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5 Things to Know About Postmenopausal Bleeding

Spotting or light bleeding after menopause might not seem like a serious problem, but you should never ignore it or wait to bring it up with your doctor. After a woman’s periods have stopped, vaginal bleeding could be a sign of a health issue—including endometrial cancer. Here’s what every postmenopausal woman should know.

1. Postmenopausal bleeding is never normal.

Whether it’s light spotting or a heavier flow, vaginal bleeding after menopause can signal potential health problems.

“It should always be brought up with your provider,” said Gina M. Mantia-Smaldone, MD, a gynecologic oncologist at Fox Chase Cancer Center. And the sooner, the better. Rather than waiting for your next planned checkup, give your gynecologist a call quickly to schedule an evaluation.

2. There are several potential causes, but some are more serious than others.

In most cases, postmenopausal bleeding is caused by issues such as endometrial atrophy (a thinning of the uterine lining), vaginal atrophy, fibroids, or endometrial polyps. The bleeding could also be a sign of endometrial cancer—a malignancy of the uterine lining, but only in a small number of cases. A 2018 study by the NCI found that only about 9 percent of postmenopausal women who saw a doctor for bleeding later received a diagnosis of endometrial cancer.

“Still, we want the option to intervene early if it is cancer, since treating it sooner leads to better outcomes,” Mantia-Smaldone said.

If endometrial cancer is found early, a woman has a 95 percent chance of surviving the cancer for at least 5 years.

3. Your age affects your risk.

The longer you’ve been in menopause, the less likely you are to experience postmenopausal bleeding. Women are significantly more likely to have bleeding in the first year of menopause compared to later on, research shows.

But women who’ve been postmenopausal for a while still need to pay attention to any bleeding—endometrial cancer most commonly affects women in their mid-60s.

4. The diagnostic process may involve multiple steps.

Even though postmenopausal bleeding can have a number of different causes, your doctor’s first objective is to rule out potential cancers.

“We’ll usually do a physical exam to look for blood or masses, such as fibroids, followed by an ultrasound to see how thick a patient’s uterine lining is,” Mantia-Smaldone explained. “A postmenopausal woman’s uterine lining should be quite thin, since she isn’t menstruating.”

Endometrial cancer can cause the lining of the uterus to thicken. If your uterine lining appears thicker than normal, your doctor will recommend a biopsy, in which a sample of your uterine lining is removed and examined under a microscope.

5. It might be worth seeing a specialist.

Your gynecologist should be able to perform your initial evaluation. But, if he or she suspects that your bleeding might be related to cancer, it’s important to see a gynecologic oncologist, Mantia-Smaldone said.

Endometrial cancer is usually treated with surgery that includes a hysterectomy, which may be followed by radiation and/or chemotherapy. Because gynecologic oncologists deal with female reproductive cancers every day, they have more experience operating on cancers, staging them correctly, and determining the best course of therapy. And that can add up to a more successful treatment outcome.

Read more about gynecologic oncologists at Fox Chase.