Only 9% of women with postmenopausal bleeding are at the risk of endometrial cancer; but you must see a doctor if you bleed a year or more after experiencing menopause.
- Common causes of postmenopausal bleeding
- Postmenopausal bleeding and endometrial cancer
- What can you do?
Menopause means that you will not be going through your menstrual cycle anymore. But what if one day, a year or more after your period stopped, you notice that you are bleeding again or have spotting. It is obviously unnerving.
Common causes of postmenopausal bleeding
As you may have read or heard, postmenopausal bleeding is not necessarily a sign of cancer. The reason in most cases is likely to be:
- Polyps: Small tissue growths on the uterus or cervix (The lower, narrow end of the uterus that forms a canal between the uterus and vagina); usually non-cancerous
- Uterine Fibroids: Benign tumours in the uterus.
- Vaginal Atrophy: Also called Atrophic Vaginitis, it causes thinning or inflammation of the vagina lining which is linked to lower levels of estrogen. Its symptoms include vaginal dryness and itch, and pain during sex.
- Endometrial hyperplasia or thickened endometrium. This can happen because of hormone replacement therapy.
Only a small percentage of women with postmenopausal bleeding are diagnosed with endometrial cancer, a cancer of the uterine lining. According to a study by JAMA (Journal of the American Medical Association) Internal Medicine, postmenopausal bleeding occurs in approximately 90% of women with endometrial cancer; but only only 9% of women with postmenopausal bleeding were diagnosed with endometrial cancer.
Postmenopausal bleeding and endometrial cancer
The study says endometrial cancer is the most common gynecologic cancer in developed countries, accounting for about 5% of cancer cases and more than 2% cancer deaths in women worldwide. Postmenopausal bleeding is a common symptom. The JAMA study also says that endometrial cancer and associated mortality rates have been on a rise and will increase more in the next decade.
Doctors say that one reason that endometrial cancer is on a rise is because of the rise in obesity. The most common type of endometrial cancer is linked to estrogen which is produced by body fat. According to one study, about 57% of endometrial cancers in the United States can be attributed to being overweight and obese. In India, according to research, endometrial cancer rate is as low as 4.3 per 100,000 (Delhi). This study is, however, from 2013.
Apart from obesity, changes in the hormonal balance, which causes changes to the endometrium, early menstruation or late menopause can cause endometrial cancer. Women who have never been pregnant, or older, post-menopause women are at a bigger risk.
What can you do?
Now that we know that postmenopausal bleeding, even if in a small number of cases, can be a symptom of endometrial cancer, what should we do if the bleeding happens?
The first thing is to call the doctor immediately and make an appointment even if the bleeding happened just once or there was a little spotting. Even if you are not sure if it was blood, seeing the doctor is important.
“(Postmenopausal bleeding) should never be ignored. It is a sign of an emergency, it is an alert that you should visit your doctor. There is a likelihood of endometrial cancer, especially if you are comorbid with diabetes or hypertension. Diabetics have a higher incidence of developing cancer if they have postmenopausal bleeding,” says Delhi-based gynaecologist Anuradha Sharma.
In these cases, the doctor usually asks for an examination of the pelvic area and the vagina, a biopsy, a transvaginal ultrasound, or a hysteroscopy (examination of the inside of the womb using a hysteroscope).
The first thing is to call the doctor immediately and make an appointment. Even if the bleeding happened just once or there was a little spotting. Even if you are not sure if it was blood, seeing the doctor is important.
It is also important to know that women who have had a pap smear to be tested for cervical cancer also need to get an examination in case of postmenopausal bleeding. A pap test does not diagnose endometrial cancer.
After the tests, depending on the diagnosis, doctors will recommend treatment. Endometrial atrophy, for instance, can be treated using medication like estrogen creams; polyps can be removed. Early diagnosis can be very helpful in all these cases. Endometrial hyperplasia can be treated using hormonal medicine or a hysterectomy (the surgical removal of the uterus and ovaries). Endometrial cancer, as well, can be treated with surgery to remove the uterus, fallopian tubes and ovaries, in a large number of cases.
Can postmenopausal bleeding be prevented? Doctors say the best way to prevent it is routine gynaecological checkups. “All women must get a routine gynae checkup at least once a year, despite your age. If you are obese, diabetic, hypertensive, you definitely have to control these. Lifestyle modification always helps. If you are overweight, you must reduce your weight. If you have blood sugar, you have to manage it well. Also, meditation, exercise, yoga, all of these practices help. If you are stressed, it is important to get help and manage stress in whichever way works best for you,” says Dr. Sharma.
- NCI Dictionary of Cancer Terms, National Cancer Institute (NCI) website
- Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women. A Systematic Review and Meta-analysis. M egan A. Clarke, PhD, MHS; Beverly J. Long, MD; A rena Del Mar Morillo, BA; Marc Arbyn, MD, MSc, PhD; Jamie N. Bakkum-Gamez, MD; Nicolas Wentzensen, MD, PhD, MS
- Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment. M ichaela A. Onstad, R osemarie E. Schmandt, and Karen H. Lu
- Hospital-based Study of Endometrial Cancer Survival in Mumbai, India. Ganesh Balasubramaniam, S Sushama, B Rasika, U Mahantshetty
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