A menopausa é uma fase natural da vida da mulher, mas nem todas as alterações devem ser encaradas como normais. Uma hemorragia após a menopausa merece atenção: pode ter causas benignas, mas também ser um sinal de cancro do endométrio, pelo que deve ser avaliada.
É com agrado que tenho visto que a menopausa é cada vez mais um tema discutido abertamente, contribuindo para desmistificar um processo natural da vida da mulher e dar a conhecer o que a ele diz respeito, o que é normal e o que deve ser entendido como um sinal de alarme.
Esta fase traz consigo alterações que podem impactar o dia-a-dia das mulheres, com ciclos menstruais que terminam e níveis hormonais que se alteram, além dos sintomas como afrontamentos, alterações de sono ou secura vaginal. Tudo isto faz parte desta nova etapa. Porém, há uma mudança que não deve ser atribuída à menopausa: o aparecimento de uma hemorragia vaginal depois de um período prolongado sem menstruação, ou seja, qualquer sangramento vaginal que ocorra depois de 12 meses sem menstruar.
Esta hemorragia pode ser semelhante à menstruação, mas também pode manifestar-se através de pequenas perdas de sangue ou um corrimento rosado ou acastanhado. O importante é saber que, mesmo quando é pouco intenso ou acontece apenas uma vez, a mulher deve procurar um profissional de saúde para uma avaliação. A razão é simples: este pode ser um dos primeiros sinais de cancro do endométrio, um tumor que se desenvolve no revestimento interno do útero.
Embora a maioria das mulheres com hemorragia pós-menopausa não tenha cancro, este é um sinal que pode, literalmente, salvar vidas, já que é muito evidente e pode significar um prognóstico muito favorável quando o tumor é diagnosticado numa fase precoce. Este é, desde logo, o sintoma mais frequente deste tipo de cancro e contribui, quando não é desvalorizado, para 80% dos diagnósticos precoces.
A avaliação médica irá permitir perceber a origem do sangramento e determinar se serão necessários exames complementares, segundo cada situação clínica. O processo envolve a realização de uma observação ginecológica e uma ecografia transvaginal, para avaliar a espessura do endométrio e identificar alterações que justifiquem uma investigação mais aprofundada, que pode envolver uma histeroscopia e/ou biópsia do endométrio.
Durante a consulta, a mulher deve referir não apenas o episódio de sangramento, mas também outros aspetos da sua história clínica, medicamentos que toma e eventuais antecedentes familiares. Isto porque existem outros fatores que podem aumentar o risco de alterações do endométrio, como obesidade (um dos principais fatores de risco para o desenvolvimento deste tipo de tumor), diabetes, determinadas terapêuticas hormonais ou fatores hereditários.
Contudo, é importante não transformar isto numa situação de alarme, mas encará-la como uma oportunidade para cuidar da saúde. Perante sinais do corpo, as mulheres tendem a desvalorizá-los, atribuindo-os ao cansaço e ao ritmo exigente do dia-a-dia, adiando, por vezes, a procura de uma avaliação médica. Existem várias causas benignas para a hemorragia pós-menopausa. Por exemplo, a redução dos estrogénios associados à menopausa pode provocar uma redução na espessura do endométrio e uma fragilidade dos tecidos da vagina.
A existência de pólipos também pode provocar um sangramento após a menopausa. A utilização de terapêutica hormonal da menopausa pode, igualmente, contribuir para hemorragias ou perdas irregulares de sangue durante determinados períodos do tratamento, sobretudo no início ou após as alterações da terapêutica.
Ainda assim, a mensagem é clara: perante uma hemorragia inesperada após a menopausa, esta deve ser motivo para procurar uma avaliação médica. Mais do que falar de medo, devemos falar de atenção. O cancro do endométrio pode ser tratado de forma eficaz quando detetado numa fase inicial, e reconhecer os possíveis sinais e procurar ajuda é uma parte fundamental para um diagnóstico precoce.
Na maioria dos casos, felizmente, a causa não será cancro, mas só uma avaliação médica poderá esclarecer a origem de um sangramento e, quando necessário, permitir atuar atempadamente. Fazê-lo não é alarmismo, é prevenção.
When Pope Leo took heat from Donald Trump and the MAGA movement for denouncing the war in Iran earlier this year, much of his Church stood with him. Conservative and liberal Catholics alike argued that Leo was right to condemn the fighting, given the administration’s holy-war rhetoric and its inconsistent justifications of the conflict.
