Hormonal imbalance or a warning sign? Doctor explains why irregular periods and postmenopausal bleeding could indicate endometrial cancer

Women visiting the clinic often come with an issue which has become rather familiar to me; i.e., irregular periods, spotting, or post-menopausal bleeding. In some instances, they have been informed that their problem is just a case of hormonal imbalance. Even though this is indeed the case at times, my experiences have also shown that this belief tends to prevent early diagnosis of a much graver ailment, endometrial cancer.

Why hormonal imbalance and cancer symptoms overlap?

According to Dr D. Sandhya Rani, Lead Consultant Obstetrician & Gynaecologist, KIMS Hospitals (Krishna Institute of Medical Sciences), Mahadevpura, Bengaluru, "The similarities between the two conditions begin at symptom levels. Changes in hormone levels during the perimenopausal period led to irregular bleeding, heavy or even lack of menstrual flow. These are rather common occurrences and tend to be harmless. The problem is that they are also characteristic to endometrial cancer in its initial stages. And since hormones changes are much more frequent, this conclusion is usually drawn by default."

Postmenopausal bleeding should never be ignored

"One of the most disturbing trends noticed is the dismissal of postmenopausal bleeding. Just to clarify, any bleeding that occurs after menopause is abnormal and should never be considered hormonal without adequate testing. Many women do not get checked when they experience this because they think it is a minor problem or simply an indicator of age. This is quite detrimental," the doctor added.

FAQ'S

Another important aspect in this regard is the presence of diseases that can contribute to the confusion in diagnosis due to the hormonal aspect. Such diseases include obesity, diabetes, and polycystic ovary disease (PCOD). These conditions may cause hormonal imbalance in the body, and in turn, can increase the risks of developing endometrial cancer.

Importance of early diagnosis and timely testing

Sometimes, screenings do not necessarily include complicated examinations. A transvaginal ultrasound examination will be able to show the thickness of the uterus lining. If there are some signs that indicate problems, an endometrial biopsy will give definite results.

Doctors should also start thinking differently about the problem. Instead of considering hormonal imbalances a cause of symptoms in high-risk patients, we should become proactive, perform an in-depth examination and conduct relevant tests.

Why must menstrual irregularities always be investigated?

Any irregularity in menstrual cycles is never to be overlooked, particularly in women of reproductive age whose cycle is not in sync with normal, in such case it must always be investigated. Physicians are expected to investigate potential underlying risk factors including obesity, polycystic ovarian disease (PCOD), diabetes, and hypertension, and in those instances, immediate diagnostic procedures including transvaginal ultrasound and endometrial biopsy, either via dilatation and curettage, office biopsy, or hysteroscopy.

However, in instances of post-menopausal bleeding, which is an issue of high significance but tends to go unnoticed or underreported for various reasons, a biopsy is required especially if there are indications of an endometrium that is too thick.

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