Post-Menopausal bleeding… DO NOT ignore

Recently I came across three women within a span of one month with complaint of bleeding years after menopause, who ultimately were diagnosed to be cancers of the uterus.

All three of them were having mild to moderate bleeding which stopped for days in between leading them to gain a false confidence that it was normal, harmless and nothing to be alarmed about.

1st was a woman aged 65 years who had her  menopause 15 years back, who started having pain and discomfort in the lower abdomen with mild bleeding  since February 2020. USG showed multiple fibroids in the uterus. She was advised to undergo hysteroscopy and biopsy which she wanted to avoid in the lockdown phase of pandemic in March which just followed this consultation.  She had intermittent spotting from March to October, never consulted  during this period thinking that it was mild and it would stop until she started having increasing pain and bleeding in Oct 2020 when she was found to have a 16 weeks size uterus ( much bigger than the size in March). She was taken up for total hysterectomy and the biopsy came out to be uterine sarcoma

The second case was a woman aged 62years who had her menopause in 2010, had post-menopausal bleeding in 2014, 2017 and 2019. Each time there was a spotting, she consulted gynecologist, was advised to undergo biopsy which she did not as the bleeding stopped soon. But each time USG showed bulky uterus which is an unusual finding in a postmenopausal woman which she ignored in spite of being told by her doctors. She came to us in Oct 2020 with continuous bleeding, ultimately gave consent for a biopsy but unfortunately was diagnosed as uterine cancer.

The third case was a woman aged 68 years bleeding intermittently and silently for last one year which she did not bother to expose to any member of her family because she thought that mild bleeding is normal. Off late she started having heavy and continuous bleeding for which she came to us and we found during evaluation that she had cancer of cervix which had spread to the opening of the birth canal thus upgrading it to stage III.

However deadly a cancer may be, it should be kept in mind that many of them particularly uterine cancer gives an alarm in the form of bleeding after menopause in the early stages of the disease when the cancer is still operable and the recurrence can be prevented with the advancements in chemotherapy and radiotherapy.

It must be clearly embedded in our minds that no amount of bleeding after menopause (however minimal it might be) is normal. It should be viewed with caution and concern, evaluated properly at the earliest to prevent the complications and arrest the progression to higher stages of cancer.