“Postmenopausal bleeding: First steps in the workup” (J Fam Pract. 2012;61:597-604) brought to mind a patient whose condition was not included in the differential for postmenopausal bleeding, but should have been.
A year ago, a 79-year-old woman came to see me because of vaginal bleeding. Her Pap test was normal, and lab tests and a transvaginal ultrasound were negative. I referred the patient to a gynecologist, who did an endometrial biopsy. That, too, was negative, but the spotting did not stop.
The gynecologist told the patient not to worry and to check back in 6 to 9 months. But a week after seeing the specialist, the patient—still worried—came back to see me. I did a CT scan of the pelvis and found ovarian cancer.
Needless to say, ovarian cancer is not very common in women of her age. Yet it is part of the differential (and another test) that the authors did not include, but that physicians evaluating women with post- menopausal bleeding should consider.
Randy M. Bork, DO
Lapeer, Mich.