Menopause for half a year and it comes again, what's going on?

Patient's question:

I am 48 years old. Six months ago, I had a D&C surgery because of excessive menstrual bleeding and thickened endometrium. One month after the surgery, I had a little bit of menstruation, but after that, it didn't come again. Now, it has been more than half a year since then. Yesterday, I suddenly had a little bit of bleeding again, and I also have lower back pain and a slight pain in my lower abdomen. I would like to ask the doctor if I might have developed a new condition. Could bleeding after menopause be due to a tumor?

Doctor's answer:

Analysis of the condition: Women in menopause often overlook the presence of gynecological tumors due to irregular menstruation. Moreover, the symptoms of tumors are also irregular vaginal bleeding, making it difficult to distinguish from clinical manifestations.
Advice: It is recommended to check with a gynecologist, undergo a cervical cytology smear test, and have a color Doppler ultrasound of the uterine adnexa. Since there was endometrial thickening during the previous D&C, if the ultrasound still shows endometrial thickening, it is best to have another D&C.
Doctor's inquiry:

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