The symptom that saves lives
Any bleeding after menopause is endometrial cancer until proved otherwise — and the good news is that this symptom brings most patients to diagnosis at stage I. Irregular or very heavy bleeding in the years around menopause also deserves evaluation with a pelvic ultrasound and, if the lining is thickened, a biopsy.
- Any vaginal bleeding after menopause
- Bleeding between periods or after intercourse
- Unusually heavy or prolonged periods around menopause
- Watery or blood-stained discharge
Diagnosis and staging
Transvaginal ultrasound measures the endometrial thickness; a pipelle or hysteroscopic biopsy provides the diagnosis. MRI assesses how deeply the tumour grows into the muscle of the uterus, which guides the extent of surgery.
Robotic hysterectomy with sentinel node mapping
The uterus, cervix, tubes and ovaries are removed robotically through keyhole incisions. Indocyanine green dye maps the sentinel lymph nodes — the first nodes the cancer would reach — so only those nodes are removed rather than a full lymphadenectomy. This means accurate staging with far fewer lymphoedema complications.
- Discharge within 24 hours in most cases
- Sentinel node mapping — precise staging, fewer complications
- Near-zero wound problems, even with obesity or diabetes
- Molecular classification of the tumour guides any further treatment
Recovery and follow-up
Most women are walking the same evening and home the next day, back to desk work in two weeks. Final pathology and molecular class decide whether radiotherapy or chemotherapy adds benefit — many stage I cancers need nothing more than surveillance.
Common questions
- Is postmenopausal bleeding always cancer?
- No — atrophy and polyps are common benign causes. But because about 1 in 10 cases is cancer, every episode warrants an ultrasound and usually a biopsy.
- What is sentinel node mapping?
- A fluorescent dye injected at the cervix travels to the first draining lymph nodes, which are identified with a near-infrared camera and removed. If they are clear, the remaining nodes are left untouched, avoiding the leg swelling of full node dissection.
- Will I need radiotherapy after a hysterectomy?
- It depends on the final stage, grade and molecular class of the tumour. Early, low-risk cancers need no further treatment; higher-risk features may lead to vaginal brachytherapy or external radiotherapy.
This page is general education, reviewed by Dr. Ishaan Allahabadi, MCh Surgical Oncology (Edge Hill, UK) · MS Surgery · MBBS (Accredited by the Royal College of Surgeons of England). It is not a substitute for individual medical advice. Treatment decisions are made after reviewing your imaging and pathology, in a multidisciplinary tumour board.