The Critical Role of Bimanual Pelvic Examination by a Midwife in the Early Detection of Advanced Endometrial Cancer in a Postmenopausal Woman With Unexplained Spotting

The Critical Role of Bimanual Pelvic Examination by a Midwife in the Early Detection of Advanced Endometrial Cancer in a Postmenopausal Woman With Unexplained Spotting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report The Critical Role of Bimanual Pelvic Examination by a Midwife in the Early Detection of Advanced Endometrial Cancer in a Postmenopausal Woman With Unexplained Spotting mina arabzadeh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8290942/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Postmenopausal bleeding is a red-flag symptom that mandates prompt and thorough evaluation to exclude malignancy. In primary healthcare settings, midwives frequently represent the first point of clinical contact for women presenting with gynecologic complaints. A postmenopausal woman presented to a primary healthcare center with intermittent vaginal spotting and no accompanying pain or systemic symptoms. Initial general examination was unremarkable. During gynecologic assessment, a careful bimanual pelvic examination performed by the attending midwife revealed an enlarged, irregular uterus with reduced mobility. Based on these abnormal findings, the patient was urgently referred to a gynecologic specialist. Subsequent imaging and histopathological evaluation confirmed advanced-stage endometrial carcinoma. This case highlights the essential diagnostic value of bimanual pelvic examination in women with postmenopausal bleeding and underscores the critical role of midwives in early detection and timely referral of gynecologic malignancies. Reinforcement of clinical examination skills in primary care may contribute to earlier diagnosis and improved outcomes in endometrial cancer. Endometrial cancer Postmenopausal bleeding Bimanual pelvic examination Midwifery Early detection Background Endometrial cancer is among the most common gynecologic malignancies worldwide, with postmenopausal bleeding being its most frequent presenting symptom [ 1 , 2 ]. Early-stage diagnosis is strongly associated with favorable prognosis; however, delayed evaluation or incomplete clinical assessment may result in diagnosis at an advanced stage, adversely affecting outcomes. In many healthcare systems, particularly at the primary care level, midwives play a pivotal role in the initial evaluation of women’s health concerns. Despite advances in imaging and laboratory diagnostics, the bimanual pelvic examination remains a fundamental component of gynecologic assessment [ 3 , 4 ]. Nonetheless, it may be underutilized or insufficiently emphasized in routine practice. This case report demonstrates how a meticulous bimanual pelvic examination performed by a midwife led to early suspicion and timely referral of a serious underlying malignancy. Case presentation A postmenopausal woman presented to a primary healthcare center with complaints of intermittent vaginal spotting of unknown origin. She reported no pelvic pain, weight loss, fever, or other systemic symptoms. Her past medical history was unremarkable, and she was not receiving hormone replacement therapy. On examination, vital signs were within normal limits, and general physical assessment revealed no abnormalities. A gynecologic evaluation was subsequently performed. During bimanual pelvic examination, the attending midwife detected an enlarged uterus with an irregular contour and reduced mobility, findings inconsistent with normal postmenopausal anatomy. Given the abnormal pelvic findings and the presence of postmenopausal bleeding, the patient was urgently referred to a gynecologist for further evaluation. Diagnostic investigations, including pelvic imaging and endometrial sampling, confirmed the presence of advanced endometrial carcinoma. Following diagnosis, the patient was referred for appropriate oncologic management. Discussion Postmenopausal bleeding should always be considered malignant until proven otherwise [ 2 , 6 ]. While transvaginal ultrasonography and histopathological evaluation are key diagnostic tools, physical examination remains an invaluable initial step in clinical assessment. In this case, the bimanual pelvic examination provided immediate and critical information that raised suspicion of malignancy and expedited referral. Midwives, as frontline healthcare providers in primary care settings, are uniquely positioned to identify early signs of gynecologic pathology [ 4 , 5 ]. This case underscores the importance of maintaining strong clinical examination skills and integrating them with diagnostic pathways. Failure to perform a comprehensive pelvic examination may delay diagnosis, resulting in disease progression and poorer prognosis. Strengthening education and ongoing training for midwives in gynecologic examination techniques is therefore essential. Emphasizing the diagnostic value of bimanual examination can enhance early detection of gynecologic cancers and improve patient outcomes. Conclusion Bimanual pelvic examination remains a vital component of the evaluation of