Abnormal Menstrual Bleeding in Perimenopausal Women

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Abnormal Menstrual Bleeding in Perimenopausal Women

One of the hallmarks of perimenopause is widely fluctuating hormones and abnormal menstrual bleeding.  The hormonal changes women experience during perimenopause can results in less predictable bleeding patterns. Irregular bleeding secondary to fluctuating hormones in general does not mean that there is something wrong.

On the other hand, endometrial hyperplasia (overgrowth of the uterine lining, which could lead to cancer) and endometrial cancer rates begin to rise around the time of perimenopause. Sometimes women fail to ovulate because there are fewer eggs available as they are nearing the end of their reproductive years.  If this happens, then progesterone is not produced.  Progesterone prepares the lining for shedding in a controlled, confined manner. Without ovulation, the uterine lining can continue to continue to build until eventually it breaks down and bleeding occurs.  Such bleeding is often profuse and prolonged. A single episode of heavy prolonged bleeding does not indicate that hyperplasia has developed.  However, if this occurs repeatedly, a woman should consult her doctor for an evaluation.

Women often ask what menstrual bleeding patterns do not signify a problem and which may need further evaluation. Keeping a menstrual calendar, or a simple diary account of all bleeding, and bringing it to your gynecology appointment for review can be very helpful. In fact, there are even menstrual bleeding apps for smartphones that you can install to make tracking any changes even easier. A couple examples are iPeriod and Tampax OnTrack.  The following bleeding patterns, particularly if they occur repeatedly, merit evaluation:

  • Very heavy menstrual bleeding, especially with clots
  • Menstrual bleeding lasting greater than 7 days or two or more days longer than usual
  • Bleeding intervals of less than 21 days from the onset of one menstrual period to the onset of the next one
  • Spotting or bleeding between periods
  • Bleeding after sexual intercourse



About the Author:

Dr. Lepine earned her medical degree from the University of California at San Diego and completed her residency at the same institution in 1994. After residency, she pursued her interests in public health and international medicine through a fellowship in the Epidemic Intelligence Service at the Centers for Disease Control and Prevention. Education and advocacy for women, particularly the under-served, has always been at the heart of her work. She has participated in both public health and clinical work in the developing world, including Rwanda, Kenya, Mexico, Bangladesh, Honduras, and Nicaragua.

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