Endometrial Cancer: Symptoms, Causes & Treatment Options

What Is Endometrial Cancer?

Endometrial cancer is a malignant tumor that develops in the endometrium, the inner lining of the uterus. It is the most common gynecologic cancer in developed countries, accounting for over 95% of all uterine cancers. The disease typically affects women after menopause, with a median age at diagnosis of 63 years.

The endometrium is the tissue that lines the inside of the uterus (womb). During the reproductive years, this lining thickens each month in preparation for pregnancy, then sheds during menstruation if pregnancy does not occur. This monthly cycle is controlled by hormones, particularly estrogen and progesterone. When the delicate balance between these hormones is disrupted, cells in the endometrium can begin to grow abnormally, potentially leading to cancer.

Endometrial cancer differs from cervical cancer, which develops in the lower part of the uterus that connects to the vagina. While cervical cancer is often caused by human papillomavirus (HPV) and can be detected through Pap smears, endometrial cancer has different risk factors and typically presents with vaginal bleeding as its primary symptom. Understanding this distinction is important because the screening, prevention, and treatment approaches differ significantly between these two types of cancer.

The disease is categorized into different types based on microscopic examination of the tumor cells. Type I endometrial cancer, which accounts for approximately 80% of cases, is typically estrogen-dependent and often associated with obesity, diabetes, and excess estrogen exposure. These tumors tend to be less aggressive and have a favorable prognosis. Type II endometrial cancer is less common but more aggressive, occurring in older women and not related to estrogen exposure. Type II cancers include serous and clear cell carcinomas, which require more intensive treatment.

How Endometrial Cancer Develops

The development of endometrial cancer typically follows a stepwise progression. In many cases, the cancer is preceded by a condition called endometrial hyperplasia, where the uterine lining becomes abnormally thick due to excessive cell growth. While simple hyperplasia rarely progresses to cancer, atypical hyperplasia (also called endometrial intraepithelial neoplasia or EIN) carries a significant risk of developing into or coexisting with cancer.

The hormone estrogen plays a central role in stimulating endometrial cell growth. Normally, progesterone balances this effect by promoting the shedding of the uterine lining during menstruation. When estrogen acts on the endometrium without adequate progesterone opposition—a situation called "unopposed estrogen"—cells can proliferate excessively. Over time, genetic mutations may accumulate, transforming normal cells into cancerous ones. This explains why conditions that increase estrogen exposure or reduce progesterone levels are associated with higher risk.

How Endometrial Cancer Spreads

Initially, endometrial cancer grows within the uterine lining. As it progresses, the tumor can invade through the endometrium into the muscular wall of the uterus (myometrium). The depth of this invasion is an important factor in determining prognosis and treatment. Cancer cells can also spread to nearby structures including the cervix, fallopian tubes, and ovaries.

Beyond local invasion, endometrial cancer can metastasize (spread) through the lymphatic system to pelvic and para-aortic lymph nodes. In advanced stages, the cancer may spread to distant organs including the lungs, liver, bones, and brain. However, because most cases are detected at an early stage due to the prominent symptom of abnormal bleeding, the majority of patients have localized disease at diagnosis.

What Are the Symptoms of Endometrial Cancer?

The most common symptom of endometrial cancer is abnormal vaginal bleeding, occurring in over 90% of cases. For postmenopausal women, any vaginal bleeding is abnormal and requires prompt medical evaluation. Premenopausal women may experience heavier or longer periods, bleeding between periods, or irregular menstrual cycles.

Endometrial cancer typically presents with symptoms early in its development, which is one reason why the prognosis is often favorable—most cases are detected before the cancer has spread. The hallmark symptom is abnormal uterine bleeding, which manifests differently depending on whether a woman has gone through menopause.

For postmenopausal women, any vaginal bleeding is considered abnormal and warrants medical attention. This includes even small amounts of spotting or blood-tinged discharge. While postmenopausal bleeding has many benign causes (such as vaginal atrophy or polyps), approximately 10% of cases are due to endometrial cancer. The risk is higher if the bleeding is recurrent, heavy, or accompanied by other symptoms.

Premenopausal women with endometrial cancer may experience changes in their normal menstrual pattern. This can include periods that are heavier or last longer than usual, bleeding or spotting between periods, or irregular cycles. Because these changes can occur for many reasons, they are sometimes dismissed or attributed to approaching menopause. However, persistent changes in menstrual bleeding should be evaluated, particularly in women with risk factors for endometrial cancer.

