What is Spotting During Menopause?

Spotting during menopause can be defined as light bleeding episodes that occur within one to fifteen years prior to actual menopause (perimenopause), up until menstrual periods completely stop. Typically, a few days of midcycle bleeding while periods are still ongoing is less common and may be due to various factors, but episodes of spotting bleeding should be reported to a gynecologist. Any type of bleeding after periods have ended may indicate serious health concerns and should be discussed with a doctor. Irregular periods are a hallmark of perimenopause, and fluctuating hormone levels can cause spotting. Women who have never noticed midcycle bleeding before may notice it rarely or frequently as their hormone levels continue to decrease. Sometimes the cause of spotting is not really related to the menopausal state. Use of birth control pills, non-hormonal intra-uterine devices (IUDs) may be associated with spotting and early pregnancy may cause this condition to occur. Other potential causal factors include vaginal injuries, stress, early miscarriage, hypothyroidism, vaginal infections, ovulation, polyps, fibroids, and certain types of cancers. When periods have been stopped for at least six to nine months, spotting during menopause is treated differently. True menopause is usually defined as a full year without periods, but a few months of no periods is often accepted as menopause instead of perimenopause. Causes of spotting during menopause can sometimes be medically more significant and require medical examination sooner. 

One of the greatest concerns with spotting during menopause is whether it is caused by cervical or uterine cancer.

The risk of reproductive cancer increases as women age. Examinations and biopsies, if necessary, can help to rule these out. Precancerous lesions, such as polyps, which are associated with light bleeding, can also be detected during exams. Another potential precancerous condition arises if the uterine endometrial lining thickens. While the risk of cancer means that spotting during menopause should be reported immediately, an exam may not reveal a serious problem. A very common cause of occasional spotting is related to menopause treatment. Women taking hormone replacement therapy may experience occasional light bleeding. Alternatively, vaginal dryness, which can accompany a drop in hormone levels, can lead to vaginal irritation and light bleeding, especially from activities such as sexual intercourse. Use of lubricants may help to reduce the risk of vaginal injury. Other causes of spotting during menopause include vaginal infections, stress, hypothyroidism, and the presence of fibroids. Episodes of heavier bleeding are also a significant concern and are relatively rare. These should be treated as highly unusual and women should seek immediate medical attention.