postmenopausal bleeding. This case report highlights the indispensable role of midwives in the early identification of serious gynecologic pathology through careful clinical examination and timely referral. Reinforcing clinical skills in primary care settings may contribute significantly to earlier diagnosis and improved outcomes in endometrial cancer. Declarations Ethics approval and consent to participate Written informed consent was obtained from the patient for participation in this case report. Consent for publication Written informed consent was obtained from the patient for publication of this case report. Competing interests The author declares that there are no competing interests. Funding This study received no external funding. Authors’ contributions MA performed the clinical examination, collected the clinical data, drafted the manuscript, and approved the final version. Acknowledgements Not applicable. References Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. American College of Obstetricians and Gynecologists. Practice Bulletin 149: Endometrial cancer. Obstet Gynecol. 2015;125(4):1006–26. American Cancer Society. Endometrial cancer: Early detection, diagnosis, and staging. World Health Organization. WHO guideline for the early diagnosis of cancer. Geneva: World Health Organization; 2017. Berek JS, Novak E. Berek & Novak’s Gynecology. 16th ed. Philadelphia: Lippincott Williams & Wilkins; 2020. Timmermans A, Opmeer BC, Khan KS, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2010;116(1):160–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8290942","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":565314739,"identity":"8b036f6d-8722-4d47-966a-fe9943a17523","order_by":0,"name":"mina arabzadeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYHACgwMMDBY88vKPDz4A8nj4iNQiIWPYkJZsANLCRowWIJawYTiQoyYB4hLUotvevPHAjxoJHsaGM2yVX3PsZNgYmB8+uoFHi9mZYwUHe45J8LAz9h67LbstGegwNmPjHHxabuQYHGZgA9rSzJd2W3IbM1ALD5s0Xi333wC1/JPgYTjGY1Ysua2eCC03eAwOM7YBtZzhMWP8uO0wEVrOpBUc7O2T4DGcwZYszbjtOA8bMyG/HD+8+cOPbzb28hLMBz/+3FZtz8/e/PAxPi0ogJkHTBKrHAQYf5CiehSMglEwCkYMAACXMkXn9wxQ0gAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"mina","middleName":"","lastName":"arabzadeh","suffix":""}],"badges":[],"createdAt":"2025-12-05 22:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8290942/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8290942/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99789300,"identity":"21f7b577-fe66-4692-9b8a-0c60b52a1260","added_by":"auto","created_at":"2026-01-08 12:49:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":275205,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8290942/v1/0d9bb9f6-babe-4d21-b3c4-689c080c8b62.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Critical Role of Bimanual Pelvic Examination by a Midwife in the Early Detection of Advanced Endometrial Cancer in a Postmenopausal Woman With Unexplained Spotting","fulltext":[{"header":"Background","content":"\u003cp\u003eEndometrial cancer is among the most common gynecologic malignancies worldwide, with postmenopausal bleeding being its most frequent presenting symptom [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Early-stage diagnosis is strongly associated with favorable prognosis; however, delayed evaluation or incomplete clinical assessment may result in diagnosis at an advanced stage, adversely affecting outcomes.\u003c/p\u003e \u003cp\u003eIn many healthcare systems, particularly at the primary care level, midwives play a pivotal role in the initial evaluation of women\u0026rsquo;s health concerns. Despite advances in imaging and laboratory diagnostics, the bimanual pelvic examination remains a fundamental component of gynecologic assessment [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Nonetheless, it may be underutilized or insufficiently emphasized in routine practice. This case report demonstrates how a meticulous bimanual pelvic examination performed by a midwife led to early suspicion and timely referral of a serious underlying malignancy.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA postmenopausal woman presented to a primary healthcare center with complaints of intermittent vaginal spotting of unknown origin. She reported no pelvic pain, weight loss, fever, or other systemic symptoms. Her past medical history was unremarkable, and she was not receiving hormone replacement therapy.\u003c/p\u003e \u003cp\u003eOn examination, vital signs were within normal limits, and general physical assessment revealed no abnormalities. A gynecologic evaluation was subsequently performed. During bimanual pelvic examination, the attending midwife detected an enlarged uterus with an irregular contour and reduced mobility, findings inconsistent with normal postmenopausal anatomy.\u003c/p\u003e \u003cp\u003eGiven the abnormal pelvic findings and the presence of postmenopausal bleeding, the patient was urgently referred to a gynecologist for further evaluation. Diagnostic investigations, including pelvic imaging and endometrial sampling, confirmed the presence of advanced endometrial carcinoma. Following diagnosis, the patient was referred for appropriate oncologic management.