Other Warning Signs

Beyond abnormal bleeding, endometrial cancer can cause other symptoms, particularly as the disease progresses:

• Abnormal vaginal discharge: This may be watery, blood-tinged, or different from normal discharge. Postmenopausal women typically have minimal vaginal discharge, so any noticeable change is significant.
• Pelvic pain or pressure: As the tumor grows, it can cause discomfort or a sense of fullness in the pelvis. Pain is more common in advanced stages.
• Pain during intercourse: Discomfort during sexual activity can occur, particularly with larger tumors.
• Difficult or painful urination: If the tumor presses on the bladder, urinary symptoms may develop.
• Unexplained weight loss: Significant unintentional weight loss is a concerning symptom that can occur with advanced cancer.

Symptoms May Have Other Causes

It is important to recognize that the symptoms of endometrial cancer can also be caused by many benign (non-cancerous) conditions. Postmenopausal bleeding, for example, is most commonly due to vaginal atrophy, endometrial polyps, or hormone fluctuations. Endometrial hyperplasia (thickening of the uterine lining) can cause similar symptoms but is not cancer, though it may be a precursor to cancer in some cases.

Uterine fibroids, which are benign growths in the muscular wall of the uterus, are another common cause of abnormal bleeding in premenopausal women. Infections, medications (including blood thinners and hormone therapy), and other conditions can also cause bleeding. This is why medical evaluation is essential—only proper testing can determine the cause of symptoms.

What Causes Endometrial Cancer?

Endometrial cancer develops when cells in the uterine lining undergo genetic changes that cause uncontrolled growth. The primary risk factor is prolonged exposure to estrogen without adequate progesterone, which occurs in obesity, never having been pregnant, early menstruation, late menopause, and certain hormone therapies. Approximately 5% of cases are hereditary, most commonly due to Lynch syndrome.

The exact cause of endometrial cancer is complex and involves multiple factors working together. At its core, cancer develops when normal cells acquire genetic mutations that allow them to grow and divide without normal controls. In endometrial cancer, these mutations often occur in genes that regulate cell growth, DNA repair, or hormone signaling. Over time, the accumulation of mutations transforms normal endometrial cells into cancer cells.

The hormone estrogen plays a central role in most cases of endometrial cancer. Estrogen stimulates the cells of the endometrium to grow and divide. When estrogen acts on the endometrium without the balancing effect of progesterone (which triggers the shedding of the uterine lining), cells can proliferate excessively. This condition of "unopposed estrogen" creates an environment where genetic mutations are more likely to occur and accumulate.

Obesity and Weight

Obesity is the single most important modifiable risk factor for endometrial cancer. Women with obesity have 2-4 times the risk of developing endometrial cancer compared to women at a healthy weight, and the risk increases with higher body mass index (BMI). Severe obesity (BMI >40) can increase risk by up to 7-fold.

The connection between obesity and endometrial cancer is related to estrogen. Fat tissue produces estrogen through a process called aromatization, where androgens (male hormones present in all women in small amounts) are converted to estrogen. More body fat means more estrogen production. Additionally, obesity often disrupts ovulation, leading to irregular menstrual cycles and reduced progesterone production. This combination of increased estrogen and decreased progesterone creates the "unopposed estrogen" situation that promotes endometrial cancer.

Reproductive and Hormonal Factors

Several reproductive factors influence endometrial cancer risk by affecting lifetime estrogen exposure:

• Never having been pregnant (nulliparity): Pregnancy involves high progesterone levels that protect the endometrium. Women who have never been pregnant lack this protective exposure.
• Early menstruation (before age 12): Starting periods early means more years of menstrual cycles and more cumulative estrogen exposure.
• Late menopause (after age 55): Similarly, later menopause extends the years of estrogen exposure.
• Infertility: Conditions that cause infertility, such as polycystic ovary syndrome (PCOS), are often associated with irregular ovulation and hormonal imbalances that increase risk.

Certain hormone therapies also affect risk. Estrogen-only hormone therapy (without progesterone) significantly increases endometrial cancer risk and is only appropriate for women who have had a hysterectomy. Combined hormone therapy (estrogen plus progestin) has a much lower or neutral effect on risk. Tamoxifen, a medication used to treat and prevent breast cancer, acts like estrogen on the uterus and increases endometrial cancer risk.

