Signs and symptoms

Postmenopausal bleeding is the most common complaint in women in whom endometrial cancer is diagnosed. Around 90% of women are diagnosed after the age of 50 years and postmenopausal bleeding is associated with an underlying carcinoma in up to 10% of women. While commonly associated with older women, endometrial cancer can occur in younger women and may present with irregular or intermenstrual bleeding. Such women often experience a delay in diagnosis, as management may initially be via a menstrual disorders clinic and characteristic findings at hysteroscopy may be lacking. Because of the strong aetiological association with estrogenic stimulation, the diagnosis should be considered in symptomatic younger women with polycystic ovary syndrome, those with irregular bleeding on hormone replacement therapy or those taking tamoxifen. Tamoxifen stimulates ovarian estrogen biosynthesis and elevates plasma estrogen levels, increasing the risk of endometrial cancer.

Endometrial hyperplasia can be termed a premalignant condition of the endometrium. Occurring as a result of estrogenic stimulation of the endometrium, endometrial hyperplasia is classified as simple or complex – in the absence of cytological atypia the risk of malignancy is low (1–4%) but the risk of co-existing or rapidly developing malignancy with a histological finding of complex endometrial hyperplasia with atypia may be as high as 43%.