
• You can manage leaks and stains with light-flow sanitary products, like panty liners
• You don’t have heavy bleeding that saturates multiple sanitary products each day
• You have occasional spotting only, meaning you don’t experience perimenopause spotting consistently every cycle

In these cases, perimenopause spotting is likely nothing more than the occasional hormone-driven spotting. In other words: a normal part of perimenopause, and not cause for worry. 

Still, perimenopause comes with so many changes, and it’s completely understandable to feel confused and overwhelmed by spotting and bleeding. You can always talk with your doctor about any concerns as you navigate perimenopause.

Signs perimenopause spotting or bleeding could be a red flag

In other cases, spotting or bleeding could point to a health condition that needs medical attention.

Talk to your doctor to evaluate your perimenopause spotting and bleeding if:

• You have very heavy bleeding that soaks through sanitary products multiple times a day
• You have spotting or bleeding for 3 weeks or longer
• You get your period every 2 weeks, or more frequently
• You regularly bleed after sex
• You have frequent and consistent spotting, meaning you experience perimenopause spotting between periods nearly every cycle

How to track perimenopause spotting and talk to your provider 

If you want to talk with your provider about perimenopause spotting, it’s a good idea to gather information ahead of your appointment. 

Tracking perimenopause spotting, bleeding, and periods is a great way to prepare. Consider keeping a symptom and bleeding journal with a perimenopause care tool like the Oova hormone kit and app. With Oova, you can easily record all of your perimenopause symptoms – and track your hormones – all from the comfort of your own home.

In your journal, keep track of information like:

• Which cycle days you see spotting
• How long spotting lasts
• How heavy your flow is
• How many sanitary products you use each day
• Blood color
• How often you get a period
• Other perimenopause symptoms, and when they occur

Then, bring this information with you to your appointment so you’re ready to discuss in detail.

Your healthcare provider might suggest evaluations and further testing, such as:

• Pelvic exam
• Blood test
• Ultrasound
• Colposcopy (an exam that checks the cervix, vulva, and vagina)
• Hysteroscopy (an exam that checks the uterus)
• Biopsy

How to manage spotting and cycle changes at home

Cycle irregularity is an unavoidable part of perimenopause, and irregularity can include perimenopause spotting. While you can’t stop your cycle from changing, you can support your hormone balance. This may steady hormone fluctuations, helping you manage and ease perimenopause symptoms.

Try incorporating these lifestyle strategies to support your mind and body as you move through perimenopause:

• Prioritize sleep
• Exercise regularly
• Eat a nutritious, perimenopause-friendly diet (Balance is key! Think: fruits, veggies, protein, and whole grains, with sweets and fats in moderation)
• Do activities that bring you joy
• Spend time with loved ones
• Seek professional support for emotional and physical wellness as needed
• With your doctor’s OK, try perimenopause supplements that may help promote hormone balance, like probiotics [5], ashwagandha [6], and soy isoflavones [7]

Medication for perimenopause spotting

Depending on your situation, your doctor may recommend medications to help ease perimenopause spotting and bleeding, cycle irregularity, and other symptoms.

Medications that stabilize hormones and regulate uterine lining stability include:

• Hormone replacement therapy (HRT)
• Intrauterine device (IUD)
• Hormonal birth control

If you’re experiencing period pain and cramps, over-the-counter pain relievers can also provide relief.

Perimenopause spotting: The bottom line

Perimenopause spotting is light bleeding between periods, caused by fluctuating hormone levels. 

When perimenopause spotting is very light and only happens occasionally, it’s likely normal and you don’t need to worry. If spotting is heavy and happens consistently each cycle, though, talk to your doctor to check what’s going on. Consider keeping a symptom and bleeding journal to help you prepare for conversations with your doctor. 

As you navigate perimenopause, give your body and mind gentle, intentional care. Eat a balanced diet, exercise regularly, aim for good sleep, and do activities that make you happy to help you manage your hormones and your symptoms.

Frequently Asked Questions About Perimenopause Spotting

Is spotting every day during perimenopause normal?

No, daily spotting isn't typical during perimenopause. While occasional spotting between periods is common, experiencing spotting consistently every day could indicate a hormonal imbalance or another health condition that needs medical attention. If you've been spotting daily for more than a week, or if the spotting is getting heavier, schedule an appointment with your doctor to rule out conditions like polyps, fibroids, or thyroid issues.

How long does perimenopause spotting last?