Hereditary Factors and Lynch Syndrome

Approximately 5% of endometrial cancers are hereditary, meaning they result from inherited genetic mutations that increase cancer susceptibility. The most common hereditary syndrome associated with endometrial cancer is Lynch syndrome (also called hereditary nonpolyposis colorectal cancer or HNPCC).

Lynch syndrome is caused by mutations in genes responsible for DNA mismatch repair (MLH1, MSH2, MSH6, and PMS2). Women with Lynch syndrome have a 40-60% lifetime risk of developing endometrial cancer, often at a younger age than sporadic cases. They also have significantly elevated risks for colorectal cancer and other malignancies. If you have endometrial cancer, especially if diagnosed before age 50 or with a family history of colorectal or endometrial cancer, testing for Lynch syndrome may be recommended.

Other Risk Factors

• Age: Risk increases with age, with most cases occurring after age 50.
• Diabetes: Women with type 2 diabetes have approximately double the risk, partly related to obesity and insulin resistance.
• Prior pelvic radiation: Radiation therapy to the pelvis for other cancers slightly increases risk.
• Endometrial hyperplasia: Particularly atypical hyperplasia (EIN) is considered a precursor to cancer.
• Prior history of breast or ovarian cancer: These conditions share some genetic and hormonal risk factors.

How Is Endometrial Cancer Diagnosed?

Endometrial cancer is diagnosed through a combination of physical examination, transvaginal ultrasound to measure endometrial thickness, and tissue biopsy to examine cells under a microscope. The gold standard for diagnosis is histological (microscopic) examination of endometrial tissue obtained through biopsy or dilation and curettage (D&C). If cancer is confirmed, imaging studies determine whether it has spread.

The diagnostic process for endometrial cancer typically begins when a woman reports abnormal vaginal bleeding to her healthcare provider. The evaluation follows a systematic approach designed to determine the cause of bleeding and, if cancer is present, to determine its extent. Many countries have standardized diagnostic pathways to ensure timely and thorough evaluation.

Initial Evaluation

The first step is a thorough medical history and physical examination. Your doctor will ask about the nature of the bleeding (timing, amount, duration), any associated symptoms, menstrual history, reproductive history, family history of cancer, and current medications. A pelvic examination allows assessment of the uterus and surrounding structures.

Transvaginal ultrasound is typically the first imaging test performed. An ultrasound probe is inserted into the vagina to obtain detailed images of the uterus. This test measures the thickness of the endometrium (endometrial stripe). In postmenopausal women not taking hormone therapy, an endometrial thickness greater than 4 mm is considered abnormal and warrants further investigation. Ultrasound can also detect other abnormalities such as polyps, fibroids, or structural changes in the uterus.

Tissue Sampling

The definitive diagnosis of endometrial cancer requires microscopic examination of tissue from the endometrium. Several methods can obtain this tissue:

• Endometrial biopsy: This office procedure involves inserting a thin, flexible tube through the cervix into the uterus to suction out a small sample of the endometrial lining. It takes only a few minutes and may cause mild cramping. Endometrial biopsy detects cancer in approximately 90% of cases where cancer is present.
• Hysteroscopy: A thin, lighted camera (hysteroscope) is inserted through the cervix to directly visualize the inside of the uterus. This allows targeted biopsies of any visible abnormalities. Polyps can be removed during the same procedure. Hysteroscopy can be performed in an office or operating room setting.
• Dilation and curettage (D&C): This procedure involves dilating the cervix and scraping tissue from the uterine lining. It is typically performed under anesthesia and may be combined with hysteroscopy. D&C provides more tissue for analysis and is sometimes recommended when office biopsy results are inconclusive.

Pathology and Staging Workup

If biopsy confirms endometrial cancer, the pathology report provides critical information including the type of cancer (endometrioid, serous, clear cell, etc.), the grade (how abnormal the cells appear, graded 1-3), and whether there are features suggesting aggressive behavior. This information guides treatment planning.

Additional imaging studies are performed to determine whether the cancer has spread beyond the uterus (staging). These typically include:

• CT scan of the chest, abdomen, and pelvis: Provides detailed images to look for enlarged lymph nodes or spread to other organs.
• MRI of the pelvis: Offers superior visualization of the uterus and can assess depth of tumor invasion into the uterine wall and potential spread to adjacent structures.
• PET-CT scan: May be used in certain situations to evaluate for distant metastases or to plan treatment for recurrent disease.

