Premenstrual spotting

Question

Dear experts,
I’m 41 and about two years ago started having premenstrual spotting around 4 – 5 days before my period. The spotting is usually light red, no need of pads until 1 – 2 days before the period starts. This happened every single month. My doc says it’s hormones and suggested oral contraceptive pills to “switch off my brain completely”. Yes, it was gone during the 4 months when I was taking the pill but came back right after I stopped the pill. My period has been regular, used to be exactly 28 days when I was younger. It is now 27 days but mostly still regular, though quite light, lasting only about 2 days. I know that I still ovulate every month. I have one child 7 years old, would be happy to have another child. Please help me with my spotting problem. It became so annoying that I am usually quite upset when it happens. I hope I can at least get rid of this problem even if I can’t have another child. What sort of test should I have before I believe that it is a hormone problem? If it is, what can I do about it? Thanks very much.

Answer

Last Updated: June 17, 2013
Several years before menopause, women experience changes in their cycles, such as lighter, or heavier bleeding, and shorter cycles. This can begin as much as 10 years before actual menopause. These changes occur as ovarian function begins to decrease, which causes a decrease in estrogen and progesterone. Both of these hormones influence the lining of the uterus, among other things. Estrogen stimulates the uterus to make a lining. Progesterone builds it up, and maintains it, if there is a baby. If the ovary is not producing good follicles, neither of these hormones will be present in sufficient amounts. Low estrogen means less utering lining. Low progesterone means the lining is not sustained properly.

The lighter menstrual flow and spotting you are experiencing is probably due to decreased hormones. The only way to know for certain is to do a hormone profile by drawing blood on specific days during a cycle.

Progesterone tests must be drawn during the post peak phase of your cycle, so it is necessary that you be charting, in order to have the blood drawn on the right days. Estrogen is usually done during the pre-peak phase.

If these hormones are low, you can receive hormone supplementation. Again, estrogen, or progesterone, must be taken at the proper times during a cycle, so it is necessary for you to be charting your cycle. The hormones in the oral contraceptives are not appropriate: they are artificial, and have different effects than human hormones, and as you noticed, they do not treat anything, they merely mask the problem.

There are physicians listed in the CANFP Directory online, who can do your hormone evaluation, and provide you with the right hormone treatment, if this is indicated. Proper hormone balance should correct the spotting problem, and may even improve your chances of conceiving.

Gail McNaughton

Answered By:

Gail McNaughton, NP
Gail McNaughton, NP, is a Nurse Practitioner

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