Definition

What Is Uterine / Endometrial Cancer?

Uterine cancer is a malignancy arising in the uterus. Most arise from the endometrium, the inner lining of the uterus, so the terms "endometrial cancer" and "uterine cancer" are often used interchangeably.

Uterine cancer is the most common gynecologic cancer in the US, with approximately 68,000 new cases each year and rising incidence linked to the obesity epidemic.

Staging follows the FIGO system, I (confined to uterus) through IV (distant metastasis). Postmenopausal bleeding is the hallmark presenting symptom, and any bleeding after menopause needs prompt investigation: most is not cancer, but about 9% is¹¹. Because bleeding comes early, this cancer is found at an earlier stage more often than ovarian or vaginal cancer¹.

A cross-section of the uterus with the fallopian tubes and ovaries, showing its lining, the endometrium, its muscle wall, the myometrium, the cervix and a tumor growing in the lining

Type I, Endometrioid (the most common, estrogen-driven)

The classic, low-grade, estrogen-dependent endometrial cancer. Typically arises from atypical endometrial hyperplasia in a background of long-term unopposed estrogen exposure² (obesity, anovulation, PCOS, tamoxifen, estrogen-only HRT). Most diagnosed at stage I with excellent prognosis.

→Hallmarks: Postmenopausal bleeding, obesity, PCOS history, low-grade well-differentiated histology
→Standard care: Total hysterectomy with bilateral salpingo-oophorectomy; adjuvant radiation/chemo for stage II+
→Holistic role: Weight management and insulin sensitivity for overall metabolic health; effects on recurrence are unproven

Type II, Serous & Clear Cell (less common, aggressive)

Non-endometrioid, high-grade, non-estrogen-driven cancers. Behave more like high-grade ovarian cancer with early peritoneal spread. Often arise in atrophic endometrium in older, thinner postmenopausal women. Higher recurrence risk even at early stage.

→Hallmarks: Older postmenopausal women, no obesity link, high-grade aggressive histology
→Standard care: Surgical staging + adjuvant platinum/taxane chemotherapy + radiation; HER2 testing for serous tumors
→Molecular: TP53 mutations are typical of serous cancers, and some are HER2-⁠positive
→Holistic role: Chemo tolerance, side-effect mitigation, recovery nutrition, careful supplement coordination

Carcinosarcoma & Uterine Sarcomas (rare)

Rare, aggressive cancers arising from the muscle (leiomyosarcoma) or stromal layer (endometrial stromal sarcoma) of the uterus, or mixed epithelial-mesenchymal tumors (carcinosarcoma). Distinct biology and treatment from carcinomas, with generally poorer prognosis.

→Hallmarks: Rapidly growing uterine mass, often initially mistaken for a fibroid, may present with bleeding or pelvic pain
→Standard care: Hysterectomy with staging; chemotherapy regimens differ by sarcoma subtype
→Holistic role: Supportive care during multimodal treatment, recovery nutrition, surveillance support

Modern Molecular Classification (TCGA, 4 groups)

Modern pathology classifies endometrial cancer into 4 molecular groups regardless of histology, increasingly guiding treatment. POLE-ultramutated (excellent prognosis), MMR-deficient/MSI-high (immunotherapy-responsive⁴), copy-number-low (intermediate) and copy-number-high/p53-⁠mutated (aggressive, serous-like).

→Standard care: Increasingly stratifies adjuvant therapy decisions; immunotherapy for MMR-deficient tumors
→Holistic role: General supportive care; no diet or supplement has been shown to act differently by molecular group

Signs & Symptoms

Symptoms of Uterine / Endometrial Cancer

Unlike ovarian cancer, uterine cancer usually gives an early, unmistakable warning, postmenopausal bleeding. In pooled studies, 91% of women with endometrial cancer had bleeding after menopause, which is why most cases are found early¹¹.

