Endometrial Cancer: The Fat’s Where it’s At!

One of the most common concerns of menopause is weight gain. Dresses become a size, or two, too small. The average size of the American woman now falls between a 16 and an 18, the lower end of plus sizes.  

But there is a much more worrisome concern about weight gain than dress size…and that’s endometrial cancer – the most common Gyn malignancy, diagnosed 59,000 times each year in the US. 

To get the most out of this post, read these four points:

1. The uterus is made of three layers of smooth muscle (the myometrium) and a thin inner thin lining (endometrium) that sheds each month as menstrual flow.
2. The endometrium responds to estrogen by growing thicker and thicker. The uterus responds to progesterone by compressing into a lush area for a potential embryo to implant and grow. Without progesterone, the uterine lining can continue to grow, and over time turn into precancer and eventually endometrial cancer.
3. Fat cells manufacture large amounts of a weak estrogen called estrone. It’s not as potent as the estradiol made in the ovaries. But if a person has 10, 20, 30 or more pounds of extra fat cells, the sum of that large estrone production is a LOT of estrogen, which equals enough estrogen to cause endometrial cancer. 
4. The most common symptom of endometrial cancer in menopause is vaginal bleeding, and postmenopausal bleeding should be investigated. 

The average age of being diagnosed with endometrial cancer is 63 years. Only 15% occur before age 50. Menopausal women who are obese are the most common group to get endometrial cancer. 

So if you are a woman in menopause, and you suddenly start bleeding again, let your doctor know and get tested. 

If you are overweight and want to lower your risk of endometrial cancer, one of the best ways to do that is by losing weight. In one study, a weight loss of ≥5% of body weight resulted in a 40% reduction in the risk of endometrial cancer compared to women who did not lose weight. If you weigh 200 pounds, just losing 10 pounds (5%) will significantly lower your risk of endometrial cancer. 

Compared to women who had a stable weight, women who gained ≥ 10% had an increased risk of endometrial cancer. 

Three Things to Lower your Risk of Endometrial Cancer?

1. Get physical. Women who exercise regularly have a lower risk of endometrial cancer than women who are sedentary.
2. Consider surgery: For women who are extremely obese, talk with a surgeon about possible weight loss surgery. This is a big decision, and should be reserved for women who are obese and other treatments haven’t been effective. In those instances, bariatric surgery (gastric bypass surgery) can be a good choice.  Weight loss surgery can lower the risk of diabetes and breast cancer as well as endometrial cancer.

1. Take progesterone: Progesterone blocks endometrial growth that is caused by estrogen. It’s the reason why women who have a uterus and take hormone therapy have to take both estrogen and progesterone. Progestins (including bioidentical progesterone and synthetic progesterone) also block the fat cells’ ability to produce estrone. Progesterone can even reverse precancerous changes in the endometrium back to normal cells. You can take progesterone in one of two ways:
   1. Progesterone can be taken as pill, creams and lozenges that send the hormone to the entire body
   2. You can also get progesterone by using a special progesterone-filled IUD that locally releases progesterone directly to the endometrium

Bottom line: if you are obese, especially if you’re BMI is over 35, and you have not had a hysterectomy (uterus removed), talk with your doctor about the risk of endometrial cancer. And if you have postmenopausal bleeding, make an appointment to be evaluated for endometrial cancer.