June is National Cancer Survivors Month and Uterine Cancer Awareness Month.
When Julie Herbert went to the emergency room in California in November 2024 due to severe vaginal bleeding, cancer was the last thing on her mind. A triage nurse at the hospital was very concerned and the 36-year-old research assistant was quickly admitted.
“They immediately took me to a room and gave me IV fluids and a blood transfusion,” Herbert said.
A Pap test conducted by the hospital revealed abnormalities.
After further testing, including a CT scan, an ultrasound and a biopsy, Herbert was diagnosed with advanced cervical cancer that had spread to her lymph nodes.
“When they told me it was cancer, I was stunned,” she said.
After all, she had gone to the gynecologist seven days earlier because of noticeable bleeding. Herbert said the doctor attributed this to heavy menstrual periods and the recent removal of her intrauterine device (IUD) and did not order any follow-up tests.
Herbert, who had had an IUD for eight years, had had the device removed three months earlier. Before it was removed she had been bleeding intermittently, but after it was removed it got worse.
Bleeding may occur during IUD removal, but excessive, persistent bleeding after removal may indicate a more serious underlying condition.
Given her bleeding history and the intensity of that bleeding, Herbert believes the medical professionals she saw should have done more.
“They said it could just be because my body was going back to normal after I removed the IUD and blamed my hormones,” Herbert said.
Herbert’s experience is not uncommon.
Ignoring abnormal bleeding can have serious consequences
Abnormal vaginal bleeding – or abnormal uterine bleeding (AUB) when it originates in the uterus – affects up to 35% of women and is defined as unexpected or persistent bleeding, including extremely heavy periods or irregular bleeding that is not related to menstruation.
But despite their prevalence and the fact that abnormal bleeding is a common symptom of gynecological cancers, they are often overlooked or attributed to fibroids, hormones, irregular periods, birth control or cervical polyps – potentially leading to the diagnosis of a more serious problem being missed.
“Cancer can happen to anyone, and my bleeding wasn’t taken as seriously as it should have been,” Herbert said.
Medical gaslighting exacerbates the problem
Medical gaslighting – when medical providers invalidate or dismiss patients’ questions, symptoms or concerns – is a major issue in women’s health, particularly in cancer treatment. This can happen to all patients, but marginalized communities are often particularly affected.
A study published in BMC Women’s Health found that over the past 20 years, women have “consistently reported poor experiences accessing care” for abnormal uterine bleeding.
Elena Ratner, MD, a gynecologic oncologist at Yale Cancer Center, said patients often come to her after seeing numerous other medical providers who failed to treat their unexpected bleeding.
“Abnormal bleeding is a tangible, clear symptom that should not be ignored, yet women are not being listened to,” Ratner said.
Abnormal bleeding can occur for many different reasons and is not always a sign of cancer, Ratner explained. “However, it is important that patients are properly examined to determine the cause, especially as early diagnosis is crucial in gynecological cancers,” she added.
Women’s pain has normalized
Several recent studies have identified a gender pain bias in which doctors assume women exaggerate their pain.
Menstrual cramps and bleeding are also often considered an unavoidable experience for women, leading to the symptoms not being taken as seriously – even though tumors on the uterus and ovaries can cause pressure and pain similar to menstrual cramps.
Ami Vaidya, MD, oncologist and co-chief of the division of gynecologic oncology at Hackensack Meridian John Theurer Cancer Center, said the continued normalization of menstrual-related pain and bleeding can cause patients to delay seeking help and cause health care providers (HCPs) to miss the symptoms of a critical medical problem.
“There is a significant and well-documented misconception in medicine that abnormal bleeding is sometimes dismissed as a normal part of ‘being a woman,’ which can lead to serious conditions being undiagnosed or delayed,” Vaidya said.
Despite diagnostic challenges, experts emphasize that there are specific symptoms of gynecologic cancers that patients should be aware of and discuss with their doctor, including:
- Abnormal bleeding — Any bleeding that is unexpected or prolonged, including extremely heavy menstrual bleeding or irregular bleeding not related to menstruation. Abnormal bleeding can be a symptom of any of the six types of gynecological cancers – cervical, ovarian, uterine, vaginal, vulvar and fallopian tube cancers (which are rare).
- Bleeding after menopause — If a patient is postmenopausal, meaning she has not had a period for 12 months, bleeding or spotting should not be ignored.
- Changes in menstruation —Heavier and/or longer menstrual bleeding than usual
- Urinary changes — Difficult, frequent or painful urination
- Pain or bleeding during or after sexual intercourse — Any discomfort or spotting associated with sexual activity
- Swelling or bloating — Feeling of swelling or bloating in the lower abdomen
- Digestive changes — Changes in appetite, indigestion, nausea and chronic constipation
Vaidya said there are several diagnostic tests that patients can discuss with their HCP that can help determine the cause of abnormal bleeding, including:
- Pelvic exam and Pap/HPV testing
- Blood tests to check for anemia or hormonal problems
- Transvaginal ultrasound to identify structural problems
- Endometrial biopsy to examine the lining of the uterus for cancer cells
- Hysteroscopy for a direct visual examination of the uterus
Vaidya recommends that patients keep a symptom diary to record any pain and/or bleeding and bring a list of questions to their doctor’s appointments.
“If you feel rejected, ask pointed questions like, ‘What specific tests can we do to rule out more serious conditions like cancer?’ If a requested test is refused, insist that the doctor document the refusal in your file – a step that often leads to action, she said.
Age bias contributes to diagnostic delays
In younger patients, abnormal bleeding can often be dismissed because doctors often assume they are too young to have cancer. A 2025 study found that younger women experience long delays in diagnosis, often due to the assumption that their symptoms are not caused by something serious.
Herbert said she believes the fact that she is over 30 contributed to her symptoms disappearing.
“I definitely think my age played a role. It ended up taking a doctor to listen to me, take my entire medical history and say, ‘This isn’t right and we need to do more tests,'” Herbert said.
Patients who are menopausal or postmenopausal may also experience delays in diagnosis.
Early gynecological cancer symptoms can often be attributed to symptoms of menopause or the normal aging process. Missed checkups may also play a role because of the false belief that regular gynecological exams may not be necessary if a patient is no longer of childbearing age or no longer menstruating.
Vadiya added that annual gynecological exams to check for uterine or ovarian abnormalities, even if patients are no longer menstruating, are still an important preventive test.
Be vigilant
Ratner maintains that patients have the right to comprehensive care that meets their medical needs.
“Patients know their own bodies, and if they know something is wrong and they are not receiving the care they think they should, they should go and find a provider who will listen to them. Demand what you deserve,” she said.
Herbert’s cancer went into remission after nearly a year of treatment – an occasion she commemorated with a watercolor phoenix tattoo.
Herbert, who plans to become more involved in the cancer support community and help connect patients with resources, said it’s important for patients to find a provider who won’t dismiss their bleeding.
“Approach the issue proactively, knowing that you have the right to be heard and that your concerns will be taken seriously.”
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