Symptom	What happens
Bleeding & Gynecologic Symptoms
Postmenopausal Bleeding (PMB)	Any vaginal bleeding or spotting after 12 consecutive months without a period. The hallmark symptom. Never normal, always warrants endometrial biopsy or pelvic ultrasound within 1 to 2 weeks.
Heavy or Prolonged Bleeding (Premenopausal)	In premenopausal women, the warning sign is menorrhagia (heavy bleeding), menometrorrhagia (heavy plus irregular bleeding) or bleeding between cycles. Persistent heavy bleeding in a woman with PCOS at any age warrants endometrial sampling.
Watery or Blood-Tinged Vaginal Discharge	A persistent thin, watery or pink-tinged vaginal discharge in a postmenopausal woman is a less classic but real presentation, especially in serous (Type II) endometrial cancer. Any new persistent discharge after menopause warrants gynecologic evaluation.
Pelvic Pain or Pressure	Persistent pelvic pressure or dull pelvic pain may indicate a larger uterine tumor, hematometra (blood collection inside the uterus) or pelvic spread. More common in advanced disease, and a clear indication for imaging when paired with bleeding.
Pain with Intercourse (Dyspareunia)	New deep dyspareunia, particularly with postmenopausal spotting after intercourse, can reflect a friable endometrial or cervical lesion. Always warrants pelvic exam, ultrasound and biopsy in postmenopausal women.
Systemic & Advanced-Stage Symptoms
Urinary Frequency or Difficulty	A growing uterine mass can compress the bladder, causing urgency and frequency. Persistent urinary symptoms in a postmenopausal woman, especially with negative cultures, warrant pelvic imaging.
Unintended Weight Loss	Loss of more than 5% of body weight without dietary or activity change can indicate advanced disease.
Fatigue & Weakness	Chronic anemia from prolonged bleeding can produce significant fatigue and weakness, sometimes preceding the recognition that the bleeding itself is abnormal. Iron-deficiency anemia in a postmenopausal woman always needs investigating, most often of the bowel; where there has been any bleeding, the uterus needs investigating too.
Leg Swelling / Lymphedema	Unilateral leg swelling can indicate pelvic lymph-node involvement compressing venous return. After surgery and lymph-node dissection, lymphedema can also be a late complication, and it warrants prompt evaluation. New one-sided leg swelling can also be a blood clot: get a same-day appointment, and call 911 or go to the emergency department if it comes with chest pain or breathlessness.

⚠️ The PMB Rule: Any postmenopausal bleeding, even a single spot, and any unscheduled bleeding on hormone replacement therapy, needs investigating to rule out endometrial cancer. The workup is straightforward (transvaginal ultrasound plus endometrial biopsy), the test is well-tolerated, and the disease is highly curable when caught early. Do not wait.

Causes

Causes of Uterine / Endometrial Cancer

The established risk factors are estrogen acting on the uterine lining without progesterone, excess weight, type 2 diabetes and metabolic syndrome, inherited genes and older age¹⁴.

Cause	How It Contributes to Uterine / Endometrial Cancer	What Helps
Excess body weight	Fat tissue makes extra estrogen; overweight or obesity raises the risk of estrogen-linked endometrial cancer two to four times, and severe obesity about seven times¹⁵	Weight management through the diet section and regular activity; among 36,794 postmenopausal women, intentional weight loss was linked with lower risk, though an effect on recurrence has not been shown⁹
Estrogen without progesterone	Estrogen-only hormone therapy after menopause and tamoxifen raise the risk, while estrogen combined with progesterone does not; never giving birth, early periods, late menopause and polycystic ovary syndrome also expose the lining to the body's own estrogen¹⁴	For anyone with a uterus, hormone therapy that includes a progestin, as your prescriber advises; on tamoxifen, report any bleeding, spotting or bloody discharge promptly, since routine scans without symptoms are not recommended¹⁰
Type 2 diabetes and metabolic syndrome	Both are listed risk factors for endometrial cancer¹⁴	The diet section's low-glycemic pattern alongside your usual diabetes care
Lynch syndrome and family history	A mother, sister or daughter with endometrial cancer, and inherited conditions such as Lynch syndrome, raise the risk¹⁴; in Lynch syndrome the size of the risk differs by gene¹²	Mismatch repair testing of the tumor and genetic counseling³; surveillance and the timing of any risk-reducing surgery are planned gene by gene¹²
Endometrial hyperplasia	A thickened uterine lining, which HRT, high estrogen levels or being overweight can cause, can lead to uterine cancer²⁰	Having any bleeding after menopause checked; depending on the type, hyperplasia is watched, treated with hormone medicine or treated with hysterectomy²⁰
Older age	Older age is the main risk factor for most cancers, and uterine cancer is most common after menopause¹⁴	Getting any bleeding after menopause checked, even a single spot²⁰

Diagnosis

How Uterine / Endometrial Cancer Is Diagnosed

Diagnosis rests on the bleeding history, pelvic ultrasound and a tissue sample (endometrial sampling, the gold standard).

