Endometrial Cancer: The Warning Signs Women Dismiss

Medically reviewed by Dr. Manan Boob — MBBS (KEM), MS ObGyn (Gold Medalist), DNB, Consultant Gynaecologist & Laparoscopic Surgeon, Shubham Hi-Tech Hospital and Test Tube Baby Centre, Amravati.

Some of the most important conversations in my clinic begin with a woman saying, “It was only a little spotting, so I didn’t want to bother anyone.” She is often in her fifties or sixties, periods long gone, and the spotting has been coming and going for a couple of months. Nobody should be apologising for this. It is exactly the symptom we want to hear about.

Let me explain why, without frightening you. Cancer of the womb lining, called endometrial cancer, is one of the more common gynaecological cancers. It also has an unusually helpful habit: it tends to announce itself early, through bleeding. The women who do best are very often the ones who picked up the phone at the first spot.

Bleeding after menopause is never “just age”

Menopause means twelve months without a period. After that, the womb lining should be quiet. If bleeding returns, in any amount and in any colour, it needs looking at.

Here is the reassuring part. In most women, the cause turns out to be benign. The lining may have become thin and fragile after menopause, there may be a polyp, or hormone tablets may be responsible. But a small number of these women have a precancerous change or an early cancer, and we cannot tell which group you belong to from the outside. A short, simple work-up sorts it out.

“It stopped on its own after two days. Surely that means it’s nothing?”

I wish it worked that way, but it doesn’t. Bleeding from the womb lining often comes and goes, and a quiet week proves nothing. Please don’t let the bleeding stopping talk you out of getting checked.

The signs women tend to dismiss

Postmenopausal bleeding is the lead symptom, but it isn’t the only one. Before menopause, the signals are easier to explain away:

• Periods that become much heavier, or last longer than usual
• Bleeding between periods, especially if you are over 45
• Irregular or unpredictable cycles that are new for you
• A watery or blood-streaked vaginal discharge that won’t go away
• Lower abdominal pressure or pain, which is usually a later feature

Heavy and irregular periods are very common in the years before menopause, and nearly always harmless. The point isn’t to worry about each one, but to have a low threshold for a check when the pattern changes and stays changed.

Who is more likely to be affected

The lining responds to oestrogen. When the body has more oestrogen than the balancing hormone progesterone for a long stretch, the lining can overgrow. That is why the risk goes up with obesity, diabetes, high blood pressure, long-standing irregular cycles from PCOS, never having been pregnant, a late menopause, or oestrogen-only hormone therapy. A family history of bowel or womb cancer at a young age also matters, because it can point to an inherited condition (Lynch syndrome). Having risk factors doesn’t mean you will get it, and having none doesn’t mean you are exempt.

Myth versus fact

Myth: “My Pap smear was normal, so my womb is fine.” Fact: A Pap smear checks the cervix. The womb lining is a different place, examined with different tests. We cover cervical screening in our guide to Pap and HPV tests.

Myth: “At my age, bleeding is just hormones.” Fact: After menopause, bleeding is a reason to be seen, not a hormone fluctuation to be tolerated.

What to expect at your appointment

There is no need to dread this visit. We start by talking through the bleeding pattern, your medicines and your health history, followed by a gentle examination. The usual next step is a transvaginal ultrasound, which measures how thick the womb lining is. A thin lining after menopause is very reassuring. If it is thicker than expected, or the bleeding keeps recurring, we take a small sample of the lining. Sometimes we look inside the womb with a thin camera, a procedure called hysteroscopy, which lets us see a polyp or a suspicious patch directly and sample it accurately. You can read about it in our simple guide to hysteroscopy or on our diagnostic and operative hysteroscopy page.

“If it does turn out to be cancer, what happens then?”

I’ll answer this honestly, because it is the question sitting behind every other one. When endometrial cancer is found, treatment is most often surgery, which removes the womb, tubes and ovaries and allows the extent of disease to be checked. Many women can have this done by keyhole surgery, which usually means smaller wounds and a quicker return to normal life. Whether anything further is needed depends on what the examination of the tissue shows: the type, the grade, and how far it has spread. I won’t give you a number from a textbook, because numbers describe groups and you are one person. What I can say is that being seen early gives the best chance of a straightforward plan. Our gynaecologic oncology and total laparoscopic hysterectomy pages explain the care in more detail.

A small note on prevention

You can’t control everything, but you can influence some of it: keeping weight in a healthy range, managing diabetes and blood pressure, and getting irregular cycles from PCOS looked after rather than ignored. If you are on hormone therapy or tamoxifen, mention any bleeding promptly, and never take oestrogen on your own without a doctor’s guidance.

Please don’t wait it out

If you have bleeding after menopause, or a change in your periods that has lasted more than a few weeks, come and see us. At Shubham Hi-Tech Hospital and Test Tube Baby Centre in Amravati, our gynaecology team can do the examination, ultrasound and, where needed, hysteroscopy and biopsy in one place, and explain every result in plain words. Call +91-8668954915 to book, or use our contact page.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.