Written by The Menopause Charity
Perimenopause, the transition phase leading up to menopause, often brings a variety of changes to a woman's menstrual cycle. One common but sometimes concerning symptom is unexpected bleeding between periods. While these irregularities can be part of the natural shift in hormonal balance, particularly involving oestrogen levels, they may also be unsettling and disruptive.
Hormonal fluctuations during perimenopause can lead to changes in period frequency, flow, and duration, with spotting or even heavy bleeding occurring at unexpected times. Understanding the causes behind this bleeding, as well as knowing when to seek medical advice, can empower women to manage these changes effectively and recognise when further intervention may be needed. This article explores why bleeding between periods can happen in perimenopause, treatment options available, and when to consult a healthcare provider.
During perimenopause, it can be common to experience bleeding between periods due to hormonal fluctuations, particularly in oestrogen. These hormonal shifts can lead to changes in menstrual frequency, duration, and flow. Many women notice periods becoming unpredictable, sometimes closer together, other times further apart. They can also vary in intensity, ranging from spotting to heavy bleeding. This irregular bleeding often happens because fluctuating oestrogen levels can lead to thickening or irregular shedding of the uterine lining, causing unexpected bleeding episodes. Other conditions, such as fibroids or polyps, which are more common during perimenopause, can also contribute to irregular bleeding patterns.
For many women, this change in bleeding is simply part of the transition to menopause, but it’s essential to monitor patterns closely. If bleeding is persistent, very heavy, or causes concern, it is recommended to consult a healthcare provider to rule out any other underlying issues, such as excessive endometrial thickening or polyps, which may require treatment.
Regular physical activity, managing stress, and maintaining a balanced diet can support hormonal balance and may alleviate some symptoms associated with perimenopause.
Hormone replacement therapy (HRT) is frequently used to balance fluctuating oestrogen and progesterone levels, which can help regulate irregular bleeding. Adjustments in HRT dosages, switching types of hormones, or changing to a continuous regimen (where both hormones are taken daily) can sometimes stabilise bleeding patterns.
Progesterone therapy specifically aids in thinning the uterine lining, helping to control heavy or irregular bleeding. An intrauterine system (IUS), also known as a hormonal coil, that releases progesterone, is another effective option to reduce or stop bleeding entirely over time.
For those who cannot or choose not to use HRT, medications such as tranexamic acid or non-steroidal anti-inflammatory drugs (NSAIDs) can help. Tranexamic acid helps slow down bleeding, while NSAIDs like ibuprofen or naproxen can reduce blood loss and alleviate related discomfort.
In cases where other treatments don’t provide relief, surgical interventions like endometrial ablation (a procedure to remove the uterine lining) may be recommended. A more permanent option, hysterectomy (removal of the uterus), is sometimes considered for severe cases, especially if the bleeding is due to other issues such as fibroids.
If you experience unusual bleeding patterns during perimenopause, certain signs indicate it’s wise to consult a healthcare professional:
Seek medical advice if bleeding is excessively heavy—such as needing to change sanitary products every one to two hours—or lasts longer than normal. Persistent heavy bleeding may lead to anaemia and could be due to underlying issues like fibroids or polyps.
While hormonal fluctuations can cause occasional spotting, consistent or unexpected bleeding between periods may warrant further evaluation to rule out hormonal imbalances or structural changes in the uterus.
Bleeding that is accompanied by pelvic pain or that differs suddenly in timing, flow, or duration could indicate conditions such as endometrial hyperplasia or other uterine abnormalities, which should be assessed by a doctor.
If bleeding occurs after menopause (when periods have ceased for a year or more), it is crucial to see a doctor, as this can sometimes signal serious issues, including endometrial abnormalities.
It is important to track your menstrual cycle and act on any change. Monitoring your bleeding patterns and changes to your periods with a diary or a period tracking app can be helpful. The information can help your healthcare professional recommend appropriate treatment options for you to consider.
For further reading on changes to your periods during perimenopause, explore our other guides written for Lil-Lets
Heavy Periods During Perimenopause https://www.lil-lets.com/uk/hub/heavy-periods-during-perimenopause/
Overcoming Period Pain in Perimenopause: Tips and Treatment https://www.lil-lets.com/uk/hub/overcoming-period-pain-in-perimenopause-tips-and-treatments/
Tips & Treatments for overcoming and managing period pain in perimenopause.
Overcoming Period Pain in Perimenopause: Tips and TreatmentsLetting your family know how menopause is impacting on your life, is so important and is a conversation you need to have.
How To Talk To Your Family About The MenopauseYour vaginal health is just as important pre and post menopause, but what changes should you expect?
Vaginal Dryness and Discharge In Menopause
Yes, it’s common. Hormonal fluctuations can cause irregular cycles, spotting, or heavier periods. However, if the bleeding is heavy, prolonged, or very frequent, consult a doctor.
Yes! Keeping a menstrual diary or using a period-tracking app can help your doctor identify patterns and potential issues.
Yes. If you’re taking HRT, especially combined oestrogen and progesterone therapy, light bleeding or spotting is common in the first few months. If it persists, your doctor may need to adjust your dosage.
There are lots of ways to help manage irregular bleeding in menopause; birth control pills or IUDs can help regulate hormones. HRT may be an option if symptoms are severe and even some simple lifestyle changes (reducing stress, maintaining a healthy weight) can help.
Any bleeding after 12 months without a period is not normal and should be evaluated. It could be caused by benign issues like thinning of the uterine lining but could also indicate something more serious and a chat with your medical practitioner is advised.
