I am postmenopausal and have been without menses for about six years. Suddenly, though, I have brownish, red spotting. Is this cause for concern?

--Lauren

Yes. Although most of the time postmenopausal bleeding turns out to be something benign (such as infection or a cut you didn't notice), it could potentially represent something as serious as uterine cancer. Postmenopausal bleeding must be investigated by your gynecologist. The options for evaluating such bleeding are D&C (dilating your cervix and scraping the lining of the uterus -- the traditional approach), hysteroscopy (looking inside your uterus with a small viewing device inserted through the cervix), endometrial biopsy (taking a small sample in the office, without having to dilate your cervix), or ultrasound to measure the thickness of the uterine lining. A new approach is to do an ultrasound after instilling a small amount of sterile water into the uterine cavity to better define the uterine lining; recent studies have suggested that if the uterine lining is very thin, the chance of uterine cancer is low. However, the most definitive method -- the "gold standard" -- is still the combination of hysteroscopy and D&C.

If you have just started hormone replacement, that may explain the bleeding -- as could a change in hormone regimen or missing some pills. Sometimes using steroids or high doses of aspirin can contribute to vaginal bleeding. There are many possibilities.

Bottom line: You must see your gynecologist -- soon -- for a thorough evaluation. Assessment of your uterine lining must be done. If you have uterine cancer, it is easily treated and cured if caught early; of all the gynecologic cancers, it is the best one to have, if you have to have cancer.

Please, call today for an appointment with your doctor.