In postmenopausal women what symptom should prompt evaluation for malignancy?

In postmenopausal women, any abnormal vaginal bleeding should prompt evaluation for malignancy. This includes bleeding that occurs after a period of amenorrhea or any unexpected spotting. Other concerning symptoms may include unusual vaginal discharge or pelvic pain, but abnormal bleeding is the most critical sign warranting further investigation for potential uterine, cervical, or ovarian cancer.