I was inspired to write a blog post on postmenopausal bleeding due to one of my patient’s recent experiences.
My patient came in to our OB/GYN office for her pap smear and exam. It had been two years since I had seen her in the office. She was postmenopausal and had only some spotting which had occurred very rarely over the past two years. She assumed that it was probably normal and was not alarmed. Unfortunately this was not the case.
My patient returned to my office for a biopsy of her endometrium (lining of her uterus), which revealed cancer cells. My patient subsequently had a hysterectomy with removal of her fallopian tubes and ovaries. At this point she requires no further treatment and is considered to be “cured”.
In a follow up with this patient said told me that she actively tells her story to women everyday. She wants to educate other women and encourage them to seek an evaluation for unusual or unexpected spotting.
Postmenopausal bleeding could have many causes. The causes of postmenopausal bleeding include: uterine cancer, infection, polyps of the uterus or cervix, endometrial or vaginal atrophy (severe thinning of the cells), cervical dysplasia, cervical cancer, and trauma. Fifteen percent of women having postmenopausal bleeding (which includes spotting) will be found to have uterine cancer. Uterine cancer is the most common cancer of the female genital tract. And two to three percent of women will develop cancer of the uterus in their lifetime.
Uterine cancer occurs primarily in postmenopausal women, however, it does also occur in women before menopause. Premenopausal women may present with prolonged bleeding or bleeding and spotting between menses. When a woman presents with such bleeding, an evaluation our her condition could include an office biopsy (endometrial biopsy), a D&C, and a pelvic ultrasound.
Postmenopausal Bleeding Equals Uterine Cancer Until Proven Otherwise
In medical school I learned that “postmenopausal bleeding equals uterine cancer until proven otherwise”. As a gynecologist I feel that women are very educated about the signs and symptoms of other cancers such as ovarian, breast and cervical cancer, but not highly educated on the warning signs of uterine cancer. Over the years, I have again and again seen patients ignore this symptom because they assume it is normal if it is just spotting. Early detection of uterine cancer is critical because if it is caught early women can be cured.
I hope women who read this blog post find it helpful. Women need to be vigilant about symptoms and need to seek medical assistance at the first sign of concern. My very dear patient inspired to write this post. I hope you take her story and my words to heart.
Please join our cause and email this to all of your female friends, share it on Facebook, or post a tweet on Twitter.
Thanks for the info. I am postmenopausal and on bio identical hormones. Last year I had some bleeding and my doc. did a biopsy and I had two ultrasounds.Bleeding stopped and it was determined no cancer. There was a small polyp and she said we did not need to do anything. I just had my annual pap it is normal but I have a bit of spotting this week. Should I be doing more? Is a DNC something she should be doing?
I have to respond to this to warn patients that not all gynecologists are as alert as the doctor writing here. My Mom, a postmenopausal woman, had excessive bleeding for three years, had been seeing a gynecologist about it, and was not diagnosed until now with cancer, the doctor had not been able to diagnose the cancer until now, so it is really important for patients to seek second opinions if their doctor does not find a cause for their bleeding