This guide explains a type of womb cancer that starts in the endometrium — the lining where a fertilised egg implants and which sheds during a period.
Clear information helps people get timely assessment and better outcomes. The Ultimate Guide outlines what the endometrium is, how the menstrual cycle affects the lining, and how cancer can develop.
Early signs can be subtle. Many women first seek help because of abnormal bleeding patterns. Bleeding after the menopause is a red-flag sign and should prompt a prompt GP review.
The guide also previews how hormones such as oestrogen and progesterone influence growth and risk, and how management is personalised. Common options include surgery and other treatment approaches depending on stage and overall health.
Later sections cover UK tests, such as ultrasound and sampling, and explain what results may mean. The tone here is factual and supportive, encouraging proactive help-seeking when concerns persist.
Key Takeaways
- This is a form of womb cancer that affects the endometrium.
- Abnormal bleeding, especially after the menopause, needs urgent review.
- Hormone balance links to risk and to some treatments.
- Management is personalised and may include surgery and other options.
- UK diagnostic tests include ultrasound and sampling; later sections explain these.
Understanding the endometrium and the uterus lining
The uterus lining is a dynamic tissue that changes with each menstrual cycle. It is the inner epithelial layer and mucous membrane of the uterus and supports normal female reproductive function. The lining maintains the uterine cavity and prepares for a fertilized egg.
What the lining does in the reproductive system
The lining responds to hormone signals from the ovaries. Under oestrogen it thickens; after ovulation, progesterone turns it secretory to support possible pregnancy.
How the lining changes throughout the cycle
The normal sequence is build, change, then shed. When no pregnancy occurs, arteries to the functional layer constrict, cells die and menstruation follows.
Layer differences and implantation
The functional layer is the part that sheds each period. The basal layer lies beneath, contains stem cells and regenerates the lining. A fertilized egg implants into the prepared lining and, if successful, the tissue is maintained to help form the placenta during pregnancy.
| Layer | Main role | Clinical note |
|---|---|---|
| Functional layer | Thickens, becomes secretory, sheds | Thickness varies throughout menstrual cycle |
| Basal layer | Regenerates lining, contains stem cells | Damage here can affect future healing |
| Overall lining | Supports implantation and monthly bleed | Clinicians interpret samples by cycle day |
Endometrial cancer explained
When cells in the lining of the uterus acquire faulty DNA, they can form a tumour that may invade nearby tissue. This begins inside the endometrium and usually starts as abnormal cell growth that escapes normal controls.
How cancer develops from cells and tissue
Cancer here means malignant change. Abnormal cells multiply, form a mass and can spread into the myometrium or beyond. Doctors look at cell appearance and behaviour to judge aggressiveness.
How this differs from other uterine conditions
Womb cancer is a specific diagnosis. Many benign uterine conditions cause similar symptoms, so tests are needed rather than self-diagnosis.
Related conditions affecting the lining of the womb
Conditions include endometriosis (endometrium-like tissue outside the uterus), adenomyosis (lining within the muscle), and endometrial hyperplasia — a thickened lining that may be pre-cancerous.
| Condition | Main feature | Why it matters |
|---|---|---|
| Endometrial hyperplasia | Thickened lining, abnormal cells | Some types raise cancer risk and need monitoring |
| Endometriosis | Tissue like lining found outside the womb | Causes pain and bleeding but is not the same as cancer |
| Adenomyosis | Endometrium within uterine muscle | Can cause heavy periods and pelvic pain |
Signs and symptoms to watch for
Many symptoms of a womb problem start with changes to bleeding or new pelvic pain.
What abnormal uterine bleeding can look like
Abnormal uterine bleeding might mean heavier periods, bleeding between cycles, bleeding after sex, or new spotting. These pattern changes matter because the timing and amount of blood help clinicians to identify cause.
Bleeding after the menopause
Bleeding after menopause always needs urgent assessment in the UK. Any new vaginal blood after periods have stopped should be reported promptly to a GP or specialist rather than being ignored.
Other warning signs
Symptoms may also include persistent pelvic pain, a feeling of pressure, or noticing lumps or swellings in the pelvis. These can occur with or without bleeding.
Do not normalise persistent or worsening symptoms. If changes appear outside a person’s usual pattern or continue over time, they should seek review.
- Clinicians ask about timing, volume, duration and clots, and about medications or hormone exposure.
- If new symptoms develop between appointments, contact the cancer doctor or specialist nurse for advice.
- Many signs overlap with benign conditions, but prompt assessment helps rule out serious causes and speeds access to tests.
For local support and to find women’s gynaecology care, seek NHS or specialist services. The next section explains causes and risk factors linked to hormones and life stage.
