Endometrial Cancer Symptoms

This article describes symptoms that occur with Endometrial Cancer.  Early recognition of the symptoms which might occur with endometrial cancer may lead to an early diagnosis and prompt treatment.  Endometrial cancer is the fourth most common cancer diagnosed in women and is the 8th most common cause of death from cancer among women in the United States.  Endometrial cancer is the most common type of gynecologic cancer.  The average age of a woman with endometrial cancer is 62 years.  About 90% of new diagnoses of endometrial cancer occur in women older than 50 years old.  Most women experience menopause at about the age of 50 years.

Endometrial cancer is more in Caucasian women however the risk of death from it is higher in women of African descent.  This is analogous to prostate cancer in men or breast cancer in women as a similar survival pattern occurs.  These differences have been studied extensively and most researchers attribute them to difference in access to health care and public health awareness.

The uterus is a female organ in the lower abdomen (or pelvis) that functions to provide a safe environment for a fetus.  The uterus sites behind the bladder and in front of the rectum.  The uterus is shaped sort of like an upside-down pear.  The neck of the pear connects to the vagina at the cervix.  The top of the pear has “arms” on the side which are called fallopian tubes that end in little finger-like projections called fimbria.  At the end of each tube is an ovary.   The endometrium is the inner lining of the uterus.  The uterus is a hollow muscle with a highly specialized function (not unlike the heart).  The layers of the uterus can respond to female hormones that normally rise and fall over the course of a menstrual cycle.  These hormones (chiefly estrogens) cause the endometrium to grow or thicken and if a fetus is not present the lining disintegrates or sheds off and this is what the woman recognizes as menstruation.

There are several different types of endometrial cancer but they are all abnormal growths of the inner lining of the uterus.  The lining of the uterus is continuous with the bottom of the “pear” and has an interface with the cervix.  This is why symptoms can also occur at the cervix and a diagnosis can also be made by sampling portions of the cervix as well.

Different types of endometrial cancer include:

  • Squamous carcinoma
  • Clear cell carcinoma
  • Secretory carcinoma
  • Mucinous carcinoma
  • Adenocarcinoma with some squamous features
  • Usual adenocarcinoma

The most common scenario that leads to discovery of endometrial cancer is an older woman who has stopped regular periods who begins to get one again.  The most important and common symptom of endometrial cancer is POST-MENOPAUSAL UTERINE BLEEDING.  This refers to bloody discharge form the vagina in an older woman.  It is important to realize that not all irregular bleeding or bleeding that occurs in an older woman is from an endometrial cancer.

Other causes of bleeding that are not cancer include:

  • Infection of the uterus or cervix
  • Wasting of the uterus or lining
  • Injury
  • A foreign body such as a IUD (intra-uterine device)
  • Benign muscle tumor (i.e. uterine fibroid)
  • Medication such as hormone replacement therapy, blood thinners (e.g. warfarin).
  • Bleeding disorders

Although there are non-cancer causes of post-menopausal vaginal bleeding, it should never be dismissed and should be brought to the attention of your doctor.  An unusual pattern of bleeding that occurs in a younger woman or a young woman that has gone several years with light or almost no period that begins to have one should also raise suspicion.  Although uterine cancer is less likely to occur in a younger woman, it should still be investigated.

While post-menopausal bleeding is the most common symptom, other symptoms may be seen as well.  These may include irregular bleeding, pelvic pain or painful intercourse.  The American College of Obstetricians and Gynecologists recommends a complete evaluation for any woman older than 35 years who has menstrual irregularity.  This might include metrorrhagia (i.e. bleeding in between normal periods) or menorrhagia (i.e. a change in the volume of bleeding, usually increased greatly).

Several risk factors for development of endometrial cancer have been established.  The most commonly noted risk factor is long exposure to or high levels of estrogen.  A woman who is taking hormone replacement therapy is likely to develop some type of bleeding.  Obesity, never having had a pregnancy, inability to become pregnant, early onset of menstruation and a late onset of menstruation are all associated with high levels of estrogen throughout the lifetime.  These are also similar risk factors for breast cancer as they tend to form in an environment of high levels of estrogen also.

Other general symptoms may include weakness, fatigue, shortness of breath or a pale appearance.  These may all occur as a result of excessive blood loss and subsequent anemia.  Anemia is never normal and in younger women might occur with iron deficiency from a poor diet and continued blood loss with menstruation.  In an older woman anemia is a red flag and should be thoroughly investigated.  The other major consideration would be colon cancer with a new found anemia in an older adult.

Treatment of endometrial cancer will often require removal of the uterus (or hysterectomy).  The term hysterectomy is really a curious one as really it should be called uterectomy (i.e. removal of the uterus).  The prefix “hyster-“is termed as such because it was thought that this organ was the origin of female “hysteria.”  It is odd that such a blatantly sexist term has persisted into modern medicine.

When symptoms of endometrial cancer are noticed, the next step is an examination by a physician and some type of imaging such as an ultrasound.  This process will also usually entail some type of sample of the lining of the uterus and/or cervix called a biopsy.  This allows the cells to be examined under a microscope and if cancer is present it can be classified.  Some types of endometrial cancer can be treated with scraping the lining of the uterus away (also known as dilation and curettage), hormonal therapy to block the growth of the uterus lining (such as high dose progesterone therapy), or  hysterectomy.  This may also include removal of the ovaries as well.  Some woman will refer to this as a “complete hysterectomy” although this really does not convey the information accurately.


  1. www.cancer.gov/cancertopics/types/endometrial
  2. www.nlm.nih.gov/medlineplus/ency/article/000910.htm
  3. Katz, VL; Lentz GM; Lobo RA; Gershenson DM. (2007) Katz: Comprehensive Gynecology, 5th ed. Chapters 3, 32. Philadelphia, PA: Mosby Elsevier
  4. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18th ed.  Chapter 75.  New York, NY: Saunders.
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.