Endometrial Cancer Prevention

There is no guaranteed way to prevent endometrial cancer. Some risk factors, such as age, genetics, and family history, cannot be changed. However, certain lifestyle choices and medical treatments may help lower your risk. Understanding your personal risk is especially important because many risk factors for endometrial cancer are related to how long the lining of the uterus, called the endometrium, is exposed to estrogen without enough progesterone to balance its effects.

Know your endometrial cancer risk

Endometrial cancer begins in the lining of the uterus. Several factors can increase the likelihood of developing it. Risk factors include:

• Older age, particularly after menopause

• Obesity

• Never having been pregnant

• Beginning menstruation at a young age

• Experiencing menopause at a later age

• Conditions that cause irregular or infrequent ovulation, such as polycystic ovary syndrome (PCOS)

• Taking estrogen without progesterone after menopause when you still have a uterus

• Taking tamoxifen

• A personal history of certain cancers

• A family history of endometrial or colorectal cancer

• Lynch syndrome or certain other inherited cancer syndromes

• Having one or more risk factors does not mean that you will develop endometrial cancer. Some people who develop the disease have few known risk factors.

• Maintain a healthy weight

• Having overweight or obesity is one of the most important modifiable risk factors for endometrial cancer.

After menopause, fat tissue can convert other hormones into estrogen. Higher amounts of body fat can therefore increase estrogen exposure, which can stimulate the endometrium and increase the risk of cancer over time. If you have overweight or obesity, even modest weight loss may provide health benefits. Your healthcare provider or a registered dietitian can help you develop an approach that is appropriate for you.

Stay physically active

Regular physical activity may help lower the risk of endometrial cancer. Exercise can help with weight management and may also influence insulin levels, inflammation, and hormone regulation. Try to make physical activity a regular part of your routine through activities you enjoy, such as walking, swimming, cycling, strength training, or other forms of movement.

Understand estrogen and progesterone

Estrogen causes the endometrium to grow. Progesterone helps balance this effect. Long periods of estrogen exposure without adequate progesterone can increase the risk of endometrial cancer. For example, people who have a uterus and use estrogen-only hormone therapy after menopause have an increased risk of endometrial cancer. Adding a progestogen can substantially reduce this risk. If you are considering menopausal hormone therapy, talk with your healthcare provider about the benefits and risks based on your symptoms, medical history, and whether you still have a uterus.

Talk with your doctor about irregular periods

Conditions that cause infrequent or irregular ovulation can result in prolonged estrogen exposure without enough progesterone. For example, some people with polycystic ovary syndrome (PCOS) have long periods of time without ovulating or menstruating. This can increase the risk of endometrial hyperplasia, an abnormal thickening of the uterine lining, and eventually endometrial cancer. If you regularly go long periods without having a menstrual period, talk with your healthcare provider. Treatments may be available to protect the endometrium.

Birth control and endometrial cancer risk

Certain forms of hormonal birth control are associated with a lower risk of endometrial cancer. Combined oral contraceptives, which contain estrogen and progestin, can significantly reduce endometrial cancer risk. This protective effect increases with longer use and can continue for many years after the pills are stopped. Some other forms of hormonal contraception that contain progestin may also protect the endometrium. Birth control has potential benefits and risks and should be selected based on your individual health needs rather than used solely for cancer prevention.

Pregnancy and breastfeeding

Pregnancy is associated with a lower risk of endometrial cancer. During pregnancy, progesterone levels are high and ovulation stops, reducing the endometrium's exposure to estrogen without progesterone. Breastfeeding may also be associated with a lower risk. These are associations rather than recommendations to become pregnant or breastfeed specifically to prevent cancer.

Know your family history

A small percentage of endometrial cancers are related to inherited genetic conditions. The most important is Lynch syndrome, which is caused by inherited changes in genes responsible for repairing damaged DNA. People with Lynch syndrome have an increased risk of several cancers, particularly colorectal and endometrial cancer. Tell your healthcare provider if you have a personal or family history of:

• Endometrial cancer at a young age

• Colorectal cancer

• Multiple relatives with endometrial or colorectal cancer

• Ovarian, stomach, urinary tract, or other Lynch syndrome-associated cancers

• A known Lynch syndrome-related genetic variant in your family

Your healthcare provider may recommend genetic counseling or testing based on your family history.

Risk-reducing surgery for people with Lynch syndrome

People with Lynch syndrome have a substantially increased lifetime risk of endometrial cancer. After completing childbearing, some people with Lynch syndrome may consider a risk-reducing hysterectomy, which removes the uterus. Removal of the fallopian tubes and ovaries may also be discussed depending on the specific genetic variant, age, and individual ovarian cancer risk. These decisions should be made with a healthcare team experienced in hereditary cancer syndromes.

Reducing your risk

You cannot control every risk factor for endometrial cancer, but there are steps you can take to protect your health. Maintaining a healthy weight, staying physically active, managing conditions that cause irregular ovulation, and using hormone therapy appropriately may help lower your risk.

It is also important to know your family history. If endometrial, colorectal, or other Lynch syndrome-associated cancers run in your family, ask your healthcare provider whether genetic counseling or testing may be appropriate.