# Womb cancer: symptoms, treatment and survival > Source: World Aid Network — https://worldaidnetwork.org/cancer/womb-cancer > Last reviewed: 2026-06-19 ## In short Womb cancer (also called endometrial or uterine cancer) is the most common cancer of the female reproductive system. The good news is that it usually has a clear, early warning sign: unexpected vaginal bleeding, especially any bleeding after the menopause. The most common gynaecological cancer — with one clear early warning sign. World Aid Network funds treatment for patients who cannot pay. ## At a glance - ~10,000: UK cases each year - Women after menopause: Most common in - Over 95% (Stage 1): Survival when caught early - Bleeding after menopause: Key sign ## What is womb cancer? Womb cancer (also called endometrial or uterine cancer) is the most common cancer of the female reproductive system. The good news is that it usually has a clear, early warning sign: unexpected vaginal bleeding, especially any bleeding after the menopause. Womb cancer — also called endometrial cancer or uterine cancer — is the most common gynaecological cancer in the UK. Around 10,000 women are diagnosed each year, and approximately 2,400 die annually from the disease. Despite being the most common, it is not the most deadly gynaecological cancer — that remains ovarian cancer — because womb cancer is often diagnosed at an early stage due to its distinctive and recognisable symptom. Post-menopausal bleeding — any vaginal bleeding that occurs 12 or more months after periods have stopped — is the hallmark symptom of womb cancer and must always be investigated. Although 9 in 10 women with post-menopausal bleeding are found not to have cancer, all cases require urgent assessment. This guide answers the twenty most commonly searched questions about womb cancer in the UK, drawing on NHS and WHO sources. ## When should you see a doctor about womb cancer? Most of these symptoms have a less serious cause — but it is always worth getting them checked. See a GP if you notice a new or persistent change. If you feel very unwell, contact NHS 111 or seek urgent help. Take a note of how long the symptom has lasted and whether it is getting worse. You do not need every sign on a list to book an appointment. This guide is general information from World Aid Network, not a diagnosis and not UK NHS care. Only a clinician can assess you. - Any vaginal bleeding after the menopause - Bleeding between periods, or much heavier periods than usual - Unusual vaginal discharge, especially if blood-stained - Pain in the lower tummy or during sex - Losing weight without trying ## What are types and risk factors? The vast majority of womb cancers (approximately 80%) are Type I endometrioid endometrial carcinomas — slow-growing tumours that are strongly driven by oestrogen excess and carry a good prognosis when detected early. Type II endometrial cancers — including high-grade serous, clear cell and carcinosarcoma — are less common but more aggressive, with a worse prognosis. The distinction matters clinically because Type I and Type II tumours have different molecular profiles and respond differently to treatment. The major risk factors for womb cancer relate to prolonged, unopposed oestrogen stimulation of the endometrium: obesity (the most important modifiable risk factor — adipose tissue converts androgens to oestrogen); Type 2 diabetes; polycystic ovary syndrome (PCOS); late menopause (over 55); never having been pregnant; tamoxifen therapy (for breast cancer); oestrogen-only HRT (without progestogen) in women with a uterus; and Lynch syndrome (mismatch repair gene mutations — associated with up to 60% lifetime risk of endometrial cancer). ## How is it diagnosed? Any woman with post-menopausal bleeding or unexpected inter-menstrual bleeding should be referred via the NHS Two Week Wait pathway to a gynaecology clinic. Investigation includes transvaginal ultrasound (an endometrial thickness of less than 4 mm effectively excludes endometrial cancer in postmenopausal women) and hysteroscopy — a direct visual inspection of the uterine cavity using a thin telescope, with guided biopsy of any abnormal areas. Pipelle endometrial biopsy (a simple outpatient procedure) is used for initial sampling. Staging of confirmed endometrial cancer uses MRI of the pelvis (to assess myometrial invasion depth and cervical involvement) and CT chest-abdomen-pelvis (to detect lymph node and distant metastasis). Molecular classification (using immunohistochemistry and molecular testing for POLE mutation, MMR deficiency and TP53 mutation) is now performed at specialist centres and directly guides adjuvant treatment decisions. ## What treatment is available? The primary treatment for endometrial cancer is surgery — total hysterectomy and bilateral salpingo-oophorectomy (removal of the uterus, cervix, fallopian tubes and ovaries), plus pelvic and para-aortic lymph node assessment. Minimally invasive (laparoscopic or robotic) surgery is preferred where possible. Adjuvant treatment after surgery depends on risk stratification: low-risk