During perimenopause, changes take place in the body due to hormonal fluctuations that occur in preparation for menopause. Among the most common of these symptoms are menstrual irregularities; a woman is likely to notice menstrual activity she has never experienced prior to menopause, such as spotting between periods. Defined as bleeding that occurs outside of normal menstruation, spotting is usually explainable, but it can sometimes symptomize worrying health issues. Keep reading to understand more about menstrual bleeding, why it occurs, and learn how to recognize when it could be cause for concern.
What Is Normal Menstrual Bleeding?
In order to understand what constitutes abnormal spotting between periods, it's helpful to understand first what's considered "normal" menstrual bleeding. The menstrual cycle generally takes place over 28 days, and during two to five of these days, bleeding known as a period occurs. In this time, between two and eight tablespoons of blood will be shed.
Any bleeding that occurs outside of a period is known as spotting. Spotting may or may not occur alongside other symptoms, such as pain, irritability, nausea, or headaches; it is dependent on the cause.
Hormones and Spotting
Menstrual activity is influenced by two hormones in particular: estrogen and progesterone. When biological or external factors affect the balance of these hormones, then menstrual irregularities, such as intermenstrual bleeding, are likely to occur. Hormone-driven causes of spotting include perimenopause and the use of hormonal contraceptives, such as the pill, implant, or injection.
Other Causes of Spotting
Though hormone fluctuations are the most common cause of intermenstrual bleeding, particularly in women approaching menopause, there are other potential causes of spotting, and these include:
- Sexually-transmitted infections (STIs), such as chlamydia, genital warts, herpes, and HIV
- An abortion, miscarriage, or other pregnancy complications
- Uterine fibroids or cervical or uterine polyps
- Injury to the vagina (e.g., from vigorous sex)
- Inflammation of the cervix
- Cervical or uterine cancer
- Underactive thyroid
Usually, the nature of other symptoms is key to recognizing and diagnosing the cause of non-hormonal spotting.
Treatment of spotting is dependent on the cause. If spotting is derived from hormonal imbalances, a change of diet, lifestyle or contraceptives may be required to help restore hormonal balance, and if the bleeding is not life-impeding, it is usually manageable simply by carrying around extra sanitary wear. More serious causes of intermenstrual bleeding are diagnosed via a series of medical exams and treated on a case-by-case basis.
While spotting between periods is usually explainable, it should not be considered normal. If you are pregnant and notice spotting, medical attention should be sought as a matter of urgency. Otherwise, use a tampon to ensure the bleeding you're experiencing is vaginal rather than rectal or urinary, and arrange a consultation with your doctor. The range of causes of intermenstrual bleeding mean that it is always worth having a medical professional identify the cause to rule out any serious health concerns.