A51-year-old female visits her health care provider for vaginal bleeding and low back pain. her health history includes anxiety disorder, type 2 diabetes, and hypertension. she is 5’2” tall and weighs 224 lbs. she smoked cigarettes for 25 years but quit 8 years ago. she is post-menopausal for over a year. what is the reason for vaginal bleeding and low back pain?