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Health condition · Clinically reviewed

Endometrial cancer, postmenopausal bleeding, molecular subtypes and modern treatment.

The most common gynaecological cancer in the UK. Usually treatable and often cured when picked up early - and molecular testing now shapes every plan.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK gynae-oncology clinician before publication.

  • 02

    Sourced from guidance

    Aligned with NICE NG12, BGCS, FIGO 2023 staging and RCPath molecular standards.

  • 03

    Current for 2026

    Reflects molecular subtyping (POLE, MMR, p53), Lynch screening for every case and immunotherapy first-line for dMMR disease.

Key facts

Endometrial cancer at a glance.

The essentials, in plain English - what it is, how it is classified in 2026, and why molecular subtyping matters.

  • What it is

    A cancer of the endometrium, the lining of the womb. The most common gynaecological cancer in the UK.

  • How common

    Around 10,000 women a year in the UK. Peak diagnosis in the 60s and 70s, uncommon before 45 unless Lynch syndrome.

  • Two classic types

    Type 1 endometrioid (about 80%) is oestrogen-driven and usually curable. Type 2 serous, clear-cell and carcinosarcoma is aggressive.

  • Molecular subtypes

    POLE ultramutated, MMR-deficient, copy-number low and copy-number high (p53 abnormal) - now embedded in FIGO 2023 staging.

  • The cardinal symptom

    Postmenopausal bleeding. Any bleeding after the menopause is a 2WW referral until proven otherwise.

  • Outlook

    Most cases are picked up early and cured by surgery. Molecular subtype now shapes both prognosis and treatment.

Why this guide matters

Postmenopausal bleeding is the signal.

Three things shape everything on this page - the symptom that triggers referral, the molecular subtypes that drive treatment, and Lynch screening for every case.

  • Postmenopausal bleeding is a 2WW referral

    Any bleeding after the menopause needs a 2-week-wait referral. Most cases will not be cancer, but this is the pathway that finds the ones that are - early.

  • Molecular subtypes drive treatment

    POLE, MMR, p53 and copy-number status are now embedded in FIGO 2023 staging. They decide who needs more or less adjuvant therapy and who benefits from immunotherapy.

  • Every tumour is screened for Lynch

    MMR immunohistochemistry is now standard on every endometrial cancer. It protects the woman, her sisters and her daughters through genetic testing.

How the diagnosis is made

From first bleed to a clear plan.

The steps a UK gynae-oncology service will normally follow, in order - so you know what to expect and why.

  1. 01

    Recognising

    2WW referral for bleeding

    Any postmenopausal bleeding triggers a 2-week-wait referral per NICE NG12. Premenopausal intermenstrual or persistent abnormal bleeding also warrants investigation.

  2. 02

    Recognising

    Clinical assessment

    History, examination and speculum to exclude cervical, vaginal or vulval sources. Risk factors reviewed - obesity, unopposed oestrogen, tamoxifen, family history.

  3. 03

    Recognising

    Transvaginal ultrasound

    Endometrial thickness is measured. In postmenopausal women a lining of 4 mm or less is reassuring; a thicker lining prompts tissue sampling.

  4. 04

    Confirming

    Hysteroscopy and biopsy

    Outpatient hysteroscopy with a Pipelle or targeted biopsy provides the tissue diagnosis. Often done as a one-stop clinic.

  5. 05

    Confirming

    Staging imaging

    MRI pelvis for local T-stage, CT of chest, abdomen and pelvis for distant disease. Occasionally PET-CT for high-risk or advanced cases.

  6. 06

    Confirming

    Molecular and Lynch testing

    RCPath standards require MMR immunohistochemistry on every endometrial cancer. POLE, p53 and MMR profiling assign the ProMisE molecular class.

  7. 07

    Planning

    Specialist MDT and plan

    A specialist gynae-oncology MDT sets stage, molecular class and treatment. Confirmed MMR deficiency triggers clinical genetics referral for germline testing.

Typical timeline: from 2WW referral to specialist MDT plan within a few weeks.

Symptoms

What endometrial cancer feels like.

