* I am 49 years old. My periods stopped two years back but last month I had periods again. My friends tell me that this is normal, but I am anxious. Please guide.

* I am 58 years old and I am told that I will need surgery to remove my uterus because I had bleeding after menopause even though my ultrasound and D&C did not show any cancer.

Any bleeding occurring after one year of no periods, after 40 years, is Post-Menopausal Bleeding (PMB). Sometimes it is difficult for women to make out if the bleeding is with urine, from piles or rectum. Use tissue paper to confirm that the bleeding is from the genital passage. Having delayed periods around the age of menopause is okay, but after a gap of one year is not normal. You must have a pap smear, which is a screening test for cancer of the mouth of the uterus, a good ultrasound with measurement of the lining of the uterus and ovaries and you may need a hysteroscopy and biopsy. Hysteroscopy is a simple and informative test. Using a thin telescope one can see a magnified view of the cavity of the uterus and suspicious areas can be picked up for testing. Very often an experienced hysteroscopist can tell whether there is a possibility of cancer, thus cutting down on the anxious waiting period before the pathology report comes. Removing the uterus is a major decision. Even after D&C, I would urge you to have a hysteroscopy before you remove your uterus. D&C is an obsolete procedure worldwide and tends to under-diagnose and miss 10 to 70 per cent of cancers altogether.

These three tests will rule out cancer which is not a common cause of postmenopausal bleeding. Even though the reported risk of uterine cancer averages 11 per cent, and benign causes for PMB as high as 70-80 per cent, it cannot be overemphasized that in all PMB cancer should be ruled out. But in 57 per cent of the women, the lining of the uterus is normal and you need to do nothing! In 8.6 per cent cases, the pathology report says ‘simple hyperplasia’. Small amount of hormones taken for about six months will correct it. Thirteen per cent have small, benign growths inside the uterus called polyps and these can be removed in the same sitting as your diagnostic hysteroscopy. Remember that postmenopausal bleeding is not a diagnosis. It is only a symptom which needs ‘looking into’. Non-cancer causes are more common than cancer. Keep your worries on hold till there is a clear diagnosis of cancer as the cause of your problem.