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Evaluation of abnormal uterine bleeding

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Stephen C. Rubin, MD
Last Modified: June 16, 2002

Dear OncoLink "Ask The Experts,"
I am 45 and having mid cycle bleeding. This has been happening for about 6 months. My doctor observed during my physical exam that my uterus was enlarged. I had an ultrasound and was told that I have multiple fibroids. Recently, I have been having constant lower left abdominal pain and leg aches. Much like I am constantly ovulating. I am worried that I may have more than just fibroids. Should I ask my physician to do a D&C to rule out the possibility of Uterine Cancer?  

Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:

The evaluation of abnormal uterine bleeding depends on a number of considerations, including the patient's age, and potential risk factors for cancers, particularly of the uterine lining (endometrium) and cervix. In women over 40, or younger women who have risk factors for endometrial cancer such as obesity or irregular ovulation, an evaluation of the endometrium is appropriate. This can often be accomplished in the doctor's office with a simple biopsy. Alternatives may include D&C, and sonography to visualize the uterine lining and gynecologic organs. I suggest you discuss the possibility of a biopsy with your physician. There are many benign causes of uterine bleeding such as fibroids or polyps, but uterine cancer should be ruled out.