Most women present with bleeding - the earlier it is investigated, the better the outcome. Some symptoms are subtle and easily missed.

  • Postmenopausal bleeding

    The cardinal symptom - present in more than 90% at diagnosis. Any bleeding after the menopause needs same-week review.

  • Intermenstrual bleeding

    Bleeding between periods or after sex in perimenopausal women. Deserves investigation, not reassurance.

  • Change in bleeding pattern

    Heavier, longer or more erratic periods in the mid-40s and beyond. Especially important if you carry Lynch syndrome.

  • Abnormal vaginal discharge

    Watery, blood-stained or offensive discharge, particularly after the menopause.

  • Pelvic pain or mass

    A late feature suggesting more advanced disease - persistent pelvic pain, bloating or a palpable mass.

  • Urinary or bowel symptoms

    Rarely, haematuria or a change in bowel habit from local invasion or advanced disease.

  • Younger onset in Lynch

    Endometrial cancer in the 40s or earlier, or a family history of bowel, endometrial or ovarian cancer, points to Lynch syndrome.

  • Red flag - any postmenopausal bleeding

    Even a single episode of bleeding after the menopause is a red flag. Do not wait to see if it settles.

Treatment

How endometrial cancer is treated in the UK.

Surgery is the mainstay. Radiotherapy, chemotherapy, immunotherapy and targeted or hormonal treatment are added according to stage, grade and molecular class.

  • Surgery

    Total hysterectomy with removal of the ovaries and tubes is the mainstay. Sentinel lymph node biopsy is increasingly used and much of it is done robotically.

  • Vaginal brachytherapy

    Internal radiotherapy delivered to the vaginal vault for low and intermediate-risk disease to reduce local recurrence.

  • External beam radiotherapy

    Used for high-risk disease, node-positive cases or when surgery is not possible. Delivered by a specialist clinical oncology team.

  • Chemotherapy

    Carboplatin and paclitaxel for high-risk, advanced or recurrent disease, often combined with radiotherapy in the highest-risk group.

  • Immunotherapy

    Pembrolizumab or dostarlimab for mismatch-repair deficient or MSI-high disease. Increasingly first-line in advanced or recurrent dMMR cancers.

  • Targeted therapy

    Pembrolizumab combined with lenvatinib for mismatch-repair proficient advanced disease, based on the KEYNOTE-775 evidence.

  • Hormonal therapy

    Progestogens - medroxyprogesterone, megestrol or a levonorgestrel IUD - for early grade 1 endometrioid tumours or where surgery is not tolerated.

  • Fertility-sparing care

    Highly selected young women with grade 1 stage IA endometrioid disease may be offered a Mirena or oral progestogens with 3 to 6 monthly hysteroscopy, then interval hysterectomy after childbearing.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and international consensus, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your gynae-oncology team knows your case and can tell you which parts of this guide apply to you. If in doubt, get seen.

  • NICE. Suspected cancer: recognition and referral (NG12).

  • British Gynaecological Cancer Society (BGCS). Uterine cancer guidelines.

  • FIGO 2023 staging system for endometrial cancer (with molecular integration).

  • Royal College of Pathologists (RCPath). Dataset for endometrial cancer histopathology and Lynch screening.

  • ESMO Clinical Practice Guidelines. Endometrial cancer.

  • Cancer Research UK. Womb (endometrial) cancer information and statistics.

Red flags

When endometrial cancer needs urgent action.

Most bleeding in women in their 50s and 60s is benign. These are the patterns that must not be watched and waited on.

  • Postmenopausal bleeding

    Any bleeding after the menopause needs a 2-week-wait referral. It is the single most important symptom and must not be watched and waited on.

  • Heavy bleeding with clots or anaemia

    Persistent heavy or clot-laden bleeding causing symptomatic anaemia needs urgent gynaecology assessment, not just iron.

  • Bleeding on tamoxifen

    Any abnormal bleeding while taking tamoxifen is a red flag - tamoxifen roughly doubles endometrial cancer risk.

  • Unopposed oestrogen HRT with bleeding

    Bleeding while on oestrogen-only HRT without adequate progestogen protection needs prompt review.

