The short answer: bleeding after menopause is the most common early sign of cancer of the womb (uterine or endometrial cancer), but most women who have it do not have cancer — it is found in about 5–10%. The chance is higher if you have risk factors such as obesity, diabetes or Lynch syndrome (listed below), and lower if the scan shows a thin womb lining (4 mm or less, where the risk is under 1%). Only a small sample of the lining (biopsy) can confirm or rule out cancer, and not every woman needs one.
In Hindi this is often searched as bachedani ke cancer ke lakshan (बच्चेदानी के कैंसर के लक्षण); in Gujarati, garbhashay nu cancer (ગર્ભાશયનું કેન્સર).
On this page
- The Most Common Early Sign of Womb Cancer
- Risk Factors for Endometrial Cancer
- How Is It Investigated?
- Premenopausal Women Are Not Immune
The Most Common Early Sign of Womb Cancer
Postmenopausal bleeding — any vaginal bleeding that occurs 12 or more months after the last menstrual period — is the first symptom in approximately 90% of uterine (endometrial) cancer cases. This means most uterine cancers are diagnosed early, when cure rates are highest. Put the other way round, only about 5–10% of women who bleed after menopause are found to have this cancer. To learn about the cancer itself, read how uterine cancer is diagnosed and treated. The challenge is that many women delay seeking assessment, reassured by the fact that most causes of postmenopausal bleeding are benign.
While the majority of cases (approximately 70–90%) will turn out to be due to atrophic vaginitis, endometrial atrophy, polyps, or fibroids, the clinical rule is clear: all postmenopausal bleeding requires investigation until endometrial malignancy has been excluded.
Risk Factors for Endometrial Cancer
These do not cause bleeding, but they make cancer a more likely explanation when bleeding happens. Tell your doctor if any apply to you:
- Obesity — body fat makes extra oestrogen; too much oestrogen without the balancing hormone progesterone is the main driver of most endometrial cancers
- Diabetes and insulin resistance
- Nulliparity (never having been pregnant)
- Late menopause (after age 55)
- Oestrogen-only hormone replacement therapy in women with an intact uterus
- Tamoxifen use for breast cancer (it can act like a weak oestrogen on the womb lining)
- Lynch syndrome (hereditary non-polyposis colorectal cancer) — an inherited condition that runs in families and raises the risk of bowel and womb cancer; the highest-risk hereditary syndrome for endometrial cancer
How Is It Investigated?
Investigation begins with a transvaginal ultrasound (TVUS), which measures the endometrial thickness. A womb lining of 4 mm or less after menopause is reassuring — the risk of cancer is under 1% — and many women need only the scan. If the lining is over 4 mm, looks unusual, or the bleeding comes back, a small sample of the lining (endometrial biopsy) is taken in the clinic; it takes under 5 minutes and results usually come in about 1–2 weeks. In some cases a hysteroscopy (a thin camera passed into the womb) is needed to take a targeted sample. Each of the tests used to assess bleeding after menopause is explained step by step on a separate page.
If endometrial cancer is confirmed on biopsy, an MRI of the pelvis and a CT scan of the chest, abdomen and pelvis are arranged to see how deep the cancer has grown into the womb muscle (myometrial invasion) and whether it has spread to the lymph glands, before surgery is planned.
Premenopausal Women Are Not Immune
Although endometrial cancer is primarily a postmenopausal disease (median age 63 at diagnosis), premenopausal women — particularly those who are obese, have polycystic ovarian syndrome, or have Lynch syndrome — can also develop it. Persistent abnormal uterine bleeding in a premenopausal woman over 40 should also be investigated.
The key message: do not normalise abnormal uterine bleeding. It deserves evaluation.
Dr. Nishtha Tripathi Patel is a gynaecological oncologist in Ahmedabad specialising in uterine, ovarian, and cervical cancers. Contact: +91 76988 00333.