Stage I disease (no further treatment); intermediate-risk (vaginal brachytherapy); high-risk or advanced disease (external beam radiotherapy, chemotherapy with carboplatin and paclitaxel, or both). For recurrent or advanced endometrial cancer, immunotherapy has transformed outcomes. Pembrolizumab combined with lenvatinib is NICE-approved for MMR-proficient advanced endometrial cancer; pembrolizumab monotherapy is approved for MMR-deficient (dMMR/MSI-H) tumours. Dostarlimab is also approved for dMMR advanced endometrial cancer. These immunotherapy-based combinations have significantly improved progression-free and overall survival compared with chemotherapy alone. ## What are the key takeaways? The most important points on womb cancer for patients, families and donors. - Womb cancer is the most common gynaecological cancer in the UK, with approximately 10,000 diagnoses per year. Most are diagnosed at an early stage, giving an excellent overall prognosis. - Post-menopausal bleeding — any vaginal bleeding 12+ months after the last period — must always be investigated urgently. It is the most important warning symptom of womb cancer. - Obesity is the most important modifiable risk factor. Adipose tissue produces oestrogen, which drives endometrial proliferation. Maintaining a healthy weight significantly reduces womb cancer risk. - Standard treatment is hysterectomy plus bilateral salpingo-oophorectomy. Adjuvant radiotherapy and/or chemotherapy are used for higher-risk disease. Immunotherapy (pembrolizumab + lenvatinib) is now standard for recurrent disease. - Lynch syndrome causes up to 60% lifetime endometrial cancer risk. Women with Lynch syndrome require enhanced surveillance and should inform their gynaecologist of their diagnosis. ## What will a donation for womb cancer treatment provide? A gift to World Aid Network's Cancer Emergency Appeal helps pay for diagnosis and treatment that a poor patient has been recommended but cannot afford. Typical partner costs start at £10 for tests and £50 for a chemotherapy session. Trustees direct gifts to the most urgent cases. This is treatment access, not laboratory research and not UK NHS care. Clinicians in partner hospitals decide the medical plan. We fund the bill in Pakistan, Indonesia and Malaysia. The Cancer Emergency Appeal funds all types of cancer. Trustees direct gifts to the most urgent hospital bills in Pakistan, Indonesia and Malaysia. - £10 — Diagnostic tests that help a partner oncologist confirm the next step - £25 — Cancer medication towards a treatment cycle a family cannot afford - £50 — One chemotherapy session for a patient who would otherwise be turned away - £100 — Surgical support or a fuller block of treatment costs ## How can I donate to help people with womb cancer? Donate by card on this page or at worldaidnetwork.org/donate and choose the Cancer Emergency Appeal. World Aid Network is a UK CIO with Charity Commission registration in progress; Gift Aid applies once registration is granted. If you need UK support as a patient or relative, see a GP, NHS 111, Macmillan or the specialist UK charity for this cancer. We fund treatment overseas; we are not a UK helpline. ## How do you get unexpected vaginal bleeding checked? Womb cancer often has a clear early warning: bleeding after the menopause, or bleeding that is not normal for you. Getting it checked promptly is how most cases are found early. - Treat any post-menopausal bleeding as a reason to see a GP: Even a small amount of blood after the menopause should be checked. Do not wait to see if it happens again. - Report bleeding between periods: Much heavier periods, bleeding between periods, or blood-stained discharge also need assessment. - Ask what tests come next: A GP may arrange an ultrasound, a biopsy, or an urgent suspected-cancer referral. - Do not put it down to age alone: Bleeding after the menopause is common enough to check and important enough not to ignore. ## Frequently asked questions ### What is womb cancer? Womb cancer (also called endometrial cancer or uterine cancer) is a malignant tumour of the lining of the uterus (the endometrium). It is the most common gynaecological cancer in the UK, with approximately 10,000 diagnoses per year. Most (approximately 80%) are Type I endometrioid adenocarcinomas — oestrogen-driven, slow-growing and generally diagnosed at an early stage with a good prognosis. ### What are the symptoms of womb cancer? Post-menopausal bleeding — any vaginal bleeding that occurs 12 or more months after periods have stopped — is the most common and most important symptom. In premenopausal women, unexpected bleeding between periods or unusually heavy periods can be a symptom. Other symptoms include: a watery or blood-stained vaginal discharge; pelvic pain or pressure; pain during or after sex; and unintentional weight loss. Any post-menopausal bleeding must be reported to a GP promptly — it should never be assumed to be normal. ### What causes womb cancer? Womb cancer is primarily driven by excess oestrogen stimulation of the endometrium without the balancing effect of