This broad agreement among Catholics, however, hid a more fundamental dispute—not about Trump or Iran, but about the principles that guide how the Church thinks about war. The “just war” theory, which draws from Saint Augustine’s writings during the fall of the Roman empire and was systematized in the Middle Ages by Saint Thomas Aquinas, exists to address a persistent theme in human history: Bad actors regularly commit terrible deeds, and nations must decide when and how to defend themselves, or to intervene on behalf of others. According to the framework, an armed conflict must have a just cause, such as responding to an unprovoked attack. It must be pursued as a last resort and have reasonable hope of success. It must be motivated by good intentions and carried out by a legitimate authority. It must rely only on just means, such as using proportional force and distinguishing between combatants and civilians. Its expected good must outweigh its inevitable harm.
Despite its long lineage, just-war theory’s influence in Catholic thought has been dwindling for decades as conflicts have become more complex and weapons more destructive. To some observers, the clearest sign yet of the framework’s fall from favor came in May, when Pope Leo wrote in his encyclical Magnifica Humanitas that it is “outdated.” A month later, 178 cardinals met at the Vatican to discuss whether the Church should move away from the language of just war. Still, many Catholics support the theory and dispute the suggestion that it’s passé. They believe that it was, and remains, the best way the Church has to make sense of war. At the center of the debate is a deeper question: How can the Church help limit violence in an all-too-violent world, in which nuclear bombs, terrorist attacks, and AI-guided drones are ever-present threats?
Just-war theory isn’t just the stuff of papal encyclicals. Military academies teach courses and host conferences about it. Human-rights laws are in part derived from it. Prominent pundits and politicians have opposed and defended some of the largest conflicts of the past few decades on just-war grounds.
Since the mid-20th century, though, the Vatican has seemed more focused on promoting peace than on explaining the ins and outs of the theory. The Church has tended to emphasize nonviolence “as the first resort and oftentimes an effective alternative to the use of military force,” Gerard Powers, who directs the Catholic Peacebuilding Studies program at the University of Notre Dame, told me. Pope John XXIII wrote about the need for nuclear disarmament; Pope Paul VI made an impassioned anti-war plea at the United Nations; Saint John Paul II described war as “always a defeat for humanity.” Recent Catholic scholarship, moreover, has highlighted the Church’s role as a mediator in conflicts—between the Colombian government and the Revolutionary Armed Forces of Colombia, for example—and criticized just-war theory for being too focused on the ethics of war rather than on nonviolent ways of preventing it.
Popes have also voiced doubts about how applicable just-war theory can be today. In 2003, the future Pope Benedict XVI said that “we should be asking ourselves if it is still licit to admit the very existence of a ‘just war.’” In 2020, Pope Francis wrote that “it is very difficult nowadays” to “speak of the possibility of a ‘just war.’” As critics of the theory have pointed out, modern weapons and tactics have far more destructive power than they had in the late Roman and medieval period, when just-war theory was formulated, which makes just-war principles especially difficult to apply. When a military uses aerial bombing, civilians are almost certain to be among the casualties. Autonomous weapons raise new questions about moral accountability, which is the core of any ethical theory.
Some critics also assert that just-war theory has been “ineffective or inadequate at preventing and restraining war,” as Eli McCarthy, a lecturer in theology at Georgetown University, told me. “Even if we see a war that looks like it might meet the just-war criteria,” he said, those same wars tend to “get us stuck in cycles of violence.” The United States entered World War II, for example, to respond to Japan’s attack on Pearl Harbor, to protect Europe against fascism and Nazism. That conflict also led to the Cold War and several proxy wars. America invaded Afghanistan after the 9/11 terrorist attacks killed thousands of civilians, but that war did not permanently rid the country of the Taliban, and escalated the War on Terror.
