Mid-Cycle Spotting in Perimenopause: What’s Normal and What’s Not

If your period has started doing whatever it wants lately showing up early, disappearing for weeks, or popping in just to say “hi” mid-cycle welcome to perimenopause.

Perimenopause is the hormonal transition phase before menopause. It can start as early as your mid-30s and last up to a decade before your final period officially marks menopause (which happens around age 51 on average). During this time, your ovaries slowly produce less estrogen and progesterone  but not in a calm, predictable way. Think hormonal rollercoaster, not gentle slope.

That hormonal chaos is why spotting and irregular bleeding are incredibly common in perimenopause. But knowing what’s normal and what deserves a doctor’s visit  matters.

 

Why Perimenopause Causes Spotting

In a “textbook” menstrual cycle, estrogen and progesterone work together to:

1. Thicken the uterine lining
2. Trigger ovulation
3. Drop if pregnancy doesn’t occur
4. Cause your period

During perimenopause, those hormones stop playing nice.

Some months estrogen spikes high.
Other months it crashes low.
Ovulation may or may not happen.

This can cause:

• Spotting between periods
• Periods that come closer together
• Periods that last longer
• Lighter or heavier bleeding
• Skipped cycles

Low estrogen can mean a thinner uterine lining, which sheds easily and causes spotting.
High estrogen (especially when progesterone is low) can cause the lining to grow thicker  leading to heavier or longer bleeding.

It’s common. It’s annoying. It’s hormonal.

 

Spotting vs. Abnormal Bleeding

Not all bleeding is harmless even during perimenopause.

You should call your OB/GYN if you experience:

• Spotting between periods

• Periods that last longer than 10 days

• Cycles shorter than 21 days

• Bleeding so heavy you soak through a pad or tampon every hour

• Bleeding that wakes you up at night

These can sometimes signal:

• Thyroid disorders

• Uterine fibroids

• Endometrial or uterine cancer

Most of the time it’s just hormones but your doctor needs to rule out anything serious.

 

What Your Doctor Will Check

To be safe, your provider may order:

• A transvaginal ultrasound to look at your uterine lining

• An endometrial biopsy to rule out abnormal cells

• Bloodwork to check thyroid function

If hormones are the culprit (which they usually are), treatment can help stabilize things.

How Perimenopause Is Treated

The most common medical treatment is low-dose hormonal birth control or a hormonal IUD. These options:

• Even out hormone fluctuations

• Reduce spotting and heavy bleeding

• Improve PMS, hot flashes, and mood swings

If estrogen isn’t an option for you, progesterone-only methods may be used instead  and they often help with sleep, too.

Some people also benefit from medications for:

• Hot flashes

• Anxiety

• Bloating

• Heart palpitations

It’s not one-size-fits-all but relief is available.

 

What Perimenopause Actually Feels Like

For many people, perimenopause hits like a surprise plot twist.

You might notice:

• Mood swings that feel unrecognizable
• Headaches
• Insomnia
• Dry skin or eyes
• Joint pain
• Anxiety
• Changes in libido
• Random spotting

It can feel like your body is glitching but you’re not broken. You’re transitioning.

And tracking symptoms, advocating for yourself, and getting the right care can make a massive difference.

 

Supporting Your Body Through the Transition

Medical treatment helps  but lifestyle changes matter, too.

Try to:

• Move your body daily
• Eat balanced meals with fiber and protein
• Limit alcohol
• Prioritize sleep
• Reduce stress when possible

And when bleeding is unpredictable, clean, non-toxic period products matter even more.

Tampon Tribe’s organic tampons and pads are made without dyes, fragrances, or chlorine  so your sensitive, hormone-shifting body isn’t absorbing unnecessary chemicals.