PUBLIC LACK OF AWARENESS CONCERNING BLEEDING AFTER MENOPAUSE

PUBLIC LACK OF AWARENESS CONCERNING BLEEDING AFTER MENOPAUSE
From Dr. Steven R. Goldstein, Menopause Specialist in NYC

A recent study published in the journal Menopause, entitled “Public Awareness and Provider Counseling Regarding Postmenopausal Bleeding as a Symptom of Endometrial Cancer” came to my attention. It of course refers to bleeding after menopause. I was shocked by the findings, and although they represented a wider cross-section of women than typically find their way to my office, still, the numbers presented show that there is a sad lack of understanding about what is acceptable and not acceptable in our menopausal patients.

In a survey of 648 women,

• 37% of them did not identify bleeding in menopause as a symptom potentially of endometrial cancer.
• Less than half of the respondents to the survey reported that their healthcare provider had counseled them on postmenopausal bleeding.
• Incredibly, 41% reported that they would not tell their provider if they had postmenopausal bleeding after only one episode.

Even our third-year medical students, at least in obstetrics and gynecology, are taught that any postmenopausal bleeding, that includes staining, spotting, and, in my opinion, even a brownish discharge is “uterine cancer until proven otherwise.”

Fortunately, only about 5% of such patients will actually have a malignancy, but such a finding mandates further evaluation. Fortunately, this can almost always be accomplished with a transvaginal sonogram and saline infusion sonogram, when necessary, rather than surgical D&C, hysteroscopy, or even hysterectomy.

I would like to think that all my patients are aware of this and would promptly report to me any bleeding that they had in menopause. However, obviously, the knowledge among physicians and healthcare providers in general is woefully lacking. The authors of this study conclude that there is a need for increased recognition of women about any postmenopausal bleeding, as well as counseling by providers to their patients. Educational interventions to raise public and provider awareness of endometrial cancer risks and symptoms clearly need to be increased.

As usual, feel free to share this information with anyone in your family, circle of friends, or relatives for whom it might be appropriate.

Dr Goldstein is a Certified Menopause Practitioner, a past President of the North American Menopause Society (now Menopause Society), and a past President of the International Menopause Society. If you are a post menopausal woman, and you have bleeding, then a consultation with Dr Goldstein, a Menopause Specialist in NYC may be appropriate.