The short answer: The most common warning sign of endometrial cancer (cancer of the womb lining, also called uterine or womb cancer) is bleeding after menopause. It is the first symptom in about 9 out of 10 women with this cancer. But most women who bleed after menopause do not have cancer: it is found in about 5–10% of them. Other signs are periods that become much heavier or longer around your 40s, bleeding between periods, and a watery or blood-tinged discharge. Pain, swelling of the tummy and weight loss usually come later. Any of these should be checked by a gynaecologist. The first test is usually a vaginal ultrasound and, if needed, a small sample of the womb lining (biopsy). In Hindi this is often searched as bachedani ke cancer ke lakshan (बच्चेदानी के कैंसर के लक्षण) or menopause ke baad bleeding (मेनोपॉज़ के बाद ब्लीडिंग).
Endometrial cancer is the most common gynaecological cancer in many high-income countries and is becoming more common in India. Because bleeding is an early and noticeable sign, it is often found at an early stage, when treatment usually aims at cure.
On this page
- 1. Bleeding after menopause — ANY amount
- 2. Periods becoming heavier or longer in your 40s
- 3. Bleeding between periods
- 4. Persistent pelvic pain
- 5. Unusual vaginal discharge — especially watery or blood-tinged
- 6. Unintended weight loss with abdominal swelling
1. Bleeding after menopause — ANY amount
Any vaginal bleeding after menopause (12 months or more after your last period) should be checked, even a single episode of spotting. About 90% of endometrial cancers cause bleeding after menopause as the first symptom. Put the other way round, most women who bleed after menopause do not have cancer: it is found in about 5–10% of them. The first test is a vaginal ultrasound. A womb lining of 4 mm or less is reassuring (the cancer risk is under 1%), and many women need only the scan. If the lining is over 4 mm, looks unusual, or the bleeding comes back, a small sample of the lining (endometrial biopsy) is taken in the clinic in a few minutes; results usually come in about 1–2 weeks. Our guide to when bleeding after menopause is a sign of uterine cancer explains each step.
2. Periods becoming heavier or longer in your 40s
Perimenopausal periods can be irregular, but heavy menstrual bleeding (changing pads every hour, large clots, periods lasting over 7 days) should be evaluated — especially if you have risk factors (obesity, PCOS, diabetes, family history).
Endometrial cancer is much less common before menopause, but it can happen in younger women, particularly those with obesity, PCOS (polycystic ovaries) or Lynch syndrome (an inherited condition that runs in families).
3. Bleeding between periods
Spotting or bleeding between menstrual periods (intermenstrual bleeding) warrants evaluation, particularly in women over 40.
4. Persistent pelvic pain
Endometrial cancer is usually painless in its early stages. Lasting pain or pressure in the lower tummy is more often caused by other conditions, such as fibroids, but in endometrial cancer it is usually a later sign. Pain that does not settle should be checked rather than dismissed as “just stress”.
5. Unusual vaginal discharge — especially watery or blood-tinged
Older women with endometrial cancer sometimes notice a watery, foul-smelling, or pink-tinged discharge rather than obvious bleeding. After menopause, a little clear discharge is often harmless, but a watery or blood-tinged discharge that keeps coming back should be checked with an ultrasound, in the same way as bleeding.
6. Unintended weight loss with abdominal swelling
Advanced endometrial cancer may cause fluid in the tummy (ascites), which makes it swell, together with weight loss elsewhere on the body. These are late signs, and the same combination can also come from other conditions, including ovarian problems. Either way it needs prompt scans.
What to do next
If you have bleeding after menopause, bleeding between periods or periods that have become much heavier, see a gynaecologist promptly. Most causes turn out not to be cancer, but the only way to know is to check. If a biopsy does show endometrial cancer, our guide to uterine cancer care explains what the report means and what happens next. Treatment usually starts with an operation, and whether it is done by open, keyhole or robotic surgery depends on your case: see uterine cancer surgery options. Dr. Nishtha Tripathi Patel sees patients at Sterling Hospitals, KD Hospital and Welcare Speciality Hospital, Ahmedabad. Call or WhatsApp +91 76988 00333.
Related
External reference: NCCN Guidelines for Endometrial Cancer.
FAQs
Is bleeding after menopause always a sign of cancer?
No. Endometrial cancer is found in about 5–10% of women who bleed after menopause. More common causes are a thin, dry womb or vaginal lining, polyps, a thickened lining (hyperplasia) or hormone treatment. Even so, any bleeding after menopause should be checked, because only tests can tell which cause it is.
Can young women get endometrial cancer?
Yes, but it is much less common before menopause. The risk is higher with obesity, PCOS, diabetes or Lynch syndrome. Bleeding between periods or periods that become much heavier and keep happening should be checked, especially if you are over 40 or have these risk factors.
Can an ultrasound show endometrial cancer?
An ultrasound cannot confirm or rule out cancer on its own. It measures the thickness of the womb lining. After menopause, a lining of 4 mm or less is reassuring, and many women need only the scan. If the lining is thicker, looks unusual, or the bleeding comes back, a small biopsy of the lining is needed, because only a biopsy can confirm cancer. If the biopsy is not possible or not enough, a hysteroscopy (a thin camera look inside the womb) is used.
Does endometrial cancer cause pain?
Usually not in the early stages. Most women first notice bleeding or a discharge. Pain in the lower tummy or pelvis, swelling of the tummy and weight loss tend to appear later, and they are more often caused by other conditions.
Is endometrial cancer curable?
It is often found early, because bleeding after menopause is an early sign, and many women are treated with the aim of cure. Treatment usually starts with an operation to remove the womb; whether any further treatment is needed depends on the final report. Your own outlook depends on the stage and type of the cancer, so ask your specialist what applies to you.
Reviewed by Dr. Nishtha Tripathi Patel, MBBS, DGO, DNB, Fellowship Gynaecological Oncology, ESGO-certified.