Test	What it shows
At-Home Screening & Risk Stratification
There is no population-wide screening test, but these tools identify women who should pursue prompt evaluation:
Bleeding Diary & Pattern Tracking	Track all bleeding episodes for 3 to 6 months, noting timing, volume, duration and any associated factors. For premenopausal women, flag heavy menstrual bleeding (more than about 2.7 fl oz [80 mL] a cycle, or bleeding for over 7 days) or bleeding between cycles; soaking a pad or tampon every hour for more than 2 hours needs a same-day appointment, and with dizziness, fainting, chest pain or breathlessness, call 911 or go to the emergency department. Any postmenopausal spotting is an immediate workup trigger.
Family-History & Lynch Syndrome Assessment	Map family history of uterine, colon, ovarian, pancreatic, urothelial and brain cancers. Lynch syndrome (hereditary nonpolyposis colorectal cancer) raises endometrial cancer risk considerably, by an amount that differs with the gene involved¹². Two or more affected relatives, especially under 50, warrant Lynch panel testing.
Clinical & Lab Workup
Transvaginal Ultrasound (TVUS)	The first-line imaging study for abnormal bleeding. Measures endometrial stripe thickness; in postmenopausal women, a stripe greater than 4 mm warrants endometrial sampling. Also evaluates myometrial invasion, fibroids and ovaries. Saline-infusion sonography adds detail for focal lesions like polyps.
Endometrial Biopsy (Office Sampling)	The gold standard for diagnosis. A thin catheter samples the lining in the office, with brief mild cramping. If biopsy is non-diagnostic or bleeding persists, proceed to hysteroscopy with dilation and curettage in the operating room.
Molecular Pathology & MMR Testing	Once cancer is confirmed, modern pathology includes MMR (MLH1/MSH2/MSH6/PMS2) immunohistochemistry on every endometrial cancer to screen for Lynch syndrome, p53 IHC and increasingly POLE sequencing. The 4 TCGA molecular groups guide adjuvant therapy decisions.
Pelvic MRI & CT/PET Staging	Pelvic MRI is the best modality for assessing myometrial invasion depth and cervical involvement preoperatively. CT of the chest/abdomen/pelvis evaluates distant disease. PET-CT is reserved for high-grade disease or restaging. Final staging is surgical (FIGO).
Hormone & Metabolic Labs	Fasting glucose, HbA1c, lipids and liver function, since type 2 diabetes and metabolic syndrome are risk factors¹⁴. CA-⁠125 may be checked for serous histology or advanced disease. HER2 testing is now standard for serous endometrial cancer.

Treatment Comparison

Conventional and Holistic Treatment for Uterine / Endometrial Cancer

For uterine cancer, surgery is the cornerstone of treatment and is highly effective at early stages. Holistic nutrition and lifestyle care is complementary, designed to be used alongside surgery, radiation, chemotherapy, hormone therapy and immunotherapy as recommended by your oncology team, not instead of them.

🌿 HOLISTIC

💊 CONVENTIONAL

🌿

Holistic / Functional Approach

Weight, insulin and estrogen exposure are the main modifiable risk factors; addressing them supports health in survivorship

Primary Role

Pre-surgical optimization, post-op recovery, insulin sensitivity, weight management and general health in survivorship

Duration

Continuous, from diagnosis through active treatment and into lifelong survivorship

Effect on Disease

May improve treatment tolerance²²; whether it reduces recurrence has not been shown in trials

