Perimenopause spotting when wiping: what it means and when to worry

You go to the loo and there's a smear of pink or brown on the paper. It isn't a period, exactly. Maybe it's a few days before one is due, or a week after one finished. Maybe a period was due and this is all that came.

Perimenopause spotting when wiping is common. Your periods are changing, and light, patchy bleeding is often part of that. In a large study of women in their 40s and early 50s, most had several bouts of spotting lasting 6 days or more (Paramsothy and others, 2014).

But spotting can have other causes too, and some need checking. This page explains what's usual, what isn't, and when to see your GP.

What does perimenopause spotting look like?

Spotting is very light bleeding. It's usually less than you'd need a pad or tampon for. You might notice:

• pink, light red or brown blood when you wipe
• a few marks on your underwear
• brown discharge before or after a period
• a light bleed when you were expecting a full period

Whether it's pink, red or brown, it's still blood. So the same rules apply about when to get it checked.

Is spotting a sign of menopause?

It can be a sign that you're in perimenopause, the years when your periods change before they stop. The NHS says that in perimenopause, periods may come more often or less often, and bleeding may get heavier or lighter.

Spotting is part of that for many women. The SWAN study followed 1,320 women aged 42 to 52, who kept daily diaries of their bleeding. About two in three had 6 or more days of spotting on at least three occasions.

But spotting on its own doesn't tell you where you are. You've only reached menopause once you've gone 12 months in a row with no period. Until then, your periods can come back, and you can still get pregnant.

The researchers also say they couldn't tell which bleeding had a medical cause. So "common" doesn't mean you can skip a check if something is new or worrying you.

Spotting instead of a period

There are a few reasons you might get spotting when a period was due:

• Perimenopause. Periods can get lighter as well as heavier. A light, short bleed in place of a period is common.
• Pregnancy. The NHS says some women have a bleed like a very light period, with some spotting, around the time their period is due. This is called implantation bleeding. If there's any chance you could be pregnant, do a pregnancy test.
• Hormonal contraception. The NHS lists hormonal contraception, such as the pill, as a cause of bleeding between periods.

When to worry about perimenopausal bleeding

It can be hard to tell perimenopause spotting from bleeding that needs checking. They can look the same. That's why the NHS asks you to get some types of bleeding checked, whatever your age.

The NHS says to see a GP or go to a sexual health clinic if you have bleeding between periods or after sex. It says this bleeding can sometimes be a sign of cancer, so any unusual bleeding should be checked.

That sounds frightening, so it helps to know this too. The NHS page on cervical cancer symptoms lists bleeding during or after sex, between periods or after menopause. It also says these symptoms are very common, can be caused by many different conditions, and don't mean you definitely have cancer.

The point of checking is to find the cause, and to treat it early if it needs treating.

What else can cause spotting?

Possible cause	What to know
Hormonal contraception, such as the pill	Can cause bleeding between periods
Polyps or fibroids	Small growths in or around the womb or on the cervix
Sexually transmitted infections, such as chlamydia	Can cause bleeding between periods or after sex
Cervical ectropion	Changes to the surface of the cervix that can bleed after sex
Vaginal dryness	Menopause is one cause. It can lead to spotting, and bleeding after sex
HRT	Irregular spotting is common in the first few months
Pregnancy	Including ectopic pregnancy, which needs urgent care
Cancer (less common)	Of the cervix or womb

Sources: the NHS pages on bleeding between periods or after sex and vaginal dryness.

Spotting after sex and vaginal dryness

Dryness can play a part in spotting, especially after sex. The NHS lists menopause as a cause of vaginal dryness, and spotting or bleeding as one of its signs.

But the NHS also says to see a GP if you have bleeding after sex. So don't put it down to dryness without getting it checked first. If dryness is the cause, your GP or pharmacist can talk you through treatments.

Spotting on HRT

The NHS says it's common to have irregular bleeding or spotting in the first few months of HRT. It usually settles within 6 months.

The NHS advises telling your GP about irregular bleeding at your first review, around 3 months in. See your GP if:

• you're still having irregular bleeding more than 6 months after starting
• your bleeding gets heavier
• you start bleeding after you hadn't had periods for a while

Please don't stop or change HRT without talking to your GP first.

Spotting after menopause is different

Everything above is about spotting while you're still having periods, even irregular ones. Once you've gone 12 months or more without a period, the advice changes.

The NHS says any bleeding after menopause should be checked by a GP, even if it's a small amount or has only happened once. That includes spotting. It's not usually serious, but it can be a sign of cancer. Your GP should refer you, and you should not have to wait more than 2 weeks to see a specialist.

So if you've had a year with no periods and then notice blood when you wipe, book a GP appointment. Don't wait to see if it happens again. Our page on bleeding after menopause explains what happens next.

Can you still get pregnant?

Yes. The NHS says it's possible to get pregnant during perimenopause, so you still need contraception:

• for 2 years after your last period, if you're 40 to 49
• for 1 year after your last period, if you're 50 or over

If your periods are hard to track because of spotting, that makes it harder to know where you are. Ask your GP or a sexual health clinic if you're not sure.

What happens when you see a GP?

The NHS says a doctor or nurse will ask about your symptoms. You may have:

• a pregnancy test
• a blood test
• a test for sexually transmitted infections, which may be a urine test or a swab
• an examination of your vagina and cervix

You may be referred for an ultrasound scan, or a closer look at your cervix (colposcopy) or inside your womb (hysteroscopy). Any treatment depends on what's causing the bleeding.

What can help in the meantime?

Keep a simple record. Write down when you spot, the colour, how much, and whether it came after sex. Note the dates of your periods too. This helps your GP see the pattern.

Use a liner. A thin panty liner can take away the worry of marks on your underwear while you wait to be seen.

Don't ignore it because it's light. The amount isn't what matters. Spotting between periods, after sex or after menopause needs checking, however small.

When to see your GP

Book an appointment if:

• you spot between periods or after sex
• you have any bleeding after 12 months with no period
• you're on HRT and the bleeding isn't settling, or starts after it had stopped
• you also have pain, a change in discharge, or pain during sex
• the spotting is new, keeps happening, or just doesn't feel right to you

If you're having heavy periods or periods every 2 weeks as well as spotting, see our page on perimenopause period changes. For the bigger picture, see our guide to the signs perimenopause is ending.

You may also find these pages useful: period changes in perimenopause, bleeding after menopause and the full list of perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms