In postmenopausal women, which symptom is most concerning for possible endometrial cancer?

• A. Frequent headaches
• B. Postmenopausal vaginal bleeding
• C. Lower back pain
• D. Normal menses

Answer: (B)

Postmenopausal vaginal bleeding is the red-flag symptom because after menopause the endometrium should be inactive and not shed. When bleeding occurs, it raises strong concern for endometrial pathology, including cancer, since cancers often present as abnormal uterine bleeding in this population. The other options don’t point specifically to endometrial cancer: headaches and lower back pain are nonspecific, and having normal menses after menopause is not possible and doesn’t indicate a malignant process. In evaluation, clinicians start with assessment and imaging to gauge endometrial thickness with a transvaginal ultrasound, and if bleeding is present, an endometrial biopsy is typically performed to confirm or exclude cancer. Early recognition of postmenopausal bleeding is crucial because earlier detection improves outcomes.