Goal

Strong recovery, fewer side effects and better metabolic health in survivorship

Full Holistic Approach Includes

Pre-surgical optimization, anti-inflammatory whole-food diet, protein 0.55 to 0.7 g per pound of body weight (1.2 to 1.5 g/kg) a day, vitamin D and ferritin correction, glycemic control
Post-op recovery, protein-anchored meals, gut motility support, gentle walking from day 1, scar massage at 6 to 8 weeks
If chemo or radiation is needed, ginger and peppermint for nausea, oral hydration, mucosal support, microbiome care
Plenty of vegetables, fiber and flax seeds
Insulin sensitization, low-glycemic eating, strength training, post-meal walks, address PCOS or diabetes if comorbid
Weight management: intentional weight loss is linked with lower endometrial cancer risk, but an effect on recurrence has not been shown⁹
Pelvic floor physical therapy after surgery and especially after radiation
Sleep, circadian rhythm and mind-body work (meditation, yoga, counseling) for survivorship

⚠️ Note on supplements during treatment: Several supplements (high-dose antioxidants, St. John's wort⁶ and some herbal extracts), as well as grapefruit, can interfere with chemotherapy and tamoxifen. Always disclose every supplement to your oncology team and pharmacist before and during treatment.

💊

Conventional / Oncologic Approach

Total hysterectomy + adjuvant radiation, chemotherapy, hormone therapy and immunotherapy depending on stage and molecular subtype

Primary Treatment

Total hysterectomy with bilateral salpingo-oophorectomy and lymph-node staging + risk-adjusted adjuvant therapy

Duration

Surgery 1 day; adjuvant therapy 3 to 6 months depending on stage; surveillance for 5 years

Effect on Disease

Tumor-directed; highly curative at early stage; combined-modality for advanced disease

Survival Outcome

About 95% at 5 years when confined to the uterus, 70% after spread to nearby lymph nodes and 20% after distant spread¹³; better for Type I than Type II

Conventional Approach Includes

Total hysterectomy with bilateral salpingo-oophorectomy (TH-BSO), the cornerstone of treatment
Sentinel lymph-node biopsy or pelvic/paraaortic lymph-node dissection for staging
Adjuvant vaginal brachytherapy or pelvic external beam radiation for intermediate-risk disease
Adjuvant chemotherapy (carboplatin + paclitaxel) for high-risk and Type II disease
HER2-⁠targeted therapy (trastuzumab) for HER2-⁠positive serous endometrial cancer
Hormonal therapy (progestin, aromatase inhibitors) for low-grade or recurrent ER+ disease, or as fertility-sparing treatment⁵
Immunotherapy (pembrolizumab + lenvatinib, or pembrolizumab alone for MMR-deficient tumors) for advanced/recurrent disease
Surveillance every 3 to 6 months for 2 years, then every 6 to 12 months for years 3 to 5, with exam and symptom review

⚠️ Common side effects: Surgery: surgical menopause if premenopausal, lymphedema, sexual function changes, pelvic adhesions. Radiation: vaginal stenosis, bowel and bladder irritation, pelvic floor dysfunction. Chemo: fatigue, nausea, peripheral neuropathy, myelosuppression. Hormonal therapy: hot flashes, mood changes, bone density loss. Immunotherapy: immune-related adverse events.

Nutritional Strategy

Diet for Uterine / Endometrial Cancer

For endometrial cancer, diet supports treatment and general health; excess weight, type 2 diabetes and metabolic syndrome are risk factors, so the pattern below is built around them¹⁴.

The insulin-first, estrogen-aware pattern for uterine cancer

The Insulin-First Eating Pattern

The diet that supports recovery and metabolic health centers on insulin sensitivity (the same eating pattern that helps PCOS and type 2 diabetes), with plenty of vegetables and fiber.

In survivorship, the priority shifts to low-glycemic, plant-forward, anti-inflammatory eating with a Mediterranean-DASH overlay.