The Vatican’s zeal for peace and seeming ambivalence about just-war theory has drawn criticism, especially among a conservative contingent of American Catholics. In the early 2000s, the philosopher Michael Novak and the writer George Weigel contended that the Church’s reflexive opposition to war downplayed governments’ moral obligation to uphold order and keep their citizens safe from autocrats and terrorists. Weigel wrote that the post–World War II Church had adopted a “functional pacifism” that ignored centuries of just-war teaching. Novak suggested that the Church underestimated the asymmetries presented by terrorism: Ideologically motivated, non-state actors intent on destruction at all costs are unlikely to be moved by diplomacy and may well be stopped only by force. More recently, J. D. Vance admonished Pope Leo in April “to be careful when he talks about matters of theology,” after the pontiff’s criticism of the Iran conflict. “There is more than a 1,000-year tradition of just-war theory,” Vance said. To skeptics of just-war theory, these criticisms exemplify its biggest flaw: how susceptible it is to being interpreted too broadly, or co-opted for political goals. Novak and Weigel defended the invasion of Iraq on just-war grounds, as did Catholic politicians including Joe Biden and the late U.S. Representative Henry Hyde.
Just-war theory’s defenders have answers to this objection and others. John Schwenkler, a philosopher at the University of Texas at Austin, told me that the fact that the theory is “only as good as those whose hands it is in” doesn’t invalidate it. Just-war theory, he said, was meant to be “a framework within which to reason and debate,” not a “decision manual” that provides ready-made answers. If anything, the sloppy use of just-war theory makes clarifying its criteria “more important than ever.”
Theorists have also applied just-war criteria to new technologies. After World War II, when popular opinion held that the use of atomic bombs in Hiroshima and Nagasaki had been a “necessary evil,” the Oxford University philosopher Elizabeth Anscombe argued against their use on just-war grounds. She and others maintained that the scale of destruction, though ghastly, was secondary: What mattered was that the United States had intentionally targeted civilians—and that was unjust. To the theory’s supporters, examples such as this show that it is neither overly permissive nor outdated; instead, it sets a high bar for the legitimate use of force and can be used to think about the ethics of novel technologies.
In Magnifica Humanitas, Leo wrote that just-war theory has “all too often been used to justify any kind of war,” even as he also affirmed “the right to self-defense in the strictest sense.” (Notre Dame’s Powers told me that “the Church has not become pacifist,” pointing out that Leo has supported Ukraine’s defensive war against Russia.) Catholic leaders and academics have interpreted this part of the encyclical in a variety of ways. In a video address delivered to attendees of a conference last month in Rome, Cardinal Robert McElroy, the archbishop of Washington, D.C., said that he understood the pope’s statement as a “remarkable transformation” toward “eclipsing the role of the just-war tradition.” The Catholic philosopher Edward Feser, however, told me that “there’s no rupture with traditional just-war theory,” since Leo “explicitly acknowledges that military action for the purpose of strict self-defense can be legitimate.” What’s not legitimate, Feser has written, are wars such as the one in Iran: those that, as he told me, are carried out under “expansive and vague” aims that seem to “shift from moment to moment.”
The Vatican now faces two challenges. It will need to clarify what it means, exactly, when it says that just-war theory is outdated. And if the Church does intend to move away from the just-war framework, it will need to offer a successor theory that better addresses the many moral challenges that modern-day wars pose.
In the early Middle Ages, when soldiers returned from battle, the Catholic Church would at times impose spiritual penalties called “penances” on them for injuring or killing someone. The particulars varied—being denied Holy Communion for a time, or being told to eat only bread and water on certain days. “I think it’s actually quite a profound thing,” Phil Klay, a Catholic writer and Iraq War veteran, told me about the practice. “You’d have to seek forgiveness even if you were in a just war.”
This tension is at the root of the Church’s debates about just-war theory. Many supporters and critics agree that the theory is prone to abuse. They also agree that peace is precious. But their disagreement underlies how all wars, no matter how righteous, are tragic because they require killing people who, as Klay put it, are “made in the image of God.”
For now, the Catholic Church seems to be distancing itself from just-war theory even more overtly than in the past. At the September conference in Rome, Cardinal Charles Maung Bo, the archbishop of Yangon in Myanmar, told attendees that “we need a new paradigm” that recognizes nonviolence as “a more effective form of defence.” Cardinal McElroy said that Leo’s Magnifica Humanitas deemed that the theory “can no longer constitute an authentic pathway of moral guidance in the life of the Church.”
But earlier this year he also said that “there are times when military force is morally legitimate.” Most Catholics invested in the Church’s teaching on war understand that despots, fanatics, and the human urge to dominate can make war unavoidable. For all of its faults, just-war theory recognizes this. Any new Church teaching would need to contend with this reality too.
This article originally stated that one of the reasons the United States entered World War II was to end the Holocaust; in fact, the government was not fully aware of the Holocaust until after it entered the war.
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