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePostmenopausal bleeding should always be considered malignant until proven otherwise [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While transvaginal ultrasonography and histopathological evaluation are key diagnostic tools, physical examination remains an invaluable initial step in clinical assessment.\u003c/p\u003e \u003cp\u003eIn this case, the bimanual pelvic examination provided immediate and critical information that raised suspicion of malignancy and expedited referral.\u003c/p\u003e \u003cp\u003eMidwives, as frontline healthcare providers in primary care settings, are uniquely positioned to identify early signs of gynecologic pathology [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This case underscores the importance of maintaining strong clinical examination skills and integrating them with diagnostic pathways. Failure to perform a comprehensive pelvic examination may delay diagnosis, resulting in disease progression and poorer prognosis.\u003c/p\u003e \u003cp\u003eStrengthening education and ongoing training for midwives in gynecologic examination techniques is therefore essential. Emphasizing the diagnostic value of bimanual examination can enhance early detection of gynecologic cancers and improve patient outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBimanual pelvic examination remains a vital component of the evaluation of postmenopausal bleeding. This case report highlights the indispensable role of midwives in the early identification of serious gynecologic pathology through careful clinical examination and timely referral. Reinforcing clinical skills in primary care settings may contribute significantly to earlier diagnosis and improved outcomes in endometrial cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for participation in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that there are no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMA performed the clinical examination, collected the clinical data, drafted the manuscript, and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394\u0026ndash;424.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Obstetricians and Gynecologists. Practice Bulletin 149: Endometrial cancer. Obstet Gynecol. 2015;125(4):1006\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Cancer Society. Endometrial cancer: Early detection, diagnosis, and staging.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. WHO guideline for the early diagnosis of cancer. Geneva: World Health Organization; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerek JS, Novak E. Berek \u0026amp; Novak\u0026rsquo;s Gynecology. 16th ed. Philadelphia: Lippincott Williams \u0026amp; Wilkins; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTimmermans A, Opmeer BC, Khan KS, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2010;116(1):160\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometrial cancer, Postmenopausal bleeding, Bimanual pelvic examination, Midwifery, Early detection","lastPublishedDoi":"10.21203/rs.3.rs-8290942/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8290942/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePostmenopausal bleeding is a red-flag symptom that mandates prompt and thorough evaluation to exclude malignancy. In primary healthcare settings, midwives frequently represent the first point of clinical contact for women presenting with gynecologic complaints. A postmenopausal woman presented to a primary healthcare center with intermittent vaginal spotting and no accompanying pain or systemic symptoms. Initial general examination was unremarkable. During gynecologic assessment, a careful bimanual pelvic examination performed by the attending midwife revealed an enlarged, irregular uterus with reduced mobility. Based on these abnormal findings, the patient was urgently referred to a gynecologic specialist. Subsequent imaging and histopathological evaluation confirmed advanced-stage endometrial carcinoma. This case highlights the essential diagnostic value of bimanual pelvic examination in women with postmenopausal bleeding and underscores the critical role of midwives in early detection and timely referral of gynecologic malignancies. Reinforcement of clinical examination skills in primary care may contribute to earlier diagnosis and improved outcomes in endometrial cancer.\u003c/p\u003e","manuscriptTitle":"The Critical Role of Bimanual Pelvic Examination by a Midwife in the Early Detection of Advanced Endometrial Cancer in a Postmenopausal Woman With Unexplained Spotting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-02 07:20:25","doi":"10.21203/rs.3.rs-8290942/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93c7930d-bb9b-4607-8bfc-001d8f6e7f2a","owner":[],"postedDate":"January 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-02T07:20:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-02 07:20:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8290942","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8290942","identity":"rs-8290942","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}