The final stage is determined after surgery, when the removed tissues can be examined microscopically. Endometrial cancer staging uses the FIGO (International Federation of Gynecology and Obstetrics) system, which considers the extent of tumor spread and guides treatment decisions.

What Are the Stages of Endometrial Cancer?

Endometrial cancer is staged using the FIGO system, ranging from Stage I (confined to the uterus) to Stage IV (spread to distant organs). Approximately 70% of cases are diagnosed at Stage I, when the cancer is localized and highly treatable with surgery alone. The stage determines prognosis and guides treatment decisions.

Cancer staging describes how far a cancer has spread at the time of diagnosis. For endometrial cancer, the FIGO (International Federation of Gynecology and Obstetrics) staging system is used. Staging is primarily surgical, meaning the final stage is determined after the uterus and other tissues are removed and examined by a pathologist. Pre-operative imaging provides an estimate, but the surgical findings give the definitive stage.

Approximately 70% of endometrial cancers are diagnosed at Stage I, when the disease is confined to the uterus. This is largely because abnormal bleeding—the cardinal symptom—prompts women to seek medical attention early. Early-stage disease has excellent outcomes, with most women being cured by surgery alone or surgery plus adjuvant therapy. The less favorable outcomes in advanced stages underscore the importance of prompt evaluation when symptoms arise.

How Is Endometrial Cancer Treated?

The primary treatment for endometrial cancer is surgery, typically total hysterectomy with removal of both fallopian tubes and ovaries (bilateral salpingo-oophorectomy). Sentinel lymph node biopsy helps determine if cancer has spread. Additional treatment with radiation therapy, chemotherapy, or immunotherapy may be recommended based on cancer stage, grade, and molecular characteristics.

Treatment for endometrial cancer is individualized based on the stage of disease, the type and grade of cancer, molecular features of the tumor, and the patient's overall health and preferences. A multidisciplinary team including gynecologic oncologists, radiation oncologists, and medical oncologists collaborates to develop the optimal treatment plan. The discussion between you and your healthcare team about treatment options should include the goals of treatment, expected benefits, and potential side effects.

Surgery

Surgery is the cornerstone of treatment for most patients with endometrial cancer. The standard operation is a total hysterectomy (removal of the uterus and cervix) combined with bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries). Removing the ovaries is important because they can harbor microscopic cancer spread and because their continued estrogen production could fuel cancer growth.

Modern surgical techniques have evolved significantly. Most hysterectomies for endometrial cancer are now performed using minimally invasive approaches—either laparoscopic surgery or robotic-assisted surgery—rather than traditional open surgery through a large abdominal incision. Minimally invasive surgery offers advantages including smaller incisions, less pain, shorter hospital stays, faster recovery, and fewer complications. Most patients can return to normal activities within 4-6 weeks.

Sentinel lymph node mapping is increasingly used to assess whether cancer has spread to lymph nodes. A dye is injected near the tumor, and the first lymph nodes that drain the area (sentinel nodes) are identified and removed for examination. If these nodes are cancer-free, more extensive lymph node removal may be avoided, reducing the risk of lymphedema (chronic swelling).

Fertility-Sparing Treatment

For young women with very early-stage, low-grade endometrial cancer who wish to preserve fertility, conservative management may be an option in carefully selected cases. This approach involves treating the cancer with high-dose progestin therapy (hormones) while preserving the uterus. Patients require close monitoring with regular biopsies to ensure the cancer responds to treatment. Once childbearing is complete, hysterectomy is strongly recommended because of the ongoing cancer risk.

This approach is only appropriate for a small subset of patients and carries some risk of the cancer progressing or recurring. It requires thorough counseling about risks and benefits and should be managed by a gynecologic oncologist experienced in this approach.

Radiation Therapy

Radiation therapy uses high-energy beams to destroy cancer cells. For endometrial cancer, radiation may be used after surgery (adjuvant therapy) to reduce the risk of cancer returning, or as primary treatment for women who cannot undergo surgery. Two types of radiation are used:

• External beam radiation therapy (EBRT): Radiation is delivered from a machine outside the body, targeting the pelvis. Treatment is typically given daily over several weeks. Side effects may include fatigue, skin changes, and bladder or bowel irritation.
• Brachytherapy (internal radiation): A radiation source is placed directly inside the vagina, allowing high doses to reach the area where cancer is most likely to recur while minimizing exposure to surrounding tissues. Brachytherapy may be used alone (vaginal brachytherapy) or in combination with external beam radiation.