What to eat or do	Details
During Active Treatment:
Protein priority	0.55 to 0.7 g per pound of body weight (1.2 to 1.5 g/kg) a day, to protect muscle
Calorie adequacy	Do not under-eat through chemo/radiation
Frequent small meals	5 to 6 per day if appetite is impaired
Hydration	About 8 to 13 cups (2 to 3 liters) daily, especially around treatment
In Survivorship:
Cruciferous vegetables daily	For fiber and variety
Low glycemic load	To keep insulin and IGF-⁠1 lower
30+ different plants per week	Fiber and polyphenol diversity for gut health
Daily movement	Post-meal walks plus strength training 2 to 3x/week
In a large cohort of postmenopausal women, intentional weight loss was associated with a lower risk of developing endometrial cancer, especially in women with obesity. Whether weight loss after treatment lowers recurrence has not yet been shown.⁹

What to eat or do	Details
❌ Foods to Remove / Minimize
These foods add calories with little nutrition.
Refined sugar & sugar-sweetened beverages	Add calories without nutrients, and excess weight is a risk factor for this cancer¹⁵. Soda, juice, candy, baked goods.
Refined flour	White bread, white pasta, pastries, crackers.
Conventional dairy in large amounts	Concentrated source of IGF-⁠1 and growth signals; the link with hormone-sensitive cancers is debated; modest intake is reasonable, but large daily intake is not.
Processed & cured meats	Bacon, deli meats, hot dogs. Classed as a cause of colorectal cancer; the category reflects how certain that link is, not how large the risk is¹⁶.
Alcohol	Raises circulating estrogen and impairs DNA repair. Limit during survivorship, abstain during active treatment.
Excess red meat (over 12 oz, or 350 g, a week)	Linked with higher colorectal cancer risk in observational data; no effect on endometrial cancer recurrence has been shown. Favor pastured poultry and fatty fish.
Raw or undercooked foods while your white cell count is low (neutropenia)	Raw sushi, soft cheeses, sprouts, rare meat. Infection risk during chemo.
✅ Foods to Emphasize
These foods lower insulin and feed the gut microbiome, and suit Type I endometrial cancer survivorship.
Cruciferous vegetables daily	Broccoli, cauliflower, Brussels sprouts, kale, cabbage, bok choy, watercress.
Quality proteins	Wild salmon and sardines, pastured eggs, organic poultry, grass-fed beef in moderation, lentils, plain Greek yogurt if tolerated.
Ground flax seeds (1 to 2 tbsp daily)	Soluble fiber helps glycemic control.
Berries & colorful fruits	Anthocyanins and polyphenols. Low glycemic, anti-inflammatory; pair with protein or fat.
Healthy fats	Extra-virgin olive oil, avocado, walnuts, almonds, pumpkin seeds, chia seeds.
Fermented foods	Kimchi, sauerkraut, plain kefir if tolerated, miso, natto, for gut health.
Slow carbs	Sweet potato, butternut squash, lentils, chickpeas, quinoa, steel-cut oats. Steady energy without insulin spikes.

Supplement Protocol

Evidence-Based Supplements for Uterine / Endometrial Cancer

Supportive supplements during and after cancer treatment must be coordinated with the oncology team, especially given the hormone-sensitive nature of Type I disease. The list below sets out common supportive options and what the evidence shows for each; always confirm with your oncologist before adding any.

