Postmenopausal bleeding and endometrial cancer

Postmenopausal bleeding is common, but worrisome because greater than one-quarter is caused by cancer. Endometrial cancer is the most common pelvic cancer. However, it is usually discovered early and is often curable. Diagnosis of postmenopausal bleeding: The primary symptom of endometrial cancer (ECa) is postmenopausal bleeding (PMB). Women who have become amenorrheic for at least six months can be considered menopausal. PMB can be caused by vaginal, cervical, uterine or ovarian cancers (Table 16.1). Twenty-five percent of women with PMB have endometrial cancer. PMB increases the risk of endometrial cancer 64-fold. Evaluation (Figure 16.1). The evaluation of the woman with PMB has been simplified in the last 10 years. Previously, all women with PMB had a dilation and curettage. This is no longer universally necessary. A physical examination should look for vaginal and cervical abnormalities, polyps, masses, uterine size and symmetry, or ovarian masses. Trauma or abuse can appear as vaginal or uterine bleeding. A Pap test should be performed. Although it is not sensitive, it can be specific for endometrial cancer. Although fewer than 20% of endometrial cancers will appear on a Pap test, it will discover approximately 80% of cervical cancers. A urinary pregnancy test is needed, if there is any chance the woman could be pregnant.