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

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.