Your patient’s menopause symptoms could be a warning sign for something worse
Key Takeaways
Industry Buzz
“It can be confusing whether something is just abnormal bleeding that occurs with the perimenopause transition, vs something that’s more concerning like postmenopausal bleeding.” — Laura Bozzuto, MD, MS, OB/GYN and assistant professor, obstetrics and gynecology, at the University of Wisconsin School of Medicine and Public Health
“Flushing can be a sign of infection, autoimmune conditions, or sometimes even cancer. When night sweats are drenching and accompanied by weight loss, we get concerned about cancer as well." —Jewel Kling, MD, professor of medicine and chair of Women’s Health Internal Medicine at Mayo Clinic
Find more of your peers' perspectives and insights below.
Dawn Willis of Canterbury, England, recently spoke with BBC about her experience of mistaking irregular bleeding symptoms for menopause.[]
As it turned out, her vaginal bleeding was ultimately diagnosed as advanced uterine cancer.
Indeed, according to the International Gynecologic Cancer Society, symptoms for uterine cancer can include irregular bleeding and pelvic pain or pressure—both of which may easily be assumed to be signs of menopause.[]
Early and accurate diagnoses can make all the difference for patient outcomes. Cleveland Clinic reports that the prognosis for uterine or endometrial cancer can be very good if it is diagnosed at an early stage.[]
Not one-size-fits-all
Providers can work with patients to educate them on indicators of menopause vs other, more concerning symptoms and establish tracking and reporting methods to determine further testing as needed.
One reason menopause can be so confusing is because it is not an identical experience across all patients, explains Laura Bozzuto, MD, MS, OB/GYN and assistant professor, obstetrics and gynecology, at the University of Wisconsin School of Medicine and Public Health.
“There is some confusion about what can be involved in the menopause transition. Different people can experience different symptoms,” she tells MDLinx.
Irregular bleeding
As a baseline, Dr. Bozzuto advises her patients to track indicators and symptoms over time, including periods as applicable. This information can help determine whether bleeding is cause for concern.
If a patient goes 6 months without a period and then has vaginal bleeding, she recommends they present to her for next steps. “It can be confusing whether something is just abnormal bleeding that occurs with the perimenopause transition, vs something that’s more concerning like postmenopausal bleeding,” she explains.
Hot flashes and night sweats
Vasomotor symptoms, otherwise known as hot flashes and night sweats, are recognized as the hallmark indicators of menopause. However, we can’t chalk them up to menopause in every instance.
“These symptoms can indicate other worrisome findings if they occur outside of menopause or in men,” says Jewel Kling, MD, professor of medicine and chair of Women’s Health Internal Medicine at the Mayo Clinic in Scottsdale, AZ. “Flushing can be a sign of infection, autoimmune conditions, or sometimes even cancer. When night sweats are drenching and accompanied by weight loss, we get concerned about cancer as well,” she says.
Thyroid concerns
Thyroid disorders are another potential culprit for vasomotor symptoms, explains Jenna Sarvaideo, DO, endocrinologist at Froedtert & The Medical College of Wisconsin.
If a patient reports hot flashes, she says, bloodwork would provide insights for potential thyroid concerns. “I want to make sure it’s not hyperthyroidism that’s causing it. That’s easily screened for with TSH,” she says.
Menopause Society Certified Practitioner Jacquelyn Saengmany at Mercyhealth in Woodstock, IL, also notes similarities between thyroid conditions and menopause symptoms. “Hypothyroidism can present with temperature regulation issues, weight fluctuations, mood change, and menstrual irregularities similar to menopause,” she explains.
Keep the conversation open
Menopause can be a confusing and challenging transition. Empowering patients to track symptoms over time and encouraging open discussions will help support individuals facing this life change, and potentially also distinguish menopause from other conditions requiring diagnosis and treatment.
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