Uterine cancer is the most common gynecologic malignancy in the United States. It commonly presents as postmenopausal bleeding (vaginal bleeding/spotting that occurs after menstrual periods had previously stopped for over one year).
The clinical approach to postmenopausal bleeding requires a prompt and efficient evaluation to diagnose or exclude cancer. The American College of Obstetrics & Gynecology recently updated their triage recommendations for postmenopausal bleeding. While the initial evaluation may include either endometrial biopsy (a small tissue sample from the inside lining of the uterus) or transvaginal ultrasound, the later has the advantage of being non invasive and consequently painless. If the transvaginal (not abdominal) ultrasound clearly demonstrates the endometrium is ≤ 4mm thick then it excludes uterine cancer with an accuracy of 99%—superior to endometrial biopsy. If it is thicker than this or cannot be clearly seen then further evaluation is warranted. For instance, we can enhance the ultrasound by performing a saline infused sonogram that more accurately reveals small polyps projecting into the uterine cavity, which may be the source of bleeding. Finally, if endometrial thickening is present and cannot be explained by these imaging studies, then an endometrial biopsy is performed in the office.
For most women we perform this entire work up conveniently during a single office consultation. This efficient process alleviates anxiety and saves time.
Should postmenopausal bleeding persist in spite of an initial negative evaluation then further testing is indicated, which usually includes the gold standard of hysteroscopic directed biopsy (placing a thin scope inside the uterine cavity to look for abnormal growths).
Even if uterine cancer is detected, it frequently has a favorable outcome. More good news… the majority of women presenting with postmenopausal bleeding do so because of changes to the vagina or uterus from estrogen deficiency. Consequently, an efficient evaluation usually yields reassurance.
Wishing you good health!
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
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