This post was written by Megan Goetz, NP-C, and Hilary Biddle RN, BSN, OCN, Parkview Cancer Institute.
Women who experience vaginal bleeding after menopause often wonder if menstrual cycles are returning. Unfortunately, vaginal bleeding after menopause is not normal and requires medical evaluation. Let’s explore the issue further.
What is menopause?
Menopause is the stop of menses or periods for one year and typically occurs between ages 45-50. However, vaginal bleeding after menopause could be a sign of a benign (non-cancerous) or malignant (cancerous) condition.
- Benign: Non-cancerous reasons for vaginal bleeding could include uterine fibroids, uterine polyps, infections, medications and trauma.
- Malignant: Cancerous reasons for postmenopausal bleeding could include endometrial cancer. Additionally, younger pre-menopausal women could also be at risk for endometrial cancer and should note irregular or heavy bleeding as this can be a symptom.
To find the cause of the bleeding, your health care provider may order additional testing, which could include an endometrial biopsy, an ultrasound and/or a dilation and curettage (D&C) procedure. Most importantly, if you experience vaginal bleeding after menopause, please contact your health care provider for evaluation.
What is endometrial cancer?
Each year, about 63,000 women in the United States are diagnosed with uterine cancer. Endometrial cancer affects the lining of the uterus or endometrium. Often, most uterine cancers develop over the years. They may start as less severe problems such as endometrial hyperplasia, an overgrowth of cells in the lining of the uterus, then progress to something more serious.
Types of endometrial cancer
Almost all uterine cancers start in the lining of the uterus or endometrium. The two main types of endometrial cancer include:
- Endometrioid adenocarcinoma
- Uterine carcinosarcoma
It’s also important to note that uterine carcinosarcoma uterine cancers are less common and usually begin in the uterus’ muscle lining.
What are the risk factors for developing endometrial cancer?
We can categorize the risk factors for developing endometrial cancer into two different groups: non-modifiable risk factors (things you cannot change) and modifiable risk factors (something you can control). Let’s examine each one.
Non-modifiable risk factors
- Personal or family history (having close relatives with uterine, ovarian or colon cancer)
- Ovarian diseases, such as polycystic ovarian syndrome (PCOS)
- Complex atypical endometrial hyperplasia and endometrial intraepithelial neoplasia (this precancerous condition may become uterine cancer if not treated)
- Number of menstrual cycles (over a lifetime)
- Breast or ovarian cancer
Modifiable risk factors
- Breast cancer drugs like Tamoxifen
- Things that affect hormone levels (estrogen replacement therapy (ERT), birth control pills, etc.)
- Never having been pregnant
- Pelvic radiation to treat other kinds of cancer
What happens after an endometrial cancer diagnosis?
If you have been diagnosed with endometrial cancer, a gynecologic oncology expert referral may be warranted. This type of physician specializes in the surgical and comprehensive treatment of women with gynecological cancers. According to the Journal of Clinical Oncology, patients with high-risk cancers have improved survival when treated by a provider specializing in gynecological oncology.
A gynecologic oncologist, such as those at Parkview Cancer Institute, has access to a team that provides patients with a multidisciplinary approach to cancer treatment, improving the overall quality of care. The team often consists of a gynecological oncologist, medical oncologist (chemotherapy doctor), radiation oncologist, palliative care provider, nurse navigator, social workers, dietitian and research team.