Postmenopausal Bleeding Needs To Be Checked

October 2, 2020

In most cases, postmenopausal bleeding is caused by a thinning of the uterine lining, vaginal atrophy, fibroids or endometrial polyps, but in a small number of cases it could be a sign of endometrial cancer – a malignancy of the uterine lining.

“Any woman who has bleeding after menopause, we want to assess it,” said Dr. John McDonald, interim chair of the Department of Obstetrics and Gynecology at The University of Alabama College of Community Health Sciences. “The take-home message: call your doctor and see if you need to make an appointment.”

McDonald, who also cares for patients at University Medical Center, which the College operates, provided the fall 2020 semester’s first Mini Medical School lecture. Mini Medical School is a joint program of UA’s OLLI program and CCHS and provides an opportunity for OLLI and community members to learn about trends in medicine and health.

Between 4% and 11% of postmenopausal women experience vaginal bleeding, and endometrial cancer will be the cause in 1% to 25% of cases, depending on risk factors, McDonald said. Vaginal bleeding is the presenting sign in more than 90% of postmenopausal women with endometrial cancer, he said.

Risk factors for endometrial cancer include older age, obesity, family history, previous breast or ovarian cancer, tamoxifen therapy and hormone replacement therapy.

McDonald said for women who experience postmenopausal bleeding, physicians will do an exam to determine exactly where the bleeding is originating. If it is vaginal bleeding, the cervix will be examined and an endometrial biopsy done, in addition to a transvaginal pelvic ultrasound, which measures the inner lining of the uterus.

The good news is that uterine cancer is typically caught early, before it’s grown outside of the uterus, McDonald said. “Endometrial or uterine cancer doesn’t really spread easily, and a hysterectomy will usually take care of it,” he said.

Mini Medical School lectures are presented by faculty physicians at CCHS, who also care for patients at UMC. The Osher Lifelong Learning Institute is a member-led educational program for those aged 50 and older.

There are eight lectures each semester in the Mini Medical School program. Future lectures this semester include: “Congestive Heart Failure and Nutrition” September 29, presented by Suzanne Henson, RD, LD; “Osteoporosis” October 6, presented by Dr. Jennifer Clem; “Geriatric Depression During COVID-19” October 13, presented by Dr. John Burkhardt; “COVID-19 Update” October 20, presented by Dr. Tom Weida; “Telehealth” October 27, presented by Dr. Nathan Culmer; and “Women’s Health and Cancer Screening” November 3, presented by Dr. Catherine Skinner.