The Symptoms Were There, the Healthcare Providers Weren't

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 bleeding that is unexpected or prolonged, including extremely heavy periods or irregular bleeding not related to menstruation.

But despite its prevalence, and the fact that abnormal bleeding is a common symptom of gynecologiccal cancers, it is frequently overlooked or attributed to fibroids, hormones, irregular periods, birth control or cervical polyps — potentially leading to a missed diagnosis of a more serious problem.

“Cancer can happen to anyone, and my bleeding was not taken as seriously as it should have been,” Herbert said.

Medical gaslighting compounds the problem

Medical gaslighting — when medical providers invalidate or dismiss patients’ questions, symptoms or concerns — is a significant issue in women's health, particularly in cancer care. This can happen with all patients, but marginalized communities are often particularly affected.

A study published in BMC Women’s Health found that women have “consistently reported poor experiences in accessing care” for abnormal uterine bleeding throughout the last 20 years.

Elena Ratner, M.D., a gynecologic oncologist at Yale Cancer Center, said that she frequently has patients come to her after they have seen numerous other medical providers who did not address 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 happen for many different reasons and is not always a sign of cancer, Ratner explained. “However, it is essential that patients are properly evaluated to determine the cause, particularly since early diagnosis is crucial for gynecological cancers,” she added.

Women’s pain has been normalized

Several recent studies have found a gender pain bias, where medical providers assume women are exaggerating their pain.

Menstrual pain and bleeding are also frequently seen as an inevitable experience for women, which leads to symptoms not being taken as seriously — even though tumors on the uterus and ovaries can cause pressure and pain that are similar to menstrual cramps.

Ami Vaidya, M.D., an oncologist and co-chief of the Division of Gynecologic Oncology at Hackensack Meridian John Theurer Cancer Center, said that the ongoing normalization of menstrual-related pain and bleeding can cause patients to delay seeking help and may lead healthcare providers (HCPs) to overlook symptoms of a critical medical issue.

“There is a significant and well-documented misconception in medicine where abnormal bleeding is sometimes dismissed as a normal part of ‘being a woman,’ which can lead to missed or delayed diagnoses of serious conditions,” said Vaidya.

Despite diagnostic challenges, experts emphasize there are specific symptoms to gynecologic cancers that patients should be aware of and speak with their provider about, including:

• Abnormal bleeding — Any bleeding that is unexpected or prolonged, including extremely heavy periods or irregular bleeding not related to menstruation. Abnormal bleeding can be a symptom of each of the six types of gynecologic cancers — cervical, ovarian, uterine, vaginal, vulvar and fallopian tube (which is rare).
• Postmenopausal bleeding — If a patient is postmenopausal, meaning that they have not had a period in 12 months — any 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 intercourse — Any discomfort or spotting related to sexual activity
• Swelling or bloating — Feeling swollen or bloated in the lower abdomen
• Digestive changes — Changes in appetite, indigestion, nausea and chronic constipation

Vaidya said there are different diagnostic exams that patients can discuss with their HCP that may help determine the cause of abnormal bleeding, including:

• Pelvic exam and Pap/HPV tests
• Blood tests to check for anemia or hormonal issues
• Transvaginal ultrasound to identify structural problems
• Endometrial biopsy to examine the uterine lining for cancerous cells
• Hysteroscopy for a direct visual inspection of the uterus

Vaidya recommends that patients keep a symptom journal to track any pain and/or bleeding and bring a list of questions to their medical appointments.

“If you feel dismissed, ask pointed questions such as, ‘What specific tests can we run to rule out more serious conditions like cancer?’ If a requested test is denied, insist that the doctor document the refusal in your chart — a step that often prompts action,” she said.

Age bias contributes to diagnosis delays

Abnormal bleeding can frequently be dismissed in younger patients because providers often assume they’re too young to have cancer. A 2025 study found that younger women encounter lengthy diagnostic delays, often due to the assumption that their symptoms are not caused by something serious.

Herbert said she thinks being in her 30s contributed to the dismissal of her symptoms.

“I definitely think my age played a role. It finally took one female doctor to listen to me, take my whole medical history, and say, ‘This isn’t right and we need to do more tests,’” said Herbert.

For patients who are going through menopause or are postmenopausal, they can also experience delays in diagnosis.

Early gynecologic cancer symptoms can frequently be attributed to menopause symptoms or the normal aging process. Missed preventive screenings can also play a role due to the misconception that regular pelvic exams may not be necessary if a patient is no longer in their reproductive years or menstruating.

Vadiya added that annual pelvic exams to check for uterine or ovarian abnormalities, even if patients are no longer menstruating, are still a crucial preventive test.

Be vigilant

Ratner asserts that patients have the right to receive comprehensive care that addresses their medical needs.

“Patients know their own bodies, and if they know something is wrong and they don't get the care they feel is right for them, they should leave and find a provider who does listen. Demand what you deserve,” she said.

For Herbert, after nearly a year of treatment, her cancer went into remission — an occasion she commemorated by getting a watercolor phoenix tattoo.

Herbert, who plans to get more involved in the cancer support community and help patients connect with resources, said it is important for patients to find a provider who won’t dismiss their bleeding.

“Be proactive about the problem and know that you have the right to be heard and have your concerns taken seriously."