progesterone. Factors that create this oestrogen excess include: obesity (adipose tissue converts androgens to oestrogen); Type 2 diabetes; PCOS; late menopause; never having been pregnant; oestrogen-only HRT without progestogen in women with an intact uterus; and tamoxifen. Lynch syndrome — an inherited DNA mismatch repair gene mutation — is the most important hereditary risk factor, carrying up to 60% lifetime endometrial cancer risk. ### Who is at highest risk of womb cancer? Risk is highest in: postmenopausal women over 60 (peak incidence); obese women (BMI over 30 — the most important modifiable risk factor); women with Type 2 diabetes; those with Lynch syndrome or a strong family history of colorectal and endometrial cancer; women who have never been pregnant; those with PCOS; women taking tamoxifen for breast cancer; and those on long-term oestrogen-only HRT without progestogen. The combined oral contraceptive pill and progestogen-releasing IUS (Mirena) are protective. ### How is womb cancer diagnosed? Investigation begins with a transvaginal ultrasound to measure the endometrial thickness. A thin endometrium (under 4 mm) effectively excludes cancer in postmenopausal women. A thick or irregular endometrium triggers hysteroscopy — a direct visual inspection of the uterine cavity using a thin camera-equipped scope — with guided biopsy. Pipelle endometrial biopsy (an outpatient sampling procedure) is used for initial tissue sampling. MRI stages the tumour locally; CT chest-abdomen-pelvis detects lymph node and distant metastasis. ### What is post-menopausal bleeding? Post-menopausal bleeding (PMB) is defined as any vaginal bleeding that occurs 12 or more months after the last menstrual period in a woman who has gone through the menopause naturally. It must always be reported to a GP and investigated urgently — it is the most common presenting symptom of womb cancer. However, approximately 90% of women investigated for PMB are found not to have cancer — other causes include atrophic vaginitis, endometrial atrophy, cervical polyps and HRT effects. ### What is hysteroscopy? Hysteroscopy is a procedure in which a thin, flexible or rigid telescope (hysteroscope) equipped with a camera and light is passed through the vagina and cervix into the uterine cavity, allowing direct visual inspection of the endometrium. Abnormal areas can be biopsied under direct vision. Outpatient hysteroscopy is performed under local anaesthetic or without anaesthetic; general anaesthetic is used if the procedure is combined with polyp removal or other operative procedures. It is the definitive investigation for suspected endometrial pathology. ### What is Lynch syndrome? Lynch syndrome (hereditary non-polyposis colorectal cancer, HNPCC) is an inherited condition caused by mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2 or EPCAM). It is the most common cause of hereditary endometrial cancer — women with Lynch syndrome have a lifetime risk of endometrial cancer of up to 60% and are also at significantly elevated risk of colorectal, ovarian and other cancers. Lynch syndrome is diagnosed through germline genetic testing. Women with Lynch syndrome should be offered annual endometrial surveillance and may opt for risk-reducing hysterectomy after completing childbearing. ### How is womb cancer treated? The primary treatment is surgery — total hysterectomy (removal of uterus and cervix) and bilateral salpingo-oophorectomy (removal of fallopian tubes and ovaries), plus lymph node assessment. Minimally invasive surgery (laparoscopic or robotic) is preferred. Adjuvant treatment depends on molecular risk stratification: low-risk Stage I — no further treatment; intermediate risk — vaginal brachytherapy; high-risk/advanced — external beam radiotherapy and/or carboplatin + paclitaxel chemotherapy. Recurrent disease: pembrolizumab + lenvatinib (NICE-approved) or dostarlimab (for dMMR tumours). ### What is the survival rate for womb cancer? Five-year survival rates in England: Stage I — approximately 90%; Stage II — approximately 75–80%; Stage III — approximately 50%; Stage IV — approximately 20%. Overall five-year survival for all stages combined is approximately 77%, reflecting the high proportion diagnosed at an early stage (around 75% of UK womb cancers are Stage I at diagnosis). Immunotherapy-based treatments for recurrent disease are improving survival for advanced and recurrent endometrial cancer. ### Can obesity cause womb cancer? Yes. Obesity is the most important modifiable risk factor for womb cancer. Adipose (fat) tissue contains an enzyme called aromatase that converts androgens into oestrogen — the higher the body fat, the greater the oestrogen production. This excess, unopposed oestrogen stimulates the endometrium, increasing the risk of pre-cancerous hyperplasia and cancer. Compared with women of healthy weight, those with a BMI over 30 have approximately twice the risk, and those with a BMI over 40 have approximately four times the risk of developing womb cancer. ### Does the Mirena coil protect against womb cancer? Yes. The levonorgestrel