# Spotting between periods in perimenopause · Peri Signals > Source: https://perisignals.com/articles/spotting-between-periods-perimenopause Periods and bleeding ## Spotting between periods in perimenopause Spotting between periods is common in perimenopause, because the hormones that time your cycle swing up and down. It is still something to report: ACOG lists bleeding or spotting between periods as not normal at any age, and the NHS says it is not usually serious but should always be checked by a doctor. By Nora Whitfield, updated 2 November 2026 ### Is it normal to spot during perimenopause? It is common, and it has an ordinary explanation more often than not. In perimenopause the ovaries make less estrogen and release an egg in some months and not in others. The [American College of Obstetricians and Gynecologists (ACOG)](https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause) describes periods in your 40s that come closer together or further apart, run heavier or lighter, or get skipped. NI Direct, which adapts NHS guidance for Northern Ireland, puts [reproductive hormones not working normally](https://www.nidirect.gov.uk/conditions/bleeding-between-periods) on its list of causes of bleeding between periods and says this is common as women approach menopause. Common is a different thing from normal in the medical sense, though, and that is where many women get stuck. The same ACOG page lists what it calls not normal at any stage: bleeding or spotting between periods, bleeding or spotting after sex, heavy bleeding, bleeding that is heavier or lasts longer than usual, and any bleeding after menopause. It adds that although periods do change as you near menopause, you should still talk to your doctor about bleeding changes, because abnormal bleeding is sometimes a sign of a health problem. So the honest answer to "is this just perimenopause?" is: probably, and only a doctor can tell you for sure. ### Spotting or a short, light period? Spotting is light bleeding outside your period, often a few drops of pink or brown blood that you notice on underwear or toilet paper. In perimenopause it can be hard to tell spotting from a period, because the periods themselves change. A cycle that used to run 28 days can shrink to 21, and a period can shrink to two light days. When cycles are this unpredictable, light bleeding 12 days after the last period could be an early, light period or spotting between two periods. You do not have to sort that out alone. What helps the doctor is the dates: the first day of each proper period, and the days of any lighter bleeding in between. Over two or three months, that record usually shows which it is. Our guide to [irregular periods in perimenopause](/articles/irregular-periods-perimenopause) covers the cycle changes that blur the line, such as cycles that differ by a week or more from one month to the next. ### Other causes of bleeding between periods Hormone changes are only one item on the list. The [NHS page on bleeding between periods or after sex](https://www.nhs.uk/symptoms/vaginal-bleeding-between-periods-or-after-sex/) names three common causes, and NI Direct adds several more. Taken together: * hormonal contraception, such as the pill, patch, implant, injection or hormonal coil, especially in the first three months, after a missed pill, or when you skip the break week * polyps and fibroids, small growths in or around the womb that are usually not cancer * sexually transmitted infections, such as chlamydia * the emergency contraceptive pill * vaginal dryness, which becomes more common as estrogen falls * harmless changes on the surface of the cervix, called cervical ectropion * stress * pregnancy, which is still possible in perimenopause because some cycles still release an egg * less often, cancer of the cervix or of the womb lining (endometrial cancer) ACOG adds endometrial hyperplasia, where the lining of the womb grows too thick. It is not cancer, but ACOG says it can lead to cancer in some cases, and that early treatment may reduce that risk. It usually comes from too much estrogen and not enough progesterone, which is the mix you get in months when no egg is released. That is one reason doctors prefer to look into spotting in your 40s rather than wait it out. NI Direct gives a clear age line. Womb cancer is more common after menopause and most cases are diagnosed in women over 50, but it advises anyone over 40 with bleeding between periods to see a GP so that it can be ruled out. ### Spotting after sex Bleeding after sex sits in the same "not normal" group on ACOG's list, and it has its own set of causes. The NHS names cervical ectropion, polyps on the cervix, vaginal dryness and sexually transmitted infections. Dryness