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Perimenopause and Day 23 of Bleeding

I am a 49 year old women and have experienced symptoms consistent with premenopause for the past few  years.  For the past year I have had irregular periods;  Some months I experience very Heavy periods and other months light periods, or I may miss 1 month, then bleed normal the next. I also have months with symptoms consistent with PMS when my period is due and then not bleed at all or the bleeding may start after all symptoms have disappeared about 1-2 weeks later.  Each of these have seemed consistent with what I know about perimenoupause and last under 7 days.
I am a wee bit more concerned this time around.  
About 5 weeks ago I experienced intense symptoms consistent with PMS.  2 weeks later I had 2 days of very light breakthrough bleeding or spotting.  I did not bleed for about 1 week and then approximately 18 days ago I began bledding again.  The bleeding was bright red but  fairly light without any other symptoms.  I continued bleeding for the next 14 days and then without any interruption in the spotting/bleeding,  5 days ago bleeding became much heavier with clots and I experienced symptoms consistent with getting my period.  The bleeding appears to have lightened over the last 2 days and is more consistent with the end of my cycle but is still bright red in color.
23 days of bleeding seems a bit odd and definatley unpleasant.
I wondered if you could give me a bit of insight into whether or not this consistent with Perimenopause or if this cycle of  bleeding is reason for concern.  
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Perimenopause is quite variable over the ten years or so that it occurs and it is different for each woman. So it is difficult to say if it is consistent with menopause or due to a potential problem. Most likely, it not a significant problem but just more in an ongoing transition. But because it represents a change for you, it is a good idea to see your doctor and have it checked. He/she might want to do a blood test to see if you are anemic or low on iron, an ultrasound of your pelvic organs to see if there is a polyp or other cause of bleeding, an endometrial biopsy to check the lining cells of the uterus, and an exam. Knowing for sure is always best. I would not be extremely worried, but I would suggest you take action and be seen.
Machelle M. Seibel, MD
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