“During the transition to menopause (called
perimenopause), it is normal to skip periods,
but very frequent or heavy bleeding episodes…”.1

Umbrella
What may the Perimenopausal Bleeding Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Abnormal Uterine Bleeding (AUB)
  • Perimenopausal Bleeding

Perimenopause

What is perimenopause?

DotS the definition of perimenopause may vary. The Australasian Menopause Society’s (AMS) definition is:

“Peri-menopause refers to the time from the onset of a change in menstrual cycle pattern or onset of menopausal symptoms, through to one year after the last menstrual period. The average duration is 4-6 years with onset in the fifth decade of life (40’s)”.2

Abnormal Uterine Bleeding

What is abnormal uterine bleeding (AUB)?

DotS the definition of AUB may vary. The International Menopause Society’s (IMS) definition is:

“Many women experience Abnormal Uterine Bleeding (AUB) during perimenopause. AUB is defined as bleeding that differs in frequency, regularity, duration or amount to your regular menstrual bleeding”.3

Perimenopause or Not

Perimenopausal BleedingIs AUB a symptom of perimenopause?

On page three in the IMS’s World Menopause Day 2017 Patient Information Leaflet Changes Before the Change: Should I Visit My GP? the IMS elaborate on:

“Changes to the menstrual cycle often carry no significant consequences; however, they could have a range of causes. So, although it may simply be a symptom of perimenopause, it is still sensible to raise the issue with your healthcare professional. In most cases, a thorough history and physical examination will indicate the cause of AUB and help discern the need for further investigation and treatment”.4

Who is a GP?

DotS and/or DotC (Depending on the Country) a GP may be a qualified and registered general practitioner, a medical practitioner, a medical doctor or a doctor.

Spotting, Perimenopause and Menopause

Does spotting mean I am not in menopause? Does spotting mean do I need to see a gynecologist or health care provider about this?

In Mayo Clinic Q and A: Spotting, Perimenopause and Menopause the (United States) Mayo Clinic elaborate on the answer to the question:

DEAR MAYO CLINIC: I am 52 and recently had gone 10 months without a period, so I had assumed I was in menopause. But, over the past three months, I’ve noticed some light spotting. Does this mean I’m not in menopause? How do I know when I’m in menopause, and do I need to see a gynecologist or health care provider about this issue?

ANSWER: It’s possible that you haven’t reached menopause yet. Clinically, menopause is defined as going without a period for one year. At 10 months, you don’t quite meet that threshold, but it is possible that you are just beginning menopause. However, depending upon when you last saw your health care provider and had a pelvic exam, it might be worthwhile to make an appointment, as there are a number of conditions where breakthrough bleeding is the first indication of an issue…”.5

Menstrual Calendar

Where may I find a menstrual calendar to keep a record of postmenopausal bleeding?

In MenoNotes the North American Menopause Society (NAMS) include:

Health Care Provider

What if I think I have perimenopausal bleeding?

If you think you have perimenopausal bleeding, it may be in your best interest to choose to talk your health care provider about this. The NAMS explain:

“During the transition to menopause (called perimenopause), it is normal to skip periods, but very frequent or heavy bleeding episodes often requires an evaluation by your healthcare provider. Any bleeding after menopause requires an evaluation by your healthcare provider”.6

In Menstrual Calendar the NAMS note:

“Call your health care provider if you experience:

  • Periods that are much heavier than usual
  • Spotting or bleeding between periods
  • Periods that last longer than 10 days
  • Bleeding after sex
  • Frequent periods (fewer than 21 days between periods)
  • Any bleeding after menopause”.7

In Perimenopause: How Do I Know If Changes In My Periods Are Normal Perimenopausal Symptoms or Something To Be Concerned About? the (United States) Cleveland Clinic elaborate on:

“Irregular periods are common and normal during perimenopause, but other conditions can cause abnormalities in menstrual bleeding. If any of the following situations apply to you, see a healthcare provider to rule out other causes.

  • Your periods are changing to become very heavy, or accompanied by blood clots
  • Your periods last several days longer than usual
  • You spot or bleed after your period
  • You experience spotting after sex
  • Your periods occur closer together”.8

In About the Menstrual Cycle the (Australian) Jean Hailes for Women’s Health explain:

“When To See Your Doctor

There are many reasons you might need to see your doctor about your periods, including:

  • Changes in the pattern of your periods
  • Increasingly heavy periods
  • Long periods of more than eight days
  • Periods that come fewer than three weeks apart
  • Periods coming more than two to three months apart
  • Painful periods that cause you to stay home
  • Bleeding between periods
  • Bleeding after intercourse

Your menstrual cycle is a normal process for your body. Each woman experiences her menstrual cycle differently, most without any difficulties. If there is any change in your cycle that worries you, see your doctor”.9

Follow up

When may follow up be required?

In Perimenopausal and Postmenopausal Bleeding the European Menopause and Andropause Society note:

“Women who experience perimenopausal or postmenopausal bleeding but who have no clear diagnosis or who have recurrent or persistent symptoms, should be followed up, typically after 6 months”.10

Health Topics A-Z

Where may I find Health Topics related to Perimenopausal Bleeding?

In Health Topics A-Z you may find:

Links

Where may I find Links related to Perimenopausal Bleeding?

Your Country may have Links similar to:

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Changes Before the Change: Should I Visit My GP? 2017:3. International Menopause Society https://www.imsociety.org/wp-content/uploads/2020/07/wmpd-2017-leaflet-english.pdf Accessed: 17 February 2023
  2. Glossary of Terms: Peri-menopause. Content Updated February 2022. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/381-glossary-of-terms Accessed: 17 February 2023
  3. Changes Before the Change: Should I Visit My GP? 2017:3. International Menopause Society https://www.imsociety.org/wp-content/uploads/2020/07/wmpd-2017-leaflet-english.pdf Accessed: 17 February 2023
  4. Changes Before the Change: Should I Visit My GP? 2017:3. International Menopause Society https://www.imsociety.org/wp-content/uploads/2020/07/wmpd-2017-leaflet-english.pdf Accessed: 17 February 2023
  5. Mayo Clinic Q and A: Spotting, Perimenopause and Menopause. 21 December 2020. Mayo Clinic https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-spotting-perimenopause-and-menopause/ Accessed: 17 February 2023
  6. Menstrual Calendar. 2015. North American Menopause Society https://www.menopause.org/docs/default-source/2015/menonote-menstrual-calendar-english.pdf Accessed: 17 February 2023
  7. Menstrual Calendar. 2015. North American Menopause Society https://www.menopause.org/docs/default-source/2015/menonote-menstrual-calendar-english.pdf Accessed: 17 February 2023
  8. Perimenopause: How Do I Know If Changes In My Periods Are Normal Perimenopausal Symptoms or Something To Be Concerned About? This Document Was Last Reviewed on: 05 October 2021. Cleveland Clinic https://my.clevelandclinic.org/health/diseases/21608-perimenopause Accessed: 17 February 2023
  9. About the Menstrual Cycle: When To See Your Doctor. Last Updated: 10 February 2022 | Last Reviewed: 10 July 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/about-the-menstrual-cycle Accessed: 17 February 2023
  10. Perimenopausal and Postmenopausal Bleeding. 2022. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/05/Perimenopausal-and-postmenopausal-bleeding.pdf Accessed: 17 February 2023
Topic Last Updated: 09 March 2023 – Topic Last Reviewed: 17 February 2023

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