is the one that often arrives with perimenopause, and the [NHS list of perimenopause symptoms](https://www.nhs.uk/conditions/menopause/symptoms/) includes it. NI Direct adds that bleeding after sex is worth reporting even if your cervical screening is up to date, so that cervical cancer can be ruled out. Mention it separately from any other spotting at the appointment. A doctor reads "after sex" and "in the middle of my cycle" as two different clues. ### When to report spotting, and how soon Most spotting is a reason to book a routine appointment, not to rush. The sources sort it like this: * **Book a GP or sexual health clinic appointment** for any bleeding between periods or after sex (NHS). If you are over 40, NI Direct says see a GP. * **On hormonal contraception,** seek advice if bleeding between periods goes on for more than three months after starting it, or if it worries you (NI Direct). * **Get an urgent GP appointment or call NHS 111** if you have recently missed a period and have unusual bleeding together with pain anywhere in your tummy. The NHS says this could be an ectopic pregnancy and needs checking as soon as possible. * **After 12 months with no period,** any bleeding or spotting at all needs checking, however light. ACOG stresses that this is the bleeding it most wants your doctor to hear about. Spotting that comes with heavier periods, clots or flooding belongs in the same conversation. Our article on [heavy periods and blood clots in perimenopause](/articles/heavy-periods-perimenopause) has the measurable signs of a period that is too heavy. ### What happens at the appointment According to the NHS, a doctor or nurse will ask about your symptoms and medical history, and may offer a pregnancy test, a blood test, an STI test (a urine sample or a swab) and an examination of the vagina and cervix. If you are between 25 and 64 and behind on cervical screening, NI Direct says you may be offered that too. If more is needed, the NHS lists referral for an ultrasound scan, a colposcopy (a closer look at the cervix) or a hysteroscopy, where a thin camera looks inside the womb. ACOG adds an endometrial biopsy, which takes a small sample of the womb lining through a thin tube. Treatment, if any, depends on the cause the tests find, and that decision sits with your doctor. Peri Signals does not give treatment advice. ### What to write down before you go Spotting is easy to forget by the time the appointment comes round, so I would keep a short note each time it happens: * the date, and the first day of your last and next periods * the colour (pink, red or brown) and roughly how much: a few drops, enough for a liner, or more * whether it followed sex, exercise or a missed pill * any pain, and where you felt it * the contraception or hormone medicine you use, and when you started it Our [printable symptom diary and appointment checklist](/articles/printable-perimenopause-symptom-diary-and-appointment-checklist) gives spotting its own row, just under period flow, with your other symptoms below. You can print it and bring it with you. If you would rather keep it on your phone, [Her Good Days](https://hergooddays.com/#get) is a free app that logs period dates and flow next to symptoms, sleep and medication, and turns the dates you pick into a PDF for your doctor with cycle lengths and your notes, marked as reported by you. Its App Store and Google Play listings are coming soon. For the full set of changes that come with this stage, from sleep to mood, see [perimenopause symptoms and how to track them](/articles/perimenopause-symptoms). ### My take If you are in your 40s and spotting between periods, I would assume perimenopause is the likely reason and book the appointment anyway, because the sources agree that a doctor should confirm it. I'd go sooner for spotting after sex, spotting that comes back cycle after cycle, or spotting with pain, and I'd treat any bleeding after a full year without a period as a reason to call that week. Take two or three months of dates with you. They turn "I've been spotting a bit" into a pattern a doctor can act on. ### Related reading Everything on cycle changes is gathered under [periods and bleeding](/topics/periods-and-bleeding), and [tracking and appointments](/topics/tracking) covers how to keep a record a doctor can use. Written by Last checked 2026-11-02 --- [Peri Signals](/) Perimenopause symptoms, explained and tracked Plain answers on perimenopause symptoms for women 35 to 65: what is common, what to tell your doctor, and how to keep a useful symptom record. Some links on this page may earn us a commission. It never decides what we write about or recommend. © 2026 Peri Signals. Independent and reader-supported.