During the peri-menopausal years, vulvar bleeding continues to occur but you may notice a few changes. As your estrogen hormone levels decrease, you will notice that your menstrual periods become more erratic. There are times when spotting may be a cause for concern; spotting may indicate a more serious health concern. Understanding what to expect and what is considered normal helps to lessen fears about the many changes happening to your body.

Menstruation and peri-menopause
In the years leading up to menopause, referred to as peri-menopause, your monthly periods may continue on a fairly regular basis. Yet your periods may occur with less predictability. They may start to taper off and you may go several months without a period, only to have one seemingly ‘out of the blue’ just when you thought you were finished. Remember that menopause really means the time when you have gone for more than 12 consecutive months without having a period. Up to that point, periods do happen, and they can be anything but monthly.

You might also find that your periods are lighter or heavier than they used to be. Periods can be longer or shorter as well, creating a lot of unpredictability. This whole peri-menopausal phase usually lasts anywhere from 8-12 years. Most women will start seeing changes in their mid to late 40s, but peri-menopause can begin as early as a woman’s 30s.

Spotting: what is normal?
Most women will have very different experiences during menopause. For some, they may have a slight spotting just before the monthly period – a sort of warning sign – while other women will get a sudden onset of menstrual flow. The problem with defining normal is that you could have periods for several months, then a few months without, before starting up again.

Spotting: what is not normal?
You have spotting when you are not expecting your period. This can be difficult to recognize as periods become more unpredictable, but if you just finished menstruating and notice more spotting, this may be a sign of a more serious condition.

Drastic changes in your menstrual flow where you soak through several sanitary pads or tampons in just a few hours. Menstrual period flow may be unusually light after years of a heavy flow.

Any spotting after a full 12 months without a period is not normal and should be checked out by your doctor.

When you notice anything unusual, always discuss your symptoms with your healthcare professional to rule out any other possible health issues including:

*Problems with a pregnancy, particularly bleeding in the first 12 weeks may indicate a miscarriage or an ectopic pregnancy. Bleeding after 12 weeks may be a more serious problem with the placenta.

*Polycystic Ovary Symptom means your ovulation cycles may be off due to peri-menopause. Abnormal hormone balances can affect the ovulation cycles and can lead to abnormal bleeding. If you are coming off birth control at this point and your fertility may be still active and an unexpected pregnancy can occur.

*Birth control pills, IUDs, and other medications may also trigger vulvar bleeding.

*Pelvic infections and sexually transmitted diseases.

*Uterine fibroids.

*Ovarian, vulvar, cervical, or uterine cancer.

Your ultimate goal heading into or going through peri-menopause should be to increase your awareness of your body and how it is changing. Granted, some changes are very subtle. But it is very important to know what to look for and understand how the various symptoms of peri-menopause can affect you. Vulvar bleeding and spotting are not automatic causes for concern, but with information and your doctor’s help, you can eliminate some of the worries and stresses of the menopause changes.


Menopause, Your Doctor, and You