Screening & Gynecologic Cancer
Endometrial (Uterine) Cancer Symptoms: Signs, Risk Factors and Diagnosis
The most common endometrial cancer symptom is abnormal vaginal bleeding. After menopause, any bleeding or spotting should be checked, even once and even if it's light. Before menopause, warning signs include bleeding between periods and periods that become much heavier, longer or more irregular. Because bleeding tends to show up early, most endometrial cancers are found at an early, highly treatable stage.
A lot of people who've gone through menopause see a little pink on the toilet paper and talk themselves out of calling. "It was only once." "It's probably hormones." Please call anyway. Most of the time the cause is benign, but this is the one symptom where a prompt visit genuinely changes outcomes.
What is endometrial cancer?
Endometrial cancer starts in the endometrium, the lining of the uterus. It's the most common gynecologic cancer in the U.S., and most uterine cancers are endometrial cancers. A much rarer type, uterine sarcoma, starts in the muscle wall.
It's most often diagnosed after menopause, but it can happen in younger people, especially those with obesity, PCOS or Lynch syndrome. Rates have been rising in the U.S., and death rates are higher among Black women, which is one more reason not to let bleeding go unchecked.
The symptoms, ranked by how often they matter
Abnormal bleeding (the big one)
About 9 in 10 people with endometrial cancer have abnormal bleeding. That includes:
- Any bleeding, spotting or pink or brown discharge after menopause
- Bleeding between periods
- Periods that are much heavier or longer than your normal
- Periods that become very irregular, especially after 45
- Bleeding after sex
Bleeding after menopause is never a normal part of aging. If you're in perimenopause, irregular periods are expected, which makes this harder to judge. A useful rule of thumb: tell your clinician if bleeding is much heavier than you're used to, happens between periods, or comes back after you've gone a full year without a period.
Other possible symptoms
- Watery or blood-tinged vaginal discharge
- Pelvic pain or pressure
- Pain during sex
- A mass you can feel in the pelvis
- Unexplained weight loss (usually in later stages)
All of these have many non-cancer causes, such as fibroids, polyps or thinning of the vaginal lining. The point is to get them looked at.
Who is at higher risk?
Many risk factors involve extra estrogen without enough progesterone to balance it, which can make the lining overgrow.
| Risk factor | Why it matters |
|---|---|
| Age over 50 | Most cases occur after menopause |
| Obesity | Fat tissue makes estrogen |
| Polycystic ovary syndrome (PCOS) | Irregular ovulation means less progesterone |
| Estrogen-only hormone therapy (with a uterus) | Unopposed estrogen thickens the lining |
| Tamoxifen use | Can stimulate the uterine lining |
| Type 2 diabetes | Linked to higher risk |
| Never being pregnant | More years of estrogen exposure without breaks |
| Early first period or late menopause | Longer lifetime estrogen exposure |
| Lynch syndrome | Inherited risk; often at younger ages |
| Endometrial hyperplasia | Overgrowth of the lining that can become cancer |
Things that lower risk include combined birth control pills or a hormonal IUD, pregnancy, and physical activity. If you have a uterus and take estrogen for menopause, you should also take a progestogen. Ask your clinician if you're not sure which you're on.
If colon or uterine cancer runs in your family, read our guide to Lynch syndrome.
Is there a screening test?
No routine screening test exists for people at average risk, and a Pap test is not designed to find endometrial cancer. Many people are surprised by this, since they assume their yearly Pap "checks everything."
The American Cancer Society advises people at menopause to know the risks and symptoms and to report any unexpected bleeding or spotting. People with Lynch syndrome may be offered an endometrial biopsy every 1 to 2 years.
What the workup is actually like
If you call about bleeding, here's what usually happens, often over one or two visits.
1. A conversation and pelvic exam. Expect questions about when the bleeding started, how much, your last period, medications (especially hormones or tamoxifen), and family history. Jot this down before you go.
2. Transvaginal ultrasound. A slim probe is placed in the vagina to measure the thickness of the uterine lining. It's more awkward than painful and takes about 10 to 15 minutes. After menopause, a thin lining (4 mm or less) makes cancer unlikely, though ongoing bleeding still needs more testing.