  • Lynch syndrome carriers

    Women with a known MMR mutation have a lifetime endometrial cancer risk of 15 to 60%. Any abnormal bleeding is investigated quickly.

  • Rapidly growing pelvic mass

    A pelvic mass with weight loss, bloating or systemic symptoms may signal an aggressive Type 2 tumour or sarcomatous component.

  • Postoperative bleeding after hysterectomy

    New vaginal bleeding after hysterectomy for endometrial cancer suggests vault recurrence and needs urgent oncology review.

  • Haematuria or fresh rectal bleeding

    Rare but important - can indicate bladder or bowel invasion from locally advanced disease.

  • New leg swelling or breathlessness

    Suspicious for venous thromboembolism, which is more common in gynaecological cancers - assess urgently.

Living with it

After treatment, a clear plan for years.

Four practical priorities after diagnosis - structured follow-up, sensible menopause care, healthy weight and diabetes control, and the family genetic pathway if Lynch is confirmed.

A quiet reminder

Small, steady changes add up.

Weight, movement and sleep influence recurrence and second cancers. Support is available through your specialist nurse and charities like Cancer Research UK and The Eve Appeal.

  1. 01 Follow-up

    Structured surveillance

    Lifelong follow-up with the specialist gynae-oncology team. Most recurrences appear in the first two to three years, so early visits are the most intensive.

  2. 02 Menopause

    Symptom-led menopause care

    Surgical menopause can be abrupt. HRT decisions after endometrial cancer are individualised - lifestyle, non-hormonal options and vaginal oestrogen are all considered.

  3. 03 Lifestyle

    Weight, activity and diabetes

    Obesity and insulin resistance drive Type 1 disease. Sustainable weight loss, activity and good diabetes control reduce recurrence and second cancers.

  4. 04 Genetics

    Family and Lynch pathway

    If you have Lynch syndrome, cascade testing for relatives and lifelong colonoscopic and gynae surveillance are commissioned through specialist services.

Frequently asked

Everything we get asked about endometrial cancer.

Quick answers on bleeding, risk, molecular testing, genetics and fertility.

  • What is endometrial cancer?

    It is a cancer that starts in the endometrium, the lining of the womb. It is the most common gynaecological cancer in the UK, with around 10,000 new cases each year. Most cases are Type 1 endometrioid tumours, which are oestrogen-driven and usually diagnosed early through investigation of postmenopausal bleeding.

  • Is postmenopausal bleeding always cancer?

    No, but it is never normal. Only about one in ten women with postmenopausal bleeding turns out to have endometrial cancer, but it is the most important cause to exclude. NICE guidance is clear - any bleeding after the menopause is a 2-week-wait referral for ultrasound and, if indicated, hysteroscopy and biopsy.

  • What are the main risk factors?

    Anything that increases lifetime exposure to unopposed oestrogen - obesity, PCOS, oestrogen-only HRT without progestogen protection, late menopause, nulliparity, tamoxifen and some oestrogen-producing ovarian tumours. Diabetes and hypertension add further risk. Lynch syndrome and Cowden syndrome are the main inherited causes.

  • What does molecular subtyping change?

    The FIGO 2023 staging now integrates molecular groups. POLE ultramutated tumours have an excellent prognosis, often needing less adjuvant treatment. MMR-deficient tumours respond well to immunotherapy. Copy-number high, p53 abnormal tumours are the most aggressive and are treated with the most intensive combined therapy.

  • Do I need genetic testing?

    Every endometrial cancer in the UK is now screened for mismatch-repair deficiency on the surgical specimen. If MMR is abnormal, you will be referred to clinical genetics for germline testing to look for Lynch syndrome, which has implications for surveillance and for your relatives.

  • Can I keep my womb if I want children?

    Sometimes. Fertility-sparing care may be offered to highly selected women with grade 1 stage IA endometrioid tumours and no myometrial invasion, using a Mirena coil or oral progestogens with 3 to 6 monthly hysteroscopy. Hysterectomy is usually recommended after childbearing is complete.

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