June is National Cancer Survivor Month and Cervical Cancer Awareness Month.
When Julie Herbert went to a California emergency room with excessive vaginal bleeding in November 2024, cancer was the furthest thing from her mind. The hospital’s triage nurses were very worried and the 36-year-old researcher was quickly admitted.
“They immediately took me to the hospital and gave me IV fluids and a blood transfusion,” Herbert said.
A Pap test performed at the hospital showed abnormal results.
After follow-up tests, including a CT scan, ultrasound and biopsy, Herbert was diagnosed with advanced cervical cancer that had spread to her lymph nodes.
“When they told me it was cancer, I was shocked,” she said.
Finally, she saw her gynecologist 7 days ago due to abnormal bleeding. Herbert said her doctor attributed it to heavy menstrual periods and recent removal of an intrauterine device (IUD) and did not order follow-up tests.
Herbert, who had had an IUD for eight years, had the device removed three months ago. There was some bleeding before it was removed, but it got worse after it was removed.
Bleeding may occur when an IUD is removed, but excessive and prolonged bleeding after removal may indicate a more serious underlying condition.
Given her history of bleeding and its intensity, Herbert believes the medical professionals she saw should have done more.
“They blamed it on my hormones, saying it might be my body returning to normal after the IUD was taken out,” Herbert said.
Herbert’s experience is not uncommon.
Ignoring abnormal bleeding can have serious consequences
Abnormal vaginal bleeding (or abnormal uterine bleeding (AUB) from the uterus) affects up to 35% of women and is defined as unexpected or prolonged bleeding, including extreme periods or irregular bleeding unrelated to menstruation.
However, despite the high prevalence and the fact that abnormal bleeding is a common symptom of gynecological cancer, it is often overlooked or caused by uterine fibroids, hormones, irregular periods, birth control, or cervical polyps, potentially leading to missed diagnosis of more serious problems.
“Cancer can happen to anyone, but my bleeding wasn’t taken as seriously as I expected,” Herbert said.
Medical Gaslighting Complicates the Problem
Medical gaslighting, in which a health care provider invalidates or ignores a patient’s questions, symptoms, or concerns, is a significant issue in women’s health, particularly cancer treatment. This can happen to any patient, but underserved communities are often particularly affected.
A study published in BMC Women’s Health found that women “consistently reported poor experiences in accessing care” for abnormal uterine bleeding over the past 20 years.
Dr. Elena Ratner, a gynecological oncologist at Yale Cancer Center, said patients often come to her after seeing numerous other health care providers who have not addressed unexpected bleeding.
“Abnormal bleeding is a clear, obvious symptom that should not be ignored, but women’s voices are not listened to,” Ratner said.
Abnormal bleeding can occur for a variety of reasons and is not always a sign of cancer, Ratner explained. However, since early diagnosis is especially important for gynecological cancer, it is important to identify the cause through an accurate evaluation of the patient,” he added.
Women’s pain has become normalized.
Several recent studies have found gender pain bias, in which health care providers assume women exaggerate their pain.
Menstrual pain and bleeding are unavoidable experiences for women. Even though tumors in the uterus and ovaries can cause pressure and pain similar to menstrual cramps, the symptoms may not be taken seriously.
The continued normalization of menstrual-related pain and bleeding may delay patients seeking help and may cause health care providers (HCPs) to overlook symptoms of important medical problems, said Ami Vaidya, MD, oncologist and co-director of gynecologic oncology at Hackensack Meridian John Theurer Cancer Center.
“There is a significant and well-documented misconception in the medical community that abnormal bleeding is sometimes dismissed as a normal part of ‘life as a woman,’ which can lead to missed or delayed diagnosis of serious conditions,” Vaidya said.
Despite the diagnostic challenges, experts emphasize that gynecological cancer has specific symptoms that patients should be aware of and discuss with their health care providers:
- abnormal bleeding — Unexpected or prolonged bleeding, including very heavy or irregular bleeding not related to menstruation. Abnormal bleeding can be a symptom of each of six types of gynecological cancer: cervical, ovarian, uterine, vaginal, vulvar, and (rarely) fallopian tube.
- menopausal bleeding — If the patient is postmenopausal, i.e. has not menstruated for 12 months, bleeding or spotting should not be ignored.
- changes in menstruation — Menstrual periods are heavier and/or longer than usual.
- urine changes — Difficult, frequent, or painful urination
- Pain or bleeding during or after intercourse — Discomfort or spotting associated with sexual activity
- swelling or bloating — Feeling swollen or bloated in the lower abdomen
- digestive changes — Changes in appetite, indigestion, nausea, chronic constipation
Vaidya said there are a variety of diagnostic tests patients can discuss with their HCP that may help determine the cause of abnormal bleeding, including:
- Pelvic exam and Pap/HPV test
- Blood tests to check for anemia or hormonal problems
- Transvaginal ultrasound to check for structural problems
- Endometrial biopsy to check for cancer cells in the lining of the uterus
- Hysteroscopy to directly examine the uterus with the naked eye
Vaidya recommends that patients keep a symptom diary to track pain and/or bleeding and bring a list of questions to their appointments.
“If you feel left out, ask pointed questions like, ‘What specific tests can you run to rule out a more serious condition, like cancer?’ If a requested test is denied, ask your doctor to note the denial in your chart. This is often the step that leads to action,” she said.
Age bias influences diagnostic delays
In young patients, abnormal bleeding is often ignored. That’s because health care providers often assume patients are too young to have cancer. A 2025 study found that young women experience long delays in diagnosis due to the assumption that their symptoms are not due to a serious cause.
Herbert said he believes reaching his 30s contributed to his symptoms disappearing.
“I definitely think my age played a role. Finally, a female doctor listened to me, took my full medical history and said, ‘This isn’t right and you need to do more tests,'” Herbert said.
Diagnosis may also be delayed in patients undergoing or postmenopausal.
Early gynecological cancer symptoms can often be attributed to menopausal symptoms or the normal aging process. Missed preventive screenings may also play a role due to the misconception that patients may no longer need regular pelvic exams if they are no longer fertile or menstruating.
Vadiya added that even if a patient is no longer menstruating, an annual pelvic exam to check for uterine or ovarian abnormalities is still an important preventative test.
be alert
Ratner argues that patients have the right to comprehensive care tailored to their medical needs.
“Patients know their bodies, and if they know something is wrong and they are not getting the care they feel is right for them, they need to walk away and find a health care provider who listens. Demand what you deserve,” she said.
After receiving treatment for nearly a year, Herbert’s cancer went into remission. To commemorate the occasion, I got a watercolor phoenix tattoo.
Herbert, who plans to become more involved in the cancer support community and help patients connect with resources, said it’s important for patients to find a provider who won’t ignore bleeding.
“Be proactive about issues and know that you have the right to be heard and your concerns taken seriously.”
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