Supplement	What it is for	Typical range	Timing	Notes & cautions
Vitamin D3 (with K2)	In a randomized trial of 25,871 adults, vitamin D did not lower cancer rates¹⁷. Supports immune function, calcium balance and bone health, especially after surgical menopause and aromatase-inhibitor therapy.	D3: set the dose with your clinician; most adults need no blood test first; K2 (MK-⁠7): 100 to 200 mcg per day	With a fat-containing meal, morning	Discuss with oncologist before/during treatment. If you take warfarin, clear any vitamin K supplement with the clinician managing your anticoagulation before starting or stopping it: vitamin K antagonizes warfarin, and changing your intake destabilizes the INR. Consistency matters more than avoidance. This does not apply in the same way to direct oral anticoagulants such as apixaban or rivaroxaban, but tell your prescriber about any supplement you take.
Omega-⁠3 EPA/DHA	Sometimes used to support appetite, weight and muscle during treatment, but evidence that it improves treatment tolerance or recovery in this cancer is limited.	2 to 4 g combined EPA+DHA per day	With meals	Choose a product with independent third-party purity testing. Discuss with oncologist; hold before surgery per surgical team protocol. At this dose, check with your doctor first if you are pregnant or could become pregnant. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day²⁵, so check this dose with your clinician first.
Berberine	Activates AMPK and lowers blood glucose and insulin; its effect on endometrial cancer outcomes has not been studied.	500 mg 2 to 3x per day (1,000 to 1,500 mg/day total) in survivorship	With meals	Discuss with oncologist before/during treatment. Can lower blood sugar; monitor it if you have diabetes. Berberine inhibits CYP3A4 and P-glycoprotein, so it can raise blood levels of many prescription medicines. Check with your prescriber before starting it, particularly alongside glucose-lowering medication, an anticoagulant, an immunosuppressant or any drug with a narrow safe range. Not for use in pregnancy or breastfeeding.
Magnesium Glycinate	Supports sleep and muscle relaxation.	300 to 400 mg elemental magnesium per day.	Evening, 30 to 60 min before bed	Adjust if loose stools occur. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice.
B-Complex	Supports energy, neurotransmitter synthesis and methylation pathways.	1 capsule per day per product label	Morning with food	Folic acid works for people with MTHFR variants; methylfolate is an alternative, not a requirement. Discuss high-dose individual folate with oncologist.
Probiotic (Multi-Strain)	Supports gut recovery during/after antibiotics and chemo; a Cochrane review found only low-certainty evidence that probiotics reduce diarrhea from radiation therapy or chemotherapy¹⁸.	25 to 50 billion CFU per day, multi-strain	Empty stomach or with light meal	Avoid during severe neutropenia without oncology approval. Resume in recovery phase.
Iron (only if documented deficiency)	Iron-deficiency anemia is common from prolonged bleeding. Supplement only when iron studies confirm true deficiency.	25 to 65 mg elemental iron per day if deficient	Empty stomach with vitamin C; or oral every other day	Confirm with ferritin and iron studies. Discuss with oncologist before/during treatment. The top of this range sits above the 45 mg/day tolerable upper intake level for adults. That is appropriate only when correcting a confirmed deficiency under clinical supervision, not as general supplementation. Test ferritin first, and retest rather than staying on it indefinitely.
Melatonin	Strong circadian regulator. Mainly useful for sleep; small older trials in advanced cancer reported fewer side effects and longer survival, but they were low quality and the survival claim is not established.	3 to 20 mg at bedtime (start at 3 mg or less; higher doses only if your oncology team advises them)	30 to 60 min before sleep	Start low (no more than 3 mg) and titrate. If you are pregnant or could become pregnant, check with your doctor first. Discuss higher doses with integrative oncology. Melatonin is commonly sold at doses well above what is needed, and more is not better. Start at the lowest available dose. Discuss it with your prescriber if you take sedatives, anticoagulants or immunosuppressants.
Ginger Capsules / Tea	Trials disagree on whether it adds to standard anti-nausea medicines in chemotherapy, so take it only alongside them¹⁹. It has a mild antiplatelet effect, so check with your oncology team first if your platelet count is low during chemotherapy.	500 to 1,500 mg per day in divided doses	Before and during chemo days; with meals	Stop 1 week before surgery (mild antiplatelet effect). Coordinate with oncology pharmacist.
Vitamin C (Oral, Dietary)	Supports collagen, immune function and post-surgical wound healing. Oral dietary intake is supportive; high-dose IV is a separate, oncology-supervised intervention.	500 to 1,000 mg per day (oral)	Divided doses with meals	Avoid high-dose oral antioxidants during specific chemo cycles without oncology guidance.

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.⁷ Nothing on this page treats endometrial cancer. Surgery, usually hysterectomy with removal of the tubes and ovaries, is the primary treatment, with radiation therapy, chemotherapy, hormonal therapy or immunotherapy added by stage and molecular subtype. The most useful point is this: any bleeding after menopause needs prompt investigation, even though most of it is not cancer, and that early presentation is why outcomes for this cancer are relatively good. Do not wait to see if it stops. Between appointments, be careful with supplements: several interact with chemotherapy and with tamoxifen, and phytoestrogen supplements in a hormone-sensitive cancer are a conversation for your oncology team rather than a self-directed decision. Diet and supplements are not an alternative to surgery, chemotherapy, radiation therapy or immunotherapy, and no dietary change should delay or replace treatment decided with your oncology team. Tell your oncology team about every supplement you take.

