Endometrial Cancer Risk Factors and Prevention

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Risk factors are certain conditions that raise your chances of getting a disease. For each person, there’s a mix of genetic, biological and lifestyle factors that play a part in endometrial cancer risk.

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Talk to your primary care provider if you have symptoms that you think may be endometrial cancer. UW Medicine Primary Care can help you get started. Learn about Fred Hutch's relationship with UW Medicine. 

Risk Factors for Endometrial Cancer

Endometrial cancer rarely affects people under age 40. Most people with endometrial cancer are 50 years old or older.

Hormone-Related Risk Factors for Endometrial Cancer

Besides age, another important risk factor is your balance of the hormones estrogen and progesterone. Factors that shift your balance toward more estrogen can increase your risk. This is why the following are risk factors:

  • Taking hormone replacement therapy (HRT) for menopause with estrogen alone. (People who have a uterus can take a form of HRT that combines estrogen and progestins, which are progesterone-like drugs. This avoids the increased risk for endometrial cancer.)
  • Having more menstrual periods — starting your period earlier in life or going through menopause later.
  • Never being pregnant.
  • Being overweight or obese (because body fat raises your estrogen level).

Other Risk Factors for Endometrial Cancer

There a several other risk factors for endometrial cancer. Some you can control, and others you can't. They include:

  • Having breast cancer, ovarian cancer, polycystic ovary syndrome, metabolic syndrome or diabetes
  • Taking tamoxifen (a hormone therapy drug) to treat or prevent breast cancer
  • Eating a high-fat diet
  • Having a sedentary (inactive) lifestyle
  • Having a family history of endometrial cancer in a first-degree relative (your mother, sister or daughter)
  • Having Lynch syndrome, also called hereditary non-polyposis colon cancer
  • Having had radiation therapy to your pelvic area
  • Having had endometrial hyperplasia, especially complex hyperplasia with atypia

Black women are at higher risk for advanced endometrial cancer and more aggressive forms and are more likely to have worse outcomes. UW Medicine gynecologic oncologist Kemi Doll, MD, MCSR, who works closely with Fred Hutch, founded Endometrial Cancer Action Network for African Americans (ECANA) to understand the reasons and improve patient care and support. “We’re trying to close that gap,” said Elizabeth Swisher, MD, Dr. Doll’s colleague and a gynecologic oncologist and clinical researcher at Fred Hutch Cancer Center. Swisher holds the Torkelson Family Endowed Chair.

Endometrial Hyperplasia

Hyperplasia means an overgrowth of cells. In endometrial hyperplasia, there’s an abnormal overgrowth of cells in the endometrium (sometimes called a thickening of the endometrium). The cells aren’t cancer. But there’s a risk they could become cancer. This is why hyperplasia may be called “precancerous.”

You might find out you have endometrial hyperplasia if you have symptoms of endometrial cancer and your care team does a biopsy (taking samples of tissue to check under a microscope in a lab). Risk is high that 25% to 50% of women with a type of endometrial hyperplasia called complex hyperplasia with atypia will go on to have endometrial cancer.

How to Reduce Your Risk If You Have Complex Hyperplasia with Atypia

To reduce the risk of endometrial cancer if you have complex hyperplasia with atypia, physicians usually advise having a hysterectomy (surgery to remove the uterus). This is the typical recommendation if you are past childbearing years or do not intend to become pregnant. Many gynecologists refer these women to a gynecologic oncologist for their surgery because of the chance of finding cancer at the time of the hysterectomy.

For younger people who hope to keep their ability to have children, physicians may sometimes take a more conservative approach. This could include using hormone therapy (usually progestins) to reduce cancer risk and doing close follow-up to watch for any signs of cancer.

Endometrial Cancer Prevention

The exact cause of endometrial cancer is unknown, so there’s no clear way to prevent it. However, you can help reduce your risk by changing lifestyle factors that you can control, such as:

  • Maintaining a healthy weight
  • Avoiding high-fat foods
  • Being more physically active

Being pregnant and breastfeeding are both protective, meaning they lower the risk.

Taking birth control pills also lowers your risk for endometrial cancer. When you’re making decisions about birth control, talk with your primary care provider or gynecologist about how to weigh all the benefits and risks in your situation.

Endometrial Cancer Risk Factors and Prevention FAQ

Along with maintaining a healthy weight, avoiding high-fat foods and being physically active, consider making these lifestyle choices to help prevent cancer overall:

  • Focus your food choices on whole grains, vegetables, fruit and beans. Try to get the nutrients you need through these foods, not supplements.
  • Eat less “fast food” or other processed foods (especially if they are high in fat, starch or sugar) and less red or processed meat. Drink less alcohol and fewer drinks sweetened with sugar.
  • Don’t smoke. Avoid other tobacco products.
  • Protect your skin from the sun.

“Many of the steps you can take to reduce your risk of cancer have the added benefit of helping to reduce your risk of cardiovascular disease, diabetes and possibly even dementia,” said Garnet Anderson, PhD, senior vice president and director of Fred Hutch’s Public Health Sciences Division and holder of the Fred Hutch 40th Anniversary Endowed Chair. “There are plenty of reasons to make these changes.”

There’s some research evidence that frequent, prolonged use of chemical hair straighteners (relaxers) might increase the risk of endometrial cancer, but the cause is not yet clear. According to the National Cancer Institute, there’s not enough evidence to prove a link between relaxers (or other hair products) and endometrial cancer.

If you have questions or concerns about any cancer risks, talk with your primary care provider. They can help you assess if you’re at increased risk and make choices to lower your risk.