The decision to use radiation depends on factors including the stage, grade, histologic type, and other pathologic features of the cancer. Low-risk early-stage cancers often do not require radiation after surgery, while higher-risk features increase the benefit of adjuvant radiation.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout the body. For endometrial cancer, chemotherapy may be recommended for:

• Advanced-stage cancer (Stage III or IV)
• Aggressive histologic types (serous, clear cell, carcinosarcoma)
• Recurrent cancer
• In combination with radiation for certain high-risk features

The most common chemotherapy regimen is carboplatin combined with paclitaxel, given intravenously every three weeks for 6 cycles. Side effects may include nausea, fatigue, hair loss, increased infection risk, and numbness or tingling in hands and feet (peripheral neuropathy). Your oncology team will monitor for side effects and provide supportive care.

Immunotherapy

Immunotherapy harnesses the body's immune system to fight cancer. For endometrial cancer, checkpoint inhibitors such as pembrolizumab have shown significant benefit, particularly for tumors with specific molecular characteristics:

• MSI-high/dMMR tumors: Tumors with high microsatellite instability or deficient mismatch repair (often associated with Lynch syndrome) respond well to immunotherapy.
• Combination therapy: The combination of pembrolizumab with lenvatinib (a targeted therapy) has shown benefit in advanced endometrial cancer regardless of MSI status.

Immunotherapy has transformed treatment options for advanced and recurrent endometrial cancer, offering improved outcomes for patients who previously had limited options.

Hormone Therapy

Hormone therapy using progestins (synthetic progesterone) can slow the growth of hormone-sensitive endometrial cancers. This is primarily used for:

• Fertility-sparing treatment in young women with early-stage, low-grade cancer
• Recurrent or metastatic cancer, particularly low-grade tumors
• Patients who cannot tolerate more aggressive treatments

Hormone therapy is given as pills or injections. While generally well-tolerated, side effects may include weight gain, fluid retention, and increased blood clot risk.

What Is the Prognosis for Endometrial Cancer?

The overall prognosis for endometrial cancer is favorable, with an 81% five-year survival rate across all stages. When detected at Stage I (the most common presentation), the five-year survival exceeds 95%. Prognosis depends on the stage at diagnosis, tumor grade and type, patient age and overall health, and molecular characteristics of the cancer.

Endometrial cancer has one of the best prognoses among gynecologic cancers, primarily because most cases are detected early due to the prominent symptom of abnormal bleeding. The five-year survival rate represents the percentage of patients who are alive five years after diagnosis. While this statistic provides useful information, individual outcomes vary based on multiple factors.

Several factors influence prognosis:

• Stage at diagnosis: This is the most important prognostic factor. Early-stage disease has excellent outcomes, while advanced-stage disease is more challenging to treat.
• Histologic type: Type I endometrioid cancers have a better prognosis than Type II aggressive variants (serous, clear cell, carcinosarcoma).
• Tumor grade: Well-differentiated (Grade 1) tumors have a better prognosis than poorly differentiated (Grade 3) tumors.
• Molecular classification: Recent research has identified molecular subtypes that help predict prognosis and guide treatment. For example, POLE-mutated tumors have an excellent prognosis, while p53-abnormal tumors have a higher risk of recurrence.
• Lymphovascular space invasion: Cancer cells in blood or lymphatic vessels suggest higher risk of spread.
• Patient factors: Age, overall health, and ability to undergo optimal treatment affect outcomes.

Most women with endometrial cancer are cured with initial treatment. For those who experience recurrence, additional treatment options including surgery, radiation, chemotherapy, and immunotherapy may control the disease for extended periods. Advances in treatment, particularly immunotherapy, continue to improve outcomes for patients with advanced or recurrent disease.

What Happens After Treatment?

After completing endometrial cancer treatment, regular follow-up appointments monitor for recurrence and manage side effects. Follow-up typically continues for 5 years, with more frequent visits initially. Most recurrences occur within the first 3 years. Surveillance includes physical examinations, symptom review, and imaging studies when indicated.

Completing cancer treatment marks the beginning of survivorship, a period focused on monitoring for recurrence, managing long-term effects of treatment, and supporting overall health. Your oncology team will establish a follow-up schedule tailored to your individual situation and risk level.