On presentation and outcome: endometrial cancer is the most common gynecologic cancer in high-income countries and its incidence is rising alongside obesity. Postmenopausal bleeding is the presenting symptom in the large majority, prompting evaluation with transvaginal ultrasound and endometrial biopsy, which is why most cases are diagnosed at an early and highly treatable stage. ↩
On the metabolic link, which is real and unusually direct. Adipose tissue converts androgens to estrogen via aromatase, producing unopposed estrogen exposure in postmenopausal women, and obesity is among the strongest modifiable risk factors for endometrial cancer, with risk rising steeply with BMI. Type 2 diabetes and polycystic ovary syndrome add further risk. This is one of the clearest cancer-metabolism relationships in oncology, and it is why lifestyle has a genuine, though supportive, role here. ↩
On Lynch syndrome: hereditary mismatch repair deficiency accounts for a meaningful minority of endometrial cancers, and endometrial cancer is frequently the sentinel cancer in women with Lynch syndrome. Universal tumor screening for mismatch repair deficiency is recommended, because it changes surveillance for the patient and for relatives and informs immunotherapy eligibility. ↩
On molecular classification: endometrial cancers are increasingly classified into molecular subgroups including POLE-ultramutated, mismatch repair deficient, p53-⁠abnormal and no-specific-molecular-profile, which predict prognosis better than histology alone and guide adjuvant treatment. Immune checkpoint inhibitors have changed outcomes in mismatch repair deficient advanced disease. ↩
On fertility-sparing treatment: in carefully selected younger women with early, low-grade disease confined to the endometrium, progestin therapy with close surveillance is an option that preserves fertility. It requires specialist assessment and is not appropriate for most patients. ↩
On supplements during treatment: high-dose antioxidants during chemotherapy or radiation therapy are generally advised against, on mechanistic grounds and on a non-significant signal of worse outcomes from a breast cancer chemotherapy trial rather than from uterine cancer, PubMed 31855498, with the wider evidence mixed, PubMed 39078314; St. John's wort induces CYP3A4 and reduces levels of several anticancer drugs, imatinib and irinotecan among them, PubMed 23394826; and concentrated phytoestrogen supplements are best avoided in hormone-sensitive disease pending oncology advice, which is a different question from eating soy foods. Give your oncology team the full list. ↩
National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
On uterine cancer numbers: the American Cancer Society estimates about 68,270 new cases of endometrial cancer in the United States in 2026, American Cancer Society. ↩
On weight loss and endometrial cancer: among 36,794 postmenopausal women, intentional weight loss was associated with lower endometrial cancer risk, most strongly in women with obesity (hazard ratio 0.44), PubMed 28165909. ↩
On tamoxifen and the uterus: the American College of Obstetricians and Gynecologists advises that abnormal bleeding or spotting on tamoxifen be investigated, and that routine endometrial surveillance without symptoms is not recommended unless risk is high, PubMed 24848920. ↩
On bleeding after menopause: a meta-analysis of 129 studies and 40,790 women found that 91% of women with endometrial cancer had postmenopausal bleeding, whatever the stage, and that 9% of women with postmenopausal bleeding had endometrial cancer, so most bleeding has another cause but every episode needs checking, PubMed 30083701. ↩
On Lynch syndrome: a 2026 meta-analysis of 33 studies found that cancer risks, including endometrial cancer risk, differ by the mismatch repair gene involved, and supports gene-specific surveillance, including the timing of risk-reducing hysterectomy, PubMed 41389835. ↩
On uterine cancer in the US: SEER estimates 68,270 new cases and 14,450 deaths in 2026 and a lifetime risk of about 3.1%. Five-year relative survival (2016 to 2022) is 80.9% overall: 94.9% when the cancer is confined to the uterus, as 67% are at diagnosis, 70.1% after spread to regional lymph nodes and 19.9% after distant spread, SEER, uterine cancer stat facts. ↩
