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HomeAnswersObstetrics and GynecologyperimenopauseWhy is there an irregular flow of spotting and heavy flow in a peri-menopausal woman?

I just spotted last month but had a heavy period this month. What could be the reason?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Sameer Kumar

Medically reviewed by

Dr. Preetha. J

Published At October 5, 2020
Reviewed AtSeptember 8, 2023

Patient's Query

Hi doctor,

I am a 43-year-old female. During my last period, I had only spotting for three days. This month I had a heavy period. Here the doctor checked my USG, blood tests, and urine test reports. She said everything is normal. She prescribed Tranexamic acid and Provera, a Progestin pill 5 mg three times a day. My endometrium was 11 mm thick. I want to change to medicine Duoluton L, a combined pill, as I am still spotting. Please advise.

Answered by Dr. Sameer Kumar


Welcome to icliniq.com.

For you, as this was just the first episode of hypomenorrhea (scanty period) followed by menorrhagia (heavy period) with continuous irregular shedding in the form of spotting per vaginum, you can wait upon it to stop or can start Duoluton L (Levonorgestrel and Ethinyl estradiol), ideally from day three to five of your cycle to allow it to offer combined pill as well as contraceptive effect. The endometrium of 11 mm does not qualify you for endometrial hyperplasia. This atypical cycle can be the onset of your peri-menopausal status, which usually starts two years before the actual beginning of menopause. If you are in your mid-cycle, you can opt to add back contraception for the next seven days after starting Duoluton L. Take pills for at least two cycles with a pill-free period of seven days.


Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sameer Kumar
Dr. Sameer Kumar

Obstetrics and Gynecology

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