postmenopausal bleeding

57 yrs old, no hormones, slightly overweight, good diet, exercise, controlled hyopthyroid for 35 years,  "healthy and happy"!  Last period 4 years ago.  Endometrial biopsy at that time due to 3 week long periods.  Came back ok.

6 weeks ago spotted for 7 days (again, has never happened in 4 yrs)--exam confirmed as coming from uterus.  Pap ok. He said ultrasound ok.  Did not do transvaginal because tech said she could see everything without it.

Did not do biopsy or anything else.  He said that uterine cancer grows so slow that he was comfortable waiting to see if anything else develops--bleeding etc.

I do have some on/off pain--no dryness issues at all.

I am NOT a worrier, but should I be comfortable not waiting?  How proactive should I be to find the cause of that 7-day episode of spotting.  He did mention something about a "clean-out" bleed which I have never heard of at my age.  I am ok with not doing anything at this point if that is the standard way of handling this.

Any thoughts on this?  thanks for answering

[Elaine Brown, MD]

Hi!
If you were my patient, and you were not a worrier, I would not do a biopsy IF your endometrial stripe measured less than 5 mm.  OK--the translation now!  Endometrial stripe means the thickness of the tissue that lines the uterus.  If this tissue is less than 5 mm thick on a TRANSVAGINAL ultrasound, it virtually rules out endometrial cancer.
If ALL of these conditions were true, AND you had no more bleeding, I wouldn't worry at all.  I would do another biopsy if you bled again, and I would also do a "peace of mind" ultrasound in 6-12 months if you wanted.
Good luck!
Dr B