Follow-up Schedule

A typical follow-up schedule for endometrial cancer includes:

• Every 3-4 months for the first 2 years
• Every 6 months for years 3-5
• Annually after 5 years (ongoing surveillance varies by practice)

Follow-up visits include a physical examination with pelvic exam, review of any symptoms, and discussion of any concerns. Routine imaging tests (CT, PET) are not typically performed unless there are symptoms or findings suggesting possible recurrence. The CA-125 blood test may be monitored in some cases, particularly for serous or clear cell cancers.

Recognizing Recurrence

Being aware of symptoms that could indicate recurrence is important. Contact your healthcare provider if you experience:

• Vaginal bleeding or discharge
• Pelvic pain or pressure
• Unexplained weight loss
• Persistent cough or shortness of breath
• Abdominal bloating or swelling
• Changes in bowel or bladder habits

If recurrence occurs, additional treatment can often control the disease. Options depend on the location and extent of recurrence, previous treatments received, and overall health. Treatment may include surgery, radiation, chemotherapy, immunotherapy, or hormone therapy.

How Does Endometrial Cancer Affect Daily Life?

Life after endometrial cancer treatment varies based on individual circumstances. Common experiences include managing surgical menopause if ovaries were removed, addressing fatigue and emotional adjustment, maintaining follow-up appointments, and adapting to physical changes. Most women return to their normal activities and enjoy good quality of life after treatment.

Cancer diagnosis and treatment affect people differently, and adjustment takes time. Understanding potential challenges and available support can help you navigate this period.

Physical Effects

Surgical menopause: If your ovaries were removed before natural menopause, you will experience immediate menopause. Symptoms may include hot flashes, night sweats, vaginal dryness, mood changes, and sleep disturbances. These symptoms can be managed with various treatments. For some women with endometrioid-type cancer and low recurrence risk, hormone therapy may be appropriate—discuss this with your oncologist.

Vaginal changes: Surgery and radiation can cause vaginal shortening, narrowing, or dryness, which may affect sexual function. Vaginal moisturizers, lubricants, and vaginal dilator exercises can help. If you have concerns about sexual health, discuss them with your healthcare team or ask for referral to a specialist.

Lymphedema: If lymph nodes were removed, you may develop swelling in the legs or pelvic area. This risk is higher with more extensive lymph node surgery or pelvic radiation. Physical therapy and compression garments can manage lymphedema if it develops.

Fatigue: Cancer-related fatigue is common and may persist for months after treatment. Gentle exercise, adequate rest, and pacing activities can help. If fatigue is severe or persistent, discuss it with your healthcare provider.

Emotional Health

A cancer diagnosis brings emotional challenges. Feelings of anxiety, fear of recurrence, sadness, or grief are normal. Many women also experience positive changes, including greater appreciation for life, stronger relationships, and a new sense of purpose. Support resources include counseling, support groups, and peer networks of cancer survivors. Don't hesitate to seek help if you're struggling emotionally.

Fertility and Family Planning

For women treated with hysterectomy, pregnancy is no longer possible. If preserving fertility was important, this loss can be deeply significant. Support from counselors familiar with fertility-related grief may be helpful. Options for building a family through surrogacy or adoption may be available depending on individual circumstances.

Can Endometrial Cancer Be Prevented?

While endometrial cancer cannot be completely prevented, risk can be reduced by maintaining a healthy weight, staying physically active, using oral contraceptives (which reduce risk even years after stopping), and promptly evaluating any abnormal bleeding. Women with hereditary risk (Lynch syndrome) may consider preventive hysterectomy after completing childbearing.

Prevention strategies focus on reducing exposure to unopposed estrogen and addressing modifiable risk factors:

• Maintain a healthy weight: Given the strong link between obesity and endometrial cancer, achieving and maintaining a healthy BMI is one of the most effective preventive measures. Even modest weight loss can reduce risk.
• Stay physically active: Regular exercise may reduce risk independent of its effect on weight, possibly through improved insulin sensitivity and hormone regulation.
• Oral contraceptives: Birth control pills significantly reduce endometrial cancer risk, with protection lasting for years after stopping use. This is due to the progesterone component counteracting estrogen's proliferative effects.
• Appropriate hormone therapy: If using hormone therapy for menopausal symptoms and you have a uterus, ensure it includes progesterone/progestin to protect the endometrium.
• Manage medical conditions: Proper management of diabetes and conditions like PCOS may help reduce risk.

For women with Lynch syndrome or other hereditary conditions that significantly increase endometrial cancer risk, prophylactic (preventive) hysterectomy after completing childbearing effectively eliminates risk. This decision should be made in consultation with genetic counselors and gynecologic oncologists.