Womb cancer

Also called Endometrial cancer, Uterine cancer

Bleeding after the menopause is womb cancer until proven otherwise. Because it bleeds early, most cases are found early and are curable.

What it is

Cancer of the lining of the womb, and the most common gynaecological cancer in the UK. It is becoming more common, largely alongside rising obesity.

It has one enormous advantage over the other gynaecological cancers: it bleeds, and it bleeds early. Postmenopausal bleeding is an unmistakable symptom that appears while the cancer is still confined to the womb, which is why the majority are diagnosed at an early stage and why survival is good.

Everything therefore turns on one rule. Any vaginal bleeding after the menopause is investigated urgently, however light, however brief, even once, even if it looked like spotting.

Fat tissue produces oestrogen, which is why obesity is the strongest modifiable risk factor, and why polycystic ovary syndrome, type 2 diabetes and never having been pregnant also raise the risk. Tamoxifen, taken after breast cancer, raises it too, and women on it should know the bleeding rule.

Lynch syndrome, an inherited condition, substantially raises the risk of both womb and bowel cancer. Testing of tumours for it is now recommended, and it changes screening for the whole family.

Signs you might notice

Any bleeding after the menopause. This is the one to act on.

Before the menopause: bleeding between periods, much heavier periods than usual, or a change in the pattern.

Vaginal discharge that is new, watery, blood-stained or offensive.

Later: pelvic pain, pain during sex, unexplained weight loss.

A GP appointment for postmenopausal bleeding should lead to an urgent referral, usually for an ultrasound to measure the womb lining and often a biopsy taken in clinic.

Bleeding while on HRT that is new, heavy or unexpected also needs assessing rather than being assumed to be the HRT.

How it can affect day-to-day life

The commonest reason for delay is embarrassment plus an assumption that a bit of spotting is nothing. Women repeatedly describe waiting to see whether it happened again.

The biopsy taken in clinic is uncomfortable and people are often not warned. Asking for pain relief beforehand, or for it to be done under anaesthetic if a previous one was very painful, is entirely reasonable and rarely offered.

Treatment is usually surgery to remove the womb and ovaries, which brings immediate surgical menopause in younger women and ends fertility. Both deserve proper discussion beforehand.

For women who want to preserve fertility, hormone treatment is sometimes an option in early disease and needs a specialist centre.

Weight management after treatment reduces recurrence risk and is usually raised badly or not at all.

Supporting someone well

Postmenopausal bleeding: GP this week, and ask for the urgent referral. Do not wait to see if it happens again.

Say it plainly to any woman in your family or care: after the menopause, any bleeding at all gets checked.

For anybody taking tamoxifen, make sure they know the same rule.

Ask about pain relief before an endometrial biopsy, and say if a previous one was very painful.

Ask about Lynch syndrome testing on the tumour, and about what it means for relatives.

Ask about HRT after surgery for a younger woman; it is often appropriate and often not offered.

Ask for the clinical nurse specialist's number.

Where to get help

A GP practice urgently for any postmenopausal bleeding.

The gynaecological oncology clinical nurse specialist once under a team.

Eve Appeal run Ask Eve, a free nurse-led information service for all five gynaecological cancers.

Macmillan Cancer Support on 0808 808 00 00.