Perimenopausal spotting between periods: what to know

During perimenopause, ovulation and hormone levels can become less predictable, so the uterine lining may shed at unexpected times. Spotting can also be linked with cervical irritation, Chlamydia, Cervical Dysplasia, Endometrial Polyps, or Uterine Fibroids. Womb Cancer can present with bleeding between periods, but spotting alone does not show that cancer is the cause. A pregnancy-related cause may also need consideration if pregnancy is possible.

Keep a simple record of the dates, colour, amount, clots, pain, discharge, and medicines or contraception around each episode. Book a clinician visit if spotting is new, keeps returning, follows sex, or becomes heavier. Assessment may include a pregnancy test, pelvic examination, infection testing, cervical screening review, or imaging depending on your history. Do not stop prescribed medicines without advice.

Seek urgent help for heavy or continuous bleeding, severe lower abdominal pain, faintness, marked weakness, fever, or a positive pregnancy test with pain or bleeding. Arrange prompt review for bleeding after menopause or a pattern that is becoming more frequent.

Could my hormone changes explain this pattern? Do I need pregnancy or infection testing? Would an examination or scan help check for polyps or fibroids?