Author: Malak Ibrahim, MSc Student in the Department of Obstetrics and Gynecology, University of British Columbia | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators)
Published: July 21, 2023
All women* and individuals with a uterus will inevitably experience menopause during their lifetime; however, the stigma around menstruation, aging, and women’s health makes it difficult to have open conversations about menopause. Almost half of women in Canada feel unprepared for perimenopause and menopause, and 54% believe the topic is still taboo.
“Menopause is seen as something women must endure, like a woman’s burden.”
- Dr. Wendy Wolfman, MD, FRCS(C), FACOG, NCMP, President of the Menopause Society of Canada
Menopause is defined as the time period after a woman has gone 12 consecutive months without menstruating. The time period leading up to menopause when women experience a range of symptoms is called perimenopause. During perimenopause, women may experience changes in their menstruation, hot flashes, sleep disruptions, cold sweats, depression, and many more symptoms. There are more than 30 symptoms that can occur as a result of hormonal changes during perimenopause, and although many women are aware of a few common symptoms such as hot flashes and night sweats, awareness of other symptoms such as depression and anxiety remain low.
So how does this relate to endometrial cancer? Endometrial cancer occurs in the inner lining of the uterus, called the endometrium. It is the most common type of uterine cancer and the most commonly diagnosed gynecologic cancer in the developed world. Unlike most cancers, the number of new endometrial cancer cases continues to rise each year. Endometrial cancer incidence increases by almost 2% each year in women under 50 years old, and 1% in women over 50 years of age. For most patients diagnosed with endometrial cancer, abnormal uterine bleeding is the first noticeable symptom. Abnormal uterine bleeding is defined as any bleeding or spotting during menopause, or any unpredictable pre-menopausal vaginal bleeding such as changes in regularity, frequency, volume, or duration. Even though abnormal uterine bleeding can prompt earlier detection of endometrial cancer, it is not specific to endometrial cancer and can indicate a number of gynecologic conditions. Up to 30% of women will experience abnormal uterine bleeding in their life, and it is especially common during perimenopause. Almost half of women experiencing abnormal uterine bleeding will delay or not seek medical care, resulting in a delayed diagnosis or leaving the underlying cause undiagnosed.
Because changes in menstruation are very common and normal during perimenopause, it can be difficult to differentiate between what is regular reproductive aging and early signs of endometrial cancer. So how can you tell the difference between perimenopausal changes in menstruation, and abnormal uterine bleeding that may indicate endometrial cancer? Unfortunately, there is no way to determine if changes in menstruation are associated with perimenopause or more serious pathologies without an endometrial biopsy. However, by raising awareness of both endometrial cancer and menopause, women can be empowered to better understand their health and identify which symptoms of concern need medical attention based on their personal risk of developing cancer. Some risk factors for uterine cancer are obesity, age, diabetes, estrogen only hormone replacement therapy, and genetic predisposition. Open conversation about menstruation and menopause with family, friends, and most importantly, healthcare providers is needed. Women who have an increased risk of uterine cancer should be especially aware of abnormal uterine bleeding and engage in conversation with their health care providers as soon as possible if they experience any unusual uterine bleeding.
To learn more about symptoms and risk factors of uterine cancer, visit UBC’s own Uterine Health Research Lab website and follow us on social media!
The Uterine Health Research Lab is currently conducting the RESToRE Study to assess the feasibