Unusual bleeding? Don't dismiss it: UAE doctors on signs of uterus cancer women may overlook

‘If only’ can be two of the most piercing words in the English language — especially when they come from wishing you had seen a doctor sooner, before cancer had a chance to take hold.

Yet, Dubai-based Nainika’s (name changed on request) mother who doesn’t wish to be named, is trying to be positive and ‘steer’ ahead, as she says. Nainika recalls the many warning signs from months ago: Fatigue and terrible abdominal pain. Her mother didn’t do tests, and finally one day after a severe collapse, she did, and discovered that she had uterine cancer. “It has been just chemotherapy since then, shuttling between India and UAE,” adds Nainika.

It has exacted an emotional, turbulent toll on the family. Her mother doesn’t wish to see anyone, because she fears well-meaning comments, and well, sympathy stings.

Nainika wishes her mother had gone sooner to the doctor. “Life is full of ‘if only’ and guilt at the moment,” she says, rather ruefully.

Uterine cancer can be difficult to recognise because some of its warning signs can easily be mistaken for ordinary hormonal changes. Periods may become heavier or irregular during perimenopause, while after menopause, some women may assume that occasional spotting is nothing to worry about.

Doctors, however, stress that new or unusual bleeding deserves attention rather than assumption. Endometrial cancer is often detected at an earlier stage because abnormal bleeding is frequently its first warning sign.

Dr Manar Jabbar Hussein, Specialist Obstetrics and Gynaecology at Medcare Women and Children Hospital, explains that while uterine cancer, particularly endometrial cancer, is more common after menopause, it can occur in younger women too.

The challenge, particularly for women approaching or going through menopause, is knowing when a change in bleeding is part of a normal hormonal transition, and when it warrants medical investigation.

Who is at higher risk of uterine cancer?

No doubt, age is an important risk factor, with endometrial cancer occurring more frequently after menopause. However, this is not the only consideration. The risk, also escalates with obesity, diabetes, high-blood pressure, polycystic ovary syndrome, prolonged exposure to oestrogen without without enough progesterone, and a personal or family history of certain cancers, according to Dr Rajul Matkar.

However, some risk factors aren’t immediately obvious. “One risk factor that is sometimes overlooked is having irregular or infrequent periods over many years, because this can mean the lining of the uterus is exposed to oestrogen for longer without regular shedding,” Dr Hussein explains.

Furthermore, PCOS can contribute to this pattern because it may cause irregular or absent ovulation. Other factors include certain inherited cancer syndromes, particularly Lynch syndrome, as well as the use of tamoxifen, a drug commonly prescribed for some women with breast cancer. As the doctors maintain: Women taking tamoxifen who experience abnormal bleeding, spotting or bloody discharge should discuss these symptoms with their doctor.

Having a risk factor, however, does not mean a woman will develop cancer. “What matters is recognising changes in bleeding patterns and discussing persistent or unusual symptoms with a doctor rather than assuming they are simply hormonal,” says Dr Hussein.

So what bleeding should women actually worry about?

This is where things can become confusing, particularly during perimenopause.

Perimenopause can cause periods to change in frequency, duration and flow. However, doctors say that not every change should automatically be attributed to hormones, explains Dr Hussein.

Warning signs can include, as noted by both the doctors:

·         Bleeding between periods

·         Periods that suddenly become much heavier or longer than usual

·         Recurrent unexplained spotting

·         A sudden change in an established menstrual pattern

·         New watery, pink or blood-stained discharge

·         Persistent pelvic pain or pressure, particularly alongside abnormal bleeding

·         Any bleeding after menopause

As Dr Matkar notes: It’s not only worth noting whether women’s periods have become irregular, but also whether there has been a significant change from their usual pattern. “The key question is not simply, ‘Is my cycle irregular?’ but ‘Has my bleeding pattern changed significantly, and is this change appropriate for my age and circumstances?’” she says.

'Listen to your body, it does tell you things'

In a survivor story published by the US Centers for Disease Control and Prevention (CDC), Lynn recalls experiencing what she described as the “worst pain of her life” in 1997. At first, she thought it might be appendicitis. Later, after moving from Fort Lauderdale, Florida, to northern Florida for a new teaching job, she began experiencing nausea and assumed it was related to the stress of the move.

However, the symptoms continued. She later developed painful cramps and excessive bleeding, prompting her to see a doctor. She was eventually diagnosed with a rare cancer, clear cell sarcoma. After surgery and discovering that the cancer had also spread to her lungs, Lynn underwent further treatment.

Today, she is cancer-free. Looking back at her experience in her CDC survivor story, she urges women not to dismiss unusual symptoms.

“Listen to your body. It does tell you things.”

Why postmenopausal bleeding should never be ignored

Yet, bleeding after menopause, is an important fact to note.  Menopause is defined retrospectively after 12 consecutive months without a menstrual period. Once a woman has reached menopause, any subsequent bleeding should be medically assessed. However, that does not mean that every case of postmenopausal bleeding is cancer, there could also be benign cause.

However, it should not just be dismissed as a late period or another hormonal fluctuation. “Any bleeding after menopause should be investigated,” Dr Matkar says.

The same principle applies before menopause: persistent, unexplained or significantly changed bleeding deserves assessment even when a benign explanation seems possible. “A useful rule is that a new, persistent or unexplained change deserves attention,” Dr Hussein adds.

Even, when the eventual diagnosis is a benign condition, getting the cause confirmed does provide reassurance and ensures that something more serious is not being missed.

What happens when uterine cancer is suspected?

If abnormal bleeding or another concerning symptom is being investigated, the first step is usually a detailed medical history and examination. The doctor may recommend imaging, often including a pelvic or transvaginal ultrasound.

An ultrasound can help doctors assess the uterus and the thickness or appearance of the endometrium, but it cannot by itself confirm endometrial cancer, as Dr Matkar explains.  If the lining appears abnormal or symptoms raise concern, doctors may recommend an endometrial biopsy, in which a sample of tissue from the uterine lining is examined. “The definitive diagnosis requires sampling of the endometrial tissue, usually through an endometrial biopsy,” Dr Matkar says.

In some cases, particularly when a focal abnormality such as a polyp is suspected or an initial biopsy does not provide enough information, doctors may recommend a hysteroscopy, allowing them to look inside the uterus and take a targeted sample. Other procedures may also be considered depending on the individual case.

The distinction between imaging and tissue diagnosis is important, as a scan may raise suspicion; tissue diagnosis confirms cancer, according to Dr Matkar.

What does the biopsy tell doctors?

The diagnosis is just the beginning of understanding the disease, as the tissue sample can help doctors determine the type and grade of the cancer. Other pathological and, where appropriate, molecular characteristics can also help doctors understand how the tumour is likely to behave and determine the most appropriate treatment. “The tissue sample is particularly important because it helps determine the type and grade of the cancer,” explains Dr Hussein.

The cancer's stage is then determined using clinical, surgical and pathological information.

In simple terms, the stage describes how far the cancer has spread, while the grade describes features of the cancer cells that help indicate how aggressively the tumour may behave.

Does a diagnosis of uterine cancer always mean a hysterectomy?

For many women with operable endometrial cancer, particularly when the disease is confined to the uterus, hysterectomy is a central part of treatment, says Dr Matkar. The exact surgery depends on the cancer’s type, stage and the woman’s individual circumstances, while additional treatment such as radiation, chemotherapy or other therapies may also be recommended.

However, a hysterectomy is not inevitable for every patient. In carefully selected younger women with very early, low-risk endometrial cancer who wish to preserve fertility, hormonal treatment may sometimes be considered instead.

“There are selected situations in which fertility-sparing hormonal treatment can be considered, for example, carefully selected younger women with low-grade, early endometrial cancer who strongly desire future fertility,” says Dr Matkar.

Such treatment requires specialist assessment and close monitoring, and cancer control remains the priority.

What women should remember about uterine cancer

 Uterine cancer does not always present in an obvious or dramatic way. In many cases, the first clue may simply be a change in bleeding. This is particularly important during perimenopause, when women may understandably assume that heavier, irregular or unpredictable periods are simply part of the transition.

The message is not that every irregular period is a sign of cancer. It is that persistent, unusual or unexplained changes should not automatically be written off as hormones. “Having one or more risk factors does not mean a woman will develop uterine cancer,” Dr Hussein says. But recognising changes and getting them assessed can prevent a potentially important symptom from being overlooked.

And for women who have already gone through menopause, the message is even clearer: Bleeding should be investigated.

Sometimes, the most important reason to get checked is not because you think something is wrong — but because you don't want to be left wondering, “What if I had gone sooner?”