intrauterine system (LNG-IUS, commonly called the Mirena coil) releases a low dose of progestogen directly into the uterine cavity, causing the endometrial lining to thin. This counteracts the oestrogen-stimulated proliferation that drives endometrial cancer and is associated with a significant reduction in womb cancer risk — estimates suggest approximately 50% risk reduction with long-term use. The LNG-IUS is also used as part of the treatment for endometrial hyperplasia (the precursor to Type I endometrial cancer). ### What is endometrial hyperplasia? Endometrial hyperplasia is the abnormal thickening of the endometrial lining due to excess oestrogen stimulation, representing a pre-cancerous condition that can progress to endometrial cancer. It is classified as simple, complex or atypical hyperplasia — the last being at highest risk of malignant transformation (approximately 29% risk of progression to cancer if untreated). Atypical hyperplasia is treated with high-dose progestogen (oral or via LNG-IUS) for women wishing to preserve fertility, or hysterectomy for those who have completed childbearing. ### Can womb cancer be prevented? Risk can be reduced by: maintaining a healthy weight; treating type 2 diabetes well; using combined HRT (oestrogen plus progestogen) rather than oestrogen-only in women with a uterus; considering the combined oral contraceptive pill or LNG-IUS (Mirena); attending Lynch syndrome surveillance if at genetic risk; and reporting any post-menopausal bleeding or unexpected inter-menstrual bleeding to a GP promptly. There is no national womb cancer screening programme for average-risk women. ### Is womb cancer the same as cervical cancer? No. Womb cancer (endometrial cancer) and cervical cancer are different diseases arising from different parts of the female reproductive tract. Womb cancer arises from the endometrium (lining of the uterus) and is primarily driven by oestrogen excess. Cervical cancer arises from the cervix (the neck of the uterus) and is caused by HPV infection in 99.7% of cases. They have different risk factors, symptoms, investigations and treatments. Cervical screening does not detect womb cancer. ### What are the types of womb cancer? The main types are: Type I endometrioid endometrial carcinoma (approximately 80% — oestrogen-driven, good prognosis, usually Grade 1 or 2); Type II cancers — high-grade serous, clear cell and carcinosarcoma (approximately 20% — not oestrogen-driven, more aggressive, worse prognosis). Molecular classification now divides endometrial cancers into four groups: POLE-mutated (best prognosis), MMR-deficient (intermediate-good, responds to immunotherapy), copy-number low (intermediate), and TP53-mutated (worst prognosis). This molecular classification increasingly guides adjuvant treatment decisions. ### Can womb cancer be treated without removing the uterus? For carefully selected young women with early-stage (Stage IA, Grade 1 endometrioid) endometrial cancer who wish to preserve fertility, fertility-sparing management with high-dose progestogen (oral megestrol or medroxyprogesterone acetate, or LNG-IUS) may be appropriate after thorough staging and multidisciplinary team discussion. This is not standard management and requires close specialist gynaecological oncology follow-up with repeated endometrial sampling. It is only considered in well-selected patients; hysterectomy remains the standard surgical treatment. ### Does tamoxifen cause womb cancer? Yes — tamoxifen, used to treat oestrogen receptor-positive breast cancer, acts as an oestrogen agonist in the uterus, stimulating endometrial proliferation and increasing the risk of endometrial cancer approximately two- to three-fold. Women taking tamoxifen should be advised to report any abnormal vaginal bleeding or discharge to their GP promptly so it can be investigated. Routine endometrial surveillance in asymptomatic tamoxifen users is not recommended by NICE as it has not been shown to improve outcomes. ### How does womb cancer affect people in developing countries? In low-income countries, womb cancer is frequently diagnosed late because symptom awareness is low and gynaecology services are concentrated in urban centres. Hysterectomy — the cornerstone of treatment — requires a specialist surgeon and a safe surgical environment that may not be available in rural settings. Chemotherapy and immunotherapy for advanced disease are largely unaffordable. World Aid Network funds cancer treatment through locally-licensed oncologists, helping to improve access to life-saving care. ## How you can help World Aid Network funds cancer treatment for poor patients in Pakistan, Indonesia and Malaysia through locally licensed oncologists. Donate at https://worldaidnetwork.org/cancer/womb-cancer or https://worldaidnetwork.org/donate?cause=cancer-treatment&appeal=cancer-emergency ## Sources - NHS — Cancer: https://www.nhs.uk/conditions/cancer/ - Cancer Research UK --- This is general information, not medical advice, published by World Aid Network. Always consult a qualified clinician about your own health.