Irregular bleeding: what is it and how to identify it in perimenopause

Have you missed your period for several months? Has the amount of menstrual bleeding changed? Do you have brown spotting instead of periods? These signs suggest irregular bleeding and could be the first symptom of perimenopause. We invite you to read on and find out what irregular menstrual bleeding is, what causes it and how it relates to perimenopause, menopause, and post menopause.

What is irregular bleeding?

It is also known as abnormal uterine bleeding or AUB and it is much more common in the later stages of childbearing, i.e., in adolescence, and in women over 45 years of age (who account for approximately 50% of cases). However, it can occur at any stage of life (Pinkerton, 2021).

Irregular bleeding - what causes it?

In 90% of cases, irregular bleeding is usually caused by ovulatory dysfunction. This means that the ovaries are not working properly, and this leads to an irregular menstrual cycle. However, it is always important to have a complete medical check-up to identify other possible causes (Pinkerton, 2021; MedLine Plus, 2020):
  • Perimenopause.
  • Polycystic ovary syndrome.
  • Clotting disorders.
  • Hormonal problems.
  • Thyroid diseases.
  • Endometriosis: the tissue that lines the uterus grows in other parts of the body such as the ovaries, fallopian tube, etc.
  • Myomatosis.
  • Endometrial cancer.
  • Pregnancy or pregnancy complications.
  • Use of some drugs such as contraceptives.

Characteristics of irregular bleeding during perimenopause

Perimenopause is the period before menopause. It usually begins around the age of 40 and is marked by a progressive decline in oestrogen hormone levels. This can result in irregular menstrual bleeding characterised by (Mayo Clinic, 2021):
  • Longer or shorter than usual time between periods.
  • Variations in the amount of usual bleeding.
  • Absence of menstruation for a few months; menstrual cycles may occur every 60 days or more.
Irregular periods are often accompanied by other symptoms of perimenopause. These include mood swings, hot flushes, sleep disturbances, bloating, vaginal dryness, among others (Mayo Clinic, 2021). However, any vaginal bleeding and even spotting during menopause and post menopause is not normal. If you do, it is important to see your doctor. A complete physical examination should be carried out. It is also suggested to consult a specialist if (Mayo Clinic, 2021):
  • Bleeding lasts more than 7 days.
  • There is spotting (brown discharge) or bleeding between periods.
  • Heavy menstruation that fills pads or tampons every hour or two hours or are accompanied by large clots.
  • Periods occur less than 21 days apart.

Possible complications

Irregular bleeding can often be heavy. And, if sustained over a long period of time, it can lead to anemia or iron deficiency. It may also be masking female infertility or endometrial cancer. It is therefore of vital importance to avoid self-medication and to see a specialist to evaluate (Pinkerton, 2021).

Recommendations for coping with irregular bleeding in menopause

If you are close to or over 40, and are beginning to experience irregular bleeding, we suggest that (Goodwing, 2020):
  • You can get daily pads to avoid staining your clothes with unexpected bleeding.
  • Use tampons or menstrual cups only if you have bleeding that warrants it.
  • Wear cotton underwear to prevent leakage.
  • Keep track of your menstrual cycles so you can accurately report their frequency, characteristics, and accompanying symptoms to your doctor.
  • Practice healthy lifestyle habits that help you cope with the other symptoms of perimenopause. For example, eat a balanced diet, engage in daily exercise and relaxation activities.
Irregular bleeding is often one of the first symptoms of perimenopause, but it can also be a sign of other health problems. So, the best thing to do is to take note of the changes in your body and see your doctor. Avoid self-medication to prevent complications. References:
  1. Goodwing M. (2020). How Perimenopause Can Affect Your Periods and What You Can Do. https://www.healthline.com/health/menopause/perimenopause-periods
  1. Mayo Clinic (2021). Perimenopausia. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
  1. MedLine Plus (2020) Sangrado vaginal o uterino. https://medlineplus.gov/spanish/ency/article/007496.htm#:~:text=El%20sangrado%20uterino%20anormal%20es,se%20acercan%20a%20la%20menopausia.
  1. Pinkerton J. (2021) Sangrado uterino anormal. https://www.msdmanuals.com/es/hogar/salud-femenina/trastornos-menstruales-y-sangrados-vaginales-an%C3%B3malos/sangrado-uterino-anormal-sua#:~:text=La%20hemorragia%20uterina%20anormal%20con,un%20nivel%20adecuado%20de%20progesterona.

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