Postmenopausal Bleeding : Early Warning Signal
 

Endometrial cancer (cancer of the uterine lining) is the  most common cancer of the female genital tract. It is also the most  curable of the gynecologic malignancies.  The reason that this  cancer is so successfully treated is that it announces its presence at a stage when, for most women, it can be cured with surgery alone.

Post menopausal bleeding is the early warning signal that tells us to look for endometrial cancer. The bleeding may be only a little bit of spotting for a day or two or or it may seem like a full blown period.  The amount of bleeding does NOT correlate with the severity of the disease so it is important for a post-menopausal woman to seek medical attention if she has ANY unexpected bleeding.  Sadly, some women assume that if they experience "only a little spotting" that stops on its own, then there must not be anything really wrong.  They ignore the early warning signal that their body is sending them.  For some, this is a fatal mistake.

Pap smears, the screening test for cervical cancer, are most often normal in women with uterine cancer.  Occasionally, endometrial cells will be seen in a pap smear.  In post- menopausal women, this is a sign that an endometrial cancer may be present and further testing should be done.

The evaluation of post menopausal bleeding generally includes a physical exam, an ultrasound exam and possibly an endometrial biopsy.  These are all simple and relatively painless procedures that can be performed in the gynecologist's office.

There are two distinct types of endometrial cancer.  The most common form is a hormone responsive cancer that appears most frequently in perimenopausal women and in women on unopposed estrogen or on Tamoxifen.

In the 1950's when estrogens were first available on the market, women were being treated with estrogen alone for menopausal symptoms.  What followed was a near epidemic of new cases of uterine cancer.  These cases were usually diagnosed early and cured with hysterectomy but their occurrence heralded research that demonstrated that the use of estrogens without progesterone resulted in an 800% increase in the incidence of uterine cancer.  It further demonstrated that with the addition of adequate amounts of progesterone, a woman with a uterus could safely take estrogens without increasing her risk  of uterine cancer.

The second kind of endometrial cancer occurs more frequently in older women who are not on estrogen. This is a much more aggressive cancer than the one that is hormone related.  The non- hormone related uterine cancer, because of its aggressive nature is more likely to present at a later stage so there is a greater likelihood that the tumor will have spread beyond the uterus at the time of diagnosis. 

Both of these cancers present with postmenopausal bleeding. Endometrial cancers that are diagnosed at an early stage are often cured with hysterectomy alone.  Women with more advanced disease usually require radiation or chemotherapy after surgery.  The sooner diagnoses and treatment are sought, the greater the possibility of a complete cure.

We are fortunate that the most common cancer of the female genital tract announces its presence at a time when it is likely to be completely curable.  I urge women to heed this early warning signal and to seek treatment without delay.