By Dr. Elizabeth Tubridy, Gynecologic Oncologist, White Plains Hospital
Bleeding after menopause can be alarming. The reassuring news is 80% to 90% of postmenopausal bleeding is caused by something benign, such as changes to vaginal tissue from menopause or noncancerous polyps. But that doesn’t mean it should be ignored.
“Most postmenopausal bleeding is not cancer, but it should always be checked,” says Dr. Elizabeth Tubridy, a gynecologic oncologist at White Plains Hospital. “The goal isn’t to cause alarm but to make sure we identify anything concerning as early as possible, when it can be most effectively treated.”
The American College of Obstetricians and Gynecologists (ACOG) recently updated its guidance for evaluating postmenopausal bleeding.
In the past, a transvaginal ultrasound was often used to measure the thickness of the uterine lining. If the lining appeared thin, that could be considered reassuring.
Under the new guidance, women who experience postmenopausal bleeding and at least one risk factor for endometrial cancer should have an endometrial biopsy – even if their ultrasound appears normal.
Those risk factors include obesity, diabetes, a family history of endometrial cancer, use of estrogen without progresterone or certain medications, such as tamoxifen, never having been pregnant and recurrent bleeding. The updated guidance also takes into account racial disparities in endometrial cancer, including the higher risk experienced by Black women.
Why the change? Earlier recommendations about ultrasounds were mostly conducted outside of the United States, limiting their applicability to our population. More recent evidence indicates that ultrasound findings alone may not be as reliable across a more diverse population.
“The ultrasound is still a valuable tool, but for someone with a risk factor, a normal result may not tell us everything we need to know,” says Dr. Tubridy.
Why Getting Checked Matters
Postmenopausal bleeding – whether it is light spotting or heavier bleeding – is the presenting symptom in approximately 90% of endometrial cancers.
An endometrial biopsy removes a small sample of tissue from the uterine lining for testing and can usually be performed in a gynecologist’s office. Dr. Tubridy also encourages women to ask their provider about pain-management options before the procedure.
If the bleeding is caused by menopausal changes such as vaginal atrophy, there are effective treatments, including vaginal moisturizers and vaginal estrogen.
“The odds are that your bleeding is caused by something benign,” says Dr. Tubridy. “Getting evaluated gives us the opportunity to reassure you, or, if there is a problem, to find it early.”
And menopause isn’t a reason to stop seeing your gynecologist. While most women don’t need a Pap smear every year, Dr. Tubridy recommends continuing annual gynecologic visits.
“Women sometimes think that once they’re menopausal, they’re done with the gynecologist, but gynecologic care is still an important part of maintaining their health,” she adds.
This story originally appeared on Health Matters, a White Plains Hospital publication.
Dr. Elizabeth Tubridy is a Gynecologic Oncologist at the White Plains Hospital Center for Cancer Care. To schedule an appointment, call 914-849-7993.
