Do You Know the Warning Signs of Uterine Cancer?

“If you have too much estrogen targeting that organ, it can create these early changes in the cells that can lead to [increased cell production] and eventually cancer,” says Jennifer Mueller, M.D., a gynecologic surgeon who specializes in treating endometrial cancer at Memorial Sloan Kettering Cancer Center.

Excess weight can also trigger insulin resistance, and that can affect hormone levels in the body. “We think maybe inflammation and insulin resistance is another pathway that can drive toward endometrial cancer,” Mueller says.

The American Cancer Society estimates that 70 percent of uterine cancers can be attributed to excess body weight and insufficient physical activity. The organization says endometrial cancer is twice as common in overweight women and more than three times as common in women with obesity than it is in women who are at a healthy weight.  

But that’s only one part of the explanation, Matulonis says. Other risk factors for the cancer include a family history, having had breast or ovarian cancer, and having used the breast cancer treatment tamoxifen. Women with polycystic ovarian syndrome are also at a higher risk for uterine cancer. More recently, scientists have linked chemical hair straighteners to a higher risk for uterine cancer.

When it comes to the increasing death rate, research shows that more women are being diagnosed with aggressive forms of uterine cancer than in the past, which could explain the shift. A study out of the National Cancer Institute found that between 2000 and 2015, incidence rates for dangerous subtypes of the cancer rose rapidly among women — especially Black women — between age 30 and 79, though it’s unclear why.

“There’s a gap right now in knowledge about exactly why we are seeing an increase in cases” and mortality, Matulonis says. She adds that more research is needed to better understand what’s driving the trends and contributing to the alarming racial and ethnic divides.

Bleeding after menopause is the No. 1 warning sign 

There aren’t routine screenings for women at average risk for uterine cancer, like there are for breast cancer, colon cancer and cervical cancer. That’s why it’s crucial to pay attention to any early warning signs of the disease, doctors say.

The most common symptom of uterine cancer is abnormal bleeding after menopause. (The average age of uterine cancer diagnosis is 60.) The American Cancer Society says about 90 percent of women with uterine cancer have abnormal bleeding.

“And when we say bleeding, I’ve started adding other words like ‘spotting,’ ‘discharge’ or ‘staining,’ ” Mueller says. It doesn’t need to be a lot of blood, she says — the smallest amount, a spot even, should prompt you to check in with your doctor. “Any kind of discharge that’s abnormal is a huge red flag,” Mueller says.

What’s more, if you have uterine fibroids, or noncancerous growths, and experience bleeding, don’t assume it’s from the fibroids, Mueller says. According to the Cleveland Clinic, it’s rare for fibroids to create any symptoms after menopause.

For women who are not in menopause, talk to your doctor if you notice bleeding between periods or a change in your periods, Soliman says. If you experience pain when you urinate or pain during intercourse, that could be another warning sign of uterine cancer. And if your routine Pap smear shows endometrial cells, “that’s another kind of a red flag that that individual needs to be further worked up,” Matulonis says. 

Treatments continue to advance

Despite the concerning statistics, there is some good news in the field: Treatment options for uterine cancer are advancing. Surgery (a hysterectomy) is the primary treatment, and Soliman says for the most common type of uterine cancer, this method is pretty successful. For more advanced forms of the disease, “there’s been a lot going on in the last four or five years” that has helped improve patient survival, she says.

For example, some people with the inherited genetic condition known as Lynch syndrome, which increases the risk for certain types of cancer, “have very good response rates” to immunotherapy treatments, or drugs that help a person’s own immune system better spot and kill cancer cells, Soliman says.

Researchers have found that others may benefit from immunotherapy plus targeted therapy, a form of treatment that targets certain changes in the cancer cells. And a study published in 2023 found that immunotherapy plus chemotherapy dramatically improved how long certain patients with advanced disease might live without the cancer getting worse. “That’s been one of the biggest changes over the past year,” Matulonis says. “There’s a lot going on in this setting with regard to different [treatments].”

Many of the new and promising treatments are being used in clinical trials, which is why the American Cancer Society says participation should be considered if you are diagnosed with uterine cancer. Mueller says it’s also important that trial populations become more diverse to better reflect “all of the patients who are diagnosed with endometrial cancer.” Doing so can help to identify the factors contributing to its disparities. 

“We really need to put more focus on endometrial cancer,” Matulonis says. “It’s really affecting women in the United States.”