Endometrial Cancer

• Bleeding after menopause is the usual presenting symptom – however, bleeding after menopause is often caused by many other benign causes such as polyps or vaginal dryness.
• Endometrial cancer can occur before menopause (occasionally) – If there is any bleeding between periods or if the periods are prolonged or heavier, this needs to be taken seriously and investigated.  

It’s important to note that while only 5 to 6 out of every 100 women with postmenopausal bleeding will be diagnosed with endometrial cancer, it remains the most significant potential cause. For this reason, any such bleeding should always be taken seriously.

Endometrial cancer develops when cells in the lining of the uterus (endometrium) grow abnormally. It's most commonly linked to an imbalance in the hormone oestrogen, especially when not balanced by progesterone. Risk factors include obesity, diabetes, polycystic ovary syndrome (PCOS), early onset of periods or late menopause, and not having children.

Combined HRT is actually protective against endometrial cancer. Risk of endometrial cancer is 30% less in women on HRT. Progesterone within the combined HRT opposes even the endogenous oestrogen in the body, which means less risk of endometrial cancer.  

Yes, endometrial cancer often presents early with abnormal vaginal bleeding, especially after menopause. This makes early detection and prompt treatment more likely.

To investigate and diagnose potential endometrial cancer, you may need the following tests:

• Pelvic examination – This helps identify other possible causes of bleeding, such as cervical polyps or thinning (atrophy) of the vaginal tissues.

• Pelvic ultrasound scan – Often the first step, this assesses the thickness of the uterine lining and checks for any abnormalities. After menopause, the endometrial lining is typically thin and measures less than 4mm.

• Hysteroscopy with biopsy – This is the gold standard test. It involves an endoscopic examination of the inside of the uterus and taking a sample (biopsy) of the endometrial lining to confirm or rule out cancer.

MRI scan is needed to make sure that the cancer cells are limited to the uterine cavity. Invasion of cells into the uterine walls can be assessed on MRI as well as lymph node status.  

There are two main types:

• Type 1 is the most common and is typically hormone-sensitive, often developing slowly.

• Type 2 is less common but more aggressive and not usually hormone-related.

Treatment and prognosis depend on the type and stage of the cancer.

A simple hysterectomy which is often carried out as a key-hole procedure is often the only treatment needed. A key-hole hysterectomy is associated with tiny incisions, a short hospital stay and quick recovery.  

After hysterectomy, the cancerous cells are further tested to see if there is spread beyond the inner half of the uterine wall. If this is a possibility, further treatment with radiotherapy may be offered to minimise chances of cancer cells coming back.

As most of the cases of endometrial cancer are diagnosed at an early stage, the prognosis is usually excellent. It is therefore important to see a doctor quickly if you have any symptoms of abnormal bleeding. 

We recommend a Well-woman check at 50 years of age which your GP can organise or we will be happy to arrange.