3. Endometrial biopsy. This is done in the office in a few minutes. A thin, flexible tube is passed through the cervix to take a small sample of the lining. Most people feel strong cramping for a short time, like a bad period cramp, and then it eases. Ask the office whether to take a pain reliever beforehand, bring a pad for light spotting afterward, and plan to go back to your day.
4. Hysteroscopy with D&C, if the biopsy can't be done or isn't clear. A thin camera looks inside the uterus and tissue is removed, usually under anesthesia, so you'll need someone to take you home.
Biopsy results usually take about a week. The wait is hard; ask how you'll get results so you're not refreshing the portal at midnight.
What does "hyperplasia" mean?
Hyperplasia means the lining has grown too thick. Hyperplasia without atypia has a low cancer risk and is often treated with progestin therapy. Atypical hyperplasia has a higher risk of becoming or already containing cancer and is usually treated with hysterectomy, unless you want to keep your fertility.
What if I'm younger and want children?
Endometrial cancer and atypical hyperplasia are less common before menopause, but they happen. For some younger people with early, low-grade disease, hormone treatment with close monitoring may be an option to preserve fertility. That needs careful discussion with a specialist and regular biopsies.
How is endometrial cancer treated?
Most endometrial cancer is treated with surgery: removing the uterus, cervix, fallopian tubes and usually the ovaries, often with minimally invasive techniques and small incisions. Lymph nodes may be checked. Some people need radiation, chemotherapy, hormone therapy or immunotherapy afterward.
Surgery is ideally done by a gynecologic oncologist, who can do staging during the same operation. If your gynecologist finds cancer or atypical hyperplasia, it's reasonable to ask, "Should I see a gynecologic oncologist before surgery?"
Lowering your risk
You can't control every risk factor, but these steps may help:
- Stay active and aim for a healthy weight. Extra body fat raises estrogen levels.
- On menopausal estrogen with a uterus? Take the progestogen too, as prescribed.
- Treat irregular periods. If you have PCOS or go months without a period, ask about protecting the lining with hormonal birth control or a hormonal IUD.
- Manage diabetes with your care team.
- Know your family history and ask about genetic counseling if colon or uterine cancer runs in the family.
When to see a doctor
Make an appointment promptly if you have:
- Any bleeding or spotting after menopause, even once and even if light
- Bleeding between periods or after sex
- Periods that have become much heavier or irregular, especially after age 40
- Ongoing watery or bloody discharge
- Pelvic pain that doesn't go away
Don't wait for your next yearly visit. When you call, say "postmenopausal bleeding" or "bleeding between periods" in those words; it helps the front desk book you sooner. If you're uninsured, New York's Medicaid and Essential Plan cover gynecologic evaluation, and NYC Health + Hospitals clinics see patients regardless of ability to pay. Search our directory for a gynecologist near you, or browse gynecologists in the Bronx and other boroughs.
Frequently asked questions
What is the first sign of endometrial cancer?
Abnormal vaginal bleeding is the most common first sign, especially any bleeding or spotting after menopause. In younger people it may show up as bleeding between periods or very heavy, irregular periods.
Is endometrial cancer the same as uterine cancer?
Most uterine cancers are endometrial cancers, which start in the lining of the uterus. A rarer type, uterine sarcoma, starts in the muscle wall.
Can a Pap smear detect uterine cancer?
No. A Pap test is designed to find cervical changes. It occasionally shows abnormal glandular cells, but it is not a screening test for endometrial cancer.
Is endometrial cancer curable?
When found early, endometrial cancer is often curable, usually with surgery. Because bleeding tends to appear early, many cases are diagnosed at an early stage.
Is there a screening test for uterine cancer?
There is no routine screening test for people at average risk. Reporting abnormal bleeding promptly is the best way to catch it early.
Sources
- National Cancer Institute — Endometrial Cancer Treatment and Screening (PDQ)
- ACOG — The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding (Committee Opinion)
- American Cancer Society — Signs and Symptoms of Endometrial Cancer
- CDC — Uterine Cancer: Symptoms and Risk Factors
- ACOG — Endometrial Cancer (FAQ)
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.