Endometrial cancer

Also known as cancer of the womb or uterine cancer

Endometrial cancer affects the lining of a woman’s uterus. It is most common in women after menopause and has a good chance of being completely cured if it is treated as soon as symptoms develop. The most common symptom is postmenopausal vaginal bleeding, so see your doctor straight away if this symptom develops.

What causes endometrial cancer?

The exact cause of endometrial cancer is unknown, but an increased level of the hormone oestrogen is thought to play a role. Oestrogen helps stimulate growth of endometrial cells and is normally balanced by progesterone which stops their growth. In the absence of progesterone, or when too much oestrogen is produced, abnormal growth of endometrial cells may lead to cancer.

Image credit: 123rf

Risk factors

The greatest risk factors for endometrial cancer are age and obesity. Endometrial cancer is much more common in post-menopausal women and being overweight increases your risk of developing endometrial cancer by at least 40%. Find out why on our risk factors FAQ page.

Other risk factors include:

  • Polycystic ovarian syndrome (PCOS) – women with PCOS often have irregular periods and are more likely to become overweight and develop diabetes.
  • Some hormone therapies used for breast cancer therapy such as Tamoxifen can also increase the risk of endometrial cancer.
    • If you are prescribed tamoxifen your doctor will discuss this with you and also talk about how this risk can be minimised.
    • It is important to remember that the small increase in risk of endometrial cancer is much less than the improvement in survival from breast cancer.
  • Hormone producing tumours – this is a rare cause of endometrial cancer.
  • Genetic problems such as Lynch syndrome. These are relatively rare (around 5%) but women with Lynch syndrome often develop endometrial cancer before menopause.

Protective factors

Endometrial cancer is less common in women who:

  • have regular periods
  • are on the combined contraceptive pill (see our risk factors FAQ)
  • use progesterone-containing intrauterine contraceptive devices
  • have had at least one baby
  • breastfed for more than 18 months
  • exercise regularly
  • maintain a healthy weight
  • do not smoke.

What are the symptoms of endometrial cancer?

Postmenopausal bleeding is the most common symptom of endometrial cancer and occurs in about 90% of women. Abdominal or pelvic pain occurs in a few women if the cancer has started to spread outside of the uterus. Difficulties with passing urine can also occur if the cancer has spread towards a woman's bladder.

How is endometrial cancer diagnosed?

The main way of diagnosing endometrial cancer is by taking a sample of the lining of the uterus in a simple procedure called a pipelle biopsy. Sometimes an ultrasound will also be performed. Dilatation and curettage (D&C) is another option.

Pipelle biopsy

A pipelle biopsy is a simple procedure in which a small plastic tube like a straw is used to obtain some cells from the lining of the uterus. The cells are sent to a lab where they are checked for abnormalities. No anaesthetic is needed for the procedure and it can be done by your GP.

A pipelle biopsy is similar to a smear test and occasionally a smear test might find abnormal cells that suggest an endometrial cancer. However, a regular smear test can not be used to reliably diagnose endometrial cancer. 


An ultrasound is a good way of looking at the thickness of the lining of the uterus. After menopause, the lining of the uterus should be quite thin. If the lining of the uterus is less than 4 mm then the chance of a cancer of the endometrium is very low.

Dilatation and curettage (D&C)

This procedure involves removal of a small amount of tissue from inside your uterus. It is usually done if it is not possible to obtain a sample of cells when a pipelle biopsy is performed or if an ultrasound shows that the lining of the uterus is thicker than is should be. It usually requires a light anaesthetic.

What are the treatment options for endometrial cancer?

The treatment options for endometrial cancer include:

  • Surgery ­– most women will require surgery to remove the uterus (known as a hysterectomy) and also the fallopian tubes and ovaries (known as a bilateral salpingo-oophrectomy)
  • Radiation treatment is often used after (and sometimes before) surgery to improve outcomes.
  • Chemotherapy may be used as well as surgery in more advanced cases.

Read more about treatment for endometrial cancer.

Can endometrial cancer be prevented?

Endometrial cancer is associated with obesity, high blood pressure and diabetes. You can lower your chance of developing endometrial cancer by:

  • Maintaining a good weight: a normal BMI is between 20 – 25. A BMI of over 30 is considered to be obese. Check your BMI with our BMI calculator.
  • Exercising regularly: You do not need to become a marathon runner but you can make small but important changes every day. Try doing things such as walking up the stairs instead of using the lift or walking or using a bicycle instead of jumping in the car. Read more about exercises to get you started.
  • Eating a healthy, balanced diet high in vegetables and low in sugary, processed foods. Read more about healthy eating.

Learn more

Cancer of the uterus Cancer Society, NZ
Womb (uterine or endometrial) cancer Cancer Research UK
Womb (uterus) cancer NHS Choices UK
Talk Peach Gynaecological Awareness, NZ 
Pipelle biopsy 3D HealthPathways, NZ

Information for healthcare providers

Ultrasound in the evaluation of abnormal vaginal bleeding Reachmd.com
Endometrial hyperplasia Radiopaedia.org

Credits: Dr Jeremy Tuohy. Last reviewed: 01 Mar 2017