On risk factors: the National Cancer Institute lists estrogen-only hormone replacement therapy after menopause, tamoxifen, obesity, metabolic syndrome, type 2 diabetes, never giving birth, early periods, late menopause, polycystic ovary syndrome, a mother, sister or daughter with endometrial cancer, genetic conditions such as Lynch syndrome, endometrial hyperplasia and older age. Estrogen combined with progesterone does not increase the risk, NCI PDQ, endometrial cancer treatment. ↩
On weight: the National Cancer Institute states that fat tissue produces excess estrogen, and that for Type I (estrogen-linked) endometrial cancer, people with overweight or obesity have two to four times the risk, and people with severe obesity about seven times the risk, of people at a healthy weight, NCI, obesity and cancer. ↩
On processed meat: the International Agency for Research on Cancer classes processed meat as carcinogenic to humans because it causes colorectal cancer; the classification describes the strength of the evidence, not the size of the risk, so it does not mean processed meat is as dangerous as tobacco, WHO, red meat and processed meat. ↩
On vitamin D and cancer: in the VITAL trial, 25,871 adults randomly assigned to 2,000 IU of vitamin D a day or placebo for a median of 5.3 years had no lower rate of invasive cancer, PubMed 30415629. ↩
On probiotics for treatment-related diarrhea: a Cochrane review of 12 randomized trials in 1,554 people with cancer found only limited, low- or very low-certainty evidence that probiotics prevent or treat diarrhea from radiation therapy or chemotherapy; all the studies were underpowered and none reported serious side effects, PubMed 30168576. ↩
On ginger and chemotherapy nausea: a 2024 meta-analysis of randomized trials found that ginger capsules taken with standard anti-nausea medicines reduced severe nausea and vomiting, but the NIH's complementary health center states that it is uncertain whether ginger helps alongside standard treatment, and that ginger supplements may be safe in pregnancy, PubMed 38625733, NCCIH, ginger. ↩
On bleeding after menopause: NHS guidance says any bleeding from the vagina after menopause needs checking by a doctor, even if it happened once or is only spotting or pink or brown discharge, and that you should not wait more than 2 weeks to see a specialist, who may offer a vaginal ultrasound, a hysteroscopy and a biopsy. It notes that most bleeding has a benign cause, but that a thickened uterine lining (endometrial hyperplasia), which HRT, high estrogen or being overweight can cause, can lead to uterine cancer, NHS, postmenopausal bleeding. ↩
On treatment: NHS guidance states that surgery is often the main treatment for uterine cancer, removing the uterus and cervix and sometimes the ovaries, tubes and lymph nodes, that recovery can take a long time, that radiation therapy or chemotherapy may follow surgery to help stop the cancer from coming back, and that you will have regular checkups but need not wait for one to report a worrying symptom, NHS, treatment for womb cancer. ↩
On side effects of pelvic radiation therapy: a Cochrane review of 92 randomized trials found that internal radiation therapy (brachytherapy) instead of external beam radiation therapy in early endometrial cancer reduced acute bowel side effects; that probiotics, dietary counseling and protein supplements may reduce radiation therapy diarrhea on low-certainty evidence; and that high-certainty evidence shows glutamine does not prevent it, PubMed 29360138. ↩
On heavy bleeding: the American College of Obstetricians and Gynecologists advises that an acute episode of heavy bleeding should be treated right away, and that anyone changing pads or tampons every hour for more than 2 hours in a row who also has chest pain, shortness of breath, light-headedness or dizziness should seek emergency care, ACOG, abnormal uterine bleeding. ↩
On fever during treatment: the National Cancer Institute states that infections during cancer treatment can be life-threatening and need urgent medical attention, that treatments such as chemotherapy raise the risk, and lists a fever of 100.5°F (38°C) or higher among the signs, NCI, infection and neutropenia. ↩
Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩

Uterine / Endometrial Cancer

What Is Uterine / Endometrial Cancer?

Type I, Endometrioid (the most common, estrogen-driven)

Type II, Serous & Clear Cell (less common, aggressive)

Carcinosarcoma & Uterine Sarcomas (rare)

Modern Molecular Classification (TCGA, 4 groups)