Normal perimenopause spotting typically lasts 1-3 days and occurs occasionally between periods. The spotting should be light enough to manage with a panty liner. However, if you experience spotting that lasts for 3 weeks or longer, or if it happens every single cycle, this warrants a conversation with your healthcare provider to ensure there isn't an underlying condition that needs treatment.

What color is perimenopause spotting?

Perimenopause spotting is usually light pink or light red in color. You may also see brown spotting, which is simply older blood that's taking longer to exit your body. Brown spotting during perimenopause is also generally normal. However, if you notice gray discharge, bright red heavy bleeding, or spotting with an unusual odor, contact your doctor as these could be signs of infection or other conditions.

Can you have brown spotting during perimenopause?

Yes, brown spotting is very common during perimenopause and is usually normal. The brown color means the blood is older and has oxidized before leaving your body. This often happens when hormone fluctuations cause your uterine lining to shed slowly or irregularly. As long as the brown spotting is light, occasional, and not accompanied by pain, foul odor, or other concerning symptoms, it's typically just another variation of normal perimenopause spotting.

What's the difference between perimenopause spotting and a period?

Perimenopause spotting is light bleeding that requires only a panty liner, appears as faint stains on underwear, or is only noticeable when wiping. A period, even a light one, typically requires pads or tampons, lasts 3-7 days, and involves more consistent flow. If you're unsure whether you're experiencing spotting or a light period, consider the amount: spotting is usually less than a tablespoon of blood total, while even a light period involves several tablespoons over multiple days.

Can stress cause spotting in perimenopause?

While stress doesn't directly cause perimenopause spotting, it can worsen hormone fluctuations that lead to spotting. Chronic stress affects your cortisol levels, which can interfere with estrogen and progesterone balance—the same hormones responsible for regulating your cycle. If you notice more frequent spotting during particularly stressful times, managing stress through exercise, sleep, meditation, or therapy may help stabilize your cycles and reduce spotting episodes.

Is spotting normal at the beginning of perimenopause?

Yes, spotting is often one of the earliest signs of perimenopause and can begin in your late 30s or early 40s. In fact, irregular cycles and spotting between periods are among the first noticeable changes many women experience as their hormones begin to shift. If you're in your late 30s or 40s and suddenly noticing mid-cycle spotting when you never had it before, it could be an early indicator that you're entering perimenopause.

Does perimenopause spotting mean menopause is close?

Not necessarily. Perimenopause can last anywhere from 4 to 10 years before you reach menopause (defined as 12 months without a period). Spotting can occur at any point during perimenopause, early, middle, or late stages. While spotting is common throughout the entire perimenopause transition, the frequency and pattern of your cycles matter more for predicting menopause timing. If your periods are becoming less frequent and you're going 60+ days between cycles, you may be in late perimenopause.

Can I still get pregnant if I'm having perimenopause spotting?

Yes, you can still get pregnant during perimenopause, even if you're experiencing spotting and irregular cycles. As long as you're still having periods (even irregular ones) and ovulating occasionally, pregnancy is possible. If you're sexually active and not planning to conceive, continue using birth control until you've gone 12 full months without a period (which confirms you've reached menopause). If you're concerned your spotting could be implantation bleeding, take a pregnancy test.

When should I worry about perimenopause spotting?

You should see your doctor about perimenopause spotting if you experience: heavy bleeding that soaks through multiple pads or tampons per day, spotting or bleeding that lasts 3+ weeks continuously, periods or spotting occurring every 2 weeks or more frequently, regular bleeding after sex, or consistent spotting between periods nearly every cycle. These patterns could indicate conditions like fibroids, polyps, endometrial hyperplasia, or other issues that need medical evaluation.

Can perimenopause spotting be pink?

Yes, pink spotting during perimenopause is completely normal. Pink spotting occurs when a small amount of blood mixes with cervical fluid or discharge. This is especially common during ovulation spotting or when hormone levels cause light, irregular shedding of the uterine lining. Pink discharge or spotting is generally nothing to worry about as long as it's light, occasional, and not accompanied by pain, itching, or an unusual odor.

How do I know if it's perimenopause spotting or something else?

The key indicators of normal perimenopause spotting are: it's light (panty liner only), occurs occasionally between periods, is light pink, red, or brown in color, and you're in the typical age range for perimenopause (late 30s to early 50s). It's likely something else if the bleeding is heavy, occurs after sex every time, comes with severe pain, has a foul odor, or you've gone 12+ months without a period (meaning you're postmenopausal). When in doubt, track your symptoms and discuss them with your doctor.