Causes and risk factors linked to hormones and life stage
Over time, different hormonal patterns can increase or reduce the chance of abnormal lining growth. This section explains how oestrogen and progesterone influence normal repair and how changes with age affect risk.
The role of oestrogen and progesterone in endometrial growth
Oestrogen stimulates the functional layer to thicken during the cycle. Progesterone then converts that tissue into a secretory lining ready for a pregnancy and limits further growth.
When estrogen exposure is unopposed by progesterone, the lining may stay over-stimulated. This prolonged stimulus can raise the chance of abnormal cell changes over time.
Menopause, an atrophic lining, and changes over time
After the menopause the endometrium usually becomes thin or atrophic. This alters what clinicians expect on scan or sampling and makes any new bleeding more concerning.
Endometrial hyperplasia and prolonged stimulation of the uterine lining
Endometrial hyperplasia is a thickened lining with abnormal cells. It is not cancer but in some forms it increases future risk and needs monitoring or treatment.
Clinicians may offer progestogen therapy for protection in selected situations. Such choices are personalised, reflecting a person’s risk, symptoms and broader health.
- Risk is multifactorial — having a factor does not mean cancer will develop.
- Changes like irregular bleeding should prompt review, not dismissal as “just hormones”.
- Suspicious patterns often lead to direct investigation of the lining by imaging or sampling.
| Factor | Effect on lining | Clinical note |
|---|---|---|
| Prolonged oestrogen | Builds and thickens lining | May lead to hyperplasia if unopposed |
| Progesterone/progestogen | Stabilises and matures lining | Used therapeutically for endometrial protection |
| Menopause | Often causes an atrophic (thin) lining | Any post‑menopausal bleed needs urgent review |
| Other risk factors | Obesity, polycystic ovaries, diabetes | Contribute to hormone imbalance and risk stratification |
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Diagnosis and tests used in the UK
Diagnosis usually follows a clear sequence: initial assessment, imaging, then tissue sampling if needed. This approach helps clinicians reach answers quickly and plan treatment or monitoring.
Initial assessment and internal examination
First, a GP will take a focused history about symptoms and timing in the menstrual cycle. They will ask when the last period was and about any medication or hormone therapy.
An internal examination may be offered to check the uterus and surrounding areas. Findings help decide which specialist tests are needed next.
Ultrasound and measuring the endometrium
An ultrasound is commonly used to view the lining and uterus. It measures endometrial thickness; average thickness is around 6.7 mm when echogenic on scan, but values vary by phase.
Measurement guides decisions, especially after the menopause. A thin lining often reassures; a thickened lining usually prompts sampling or further imaging.
Sampling the lining and checking cells under the microscope
Sampling takes a small tissue specimen to examine cells. Pathologists look for normal tissue, hyperplasia or cancerous change.
This test gives definitive information and helps plan care. It is described to patients in practical, non-graphic terms before the procedure.
How clinicians interpret findings across the cycle
Pre‑menopausal results depend on cycle timing. The lining and cell appearance change throughout the menstrual cycle and around menstruation.
Clinicians therefore ask about cycle day and recent bleeding to place findings in context and avoid misinterpretation.
When further investigations may be recommended
If results are unclear, symptoms persist, or a cancer diagnosis needs staging, clinicians may order MRI, hysteroscopy or repeat sampling. Follow‑up often includes regular internal checks after treatment.
People should report new bleeding, pelvic pain or lumps between appointments. Many services now offer patient‑initiated follow‑up so problems are reviewed promptly.
| Step | What it shows | Next steps |
|---|---|---|
| History & exam | Pattern of symptoms, possible palpable changes | Refer for ultrasound or specialist clinic |
| Ultrasound | Appearance of uterus and lining; endometrium thickness (~6.7 mm average) | Decide on biopsy or further imaging |
| Biopsy / sampling | Cells and tissue diagnosis under microscope | Plan treatment, monitoring, or staging tests |
| Advanced imaging | MRI or further scans for staging | Surgical planning or oncological referral |
Conclusion
Follow-up care and practical support are important parts of the recovery journey. This guide gives clear information about the lining, why hormone balance matters, and which signs need prompt review.
Diagnosis in the UK relies on tests such as ultrasound and sampling, with results interpreted in context of the cycle for pre‑menopausal people. Report any new vaginal bleeding, pelvic pain or lumps straight away.
Treatment plans can include surgery, other treatments or therapy chosen for stage and overall health. If cancer returns locally it can often be treated successfully, so timely reporting matters.
Recovery takes time and feelings of anxiety are common. Contact the cancer team or Macmillan on 0808 808 00 00 for support. Small changes — eating well and staying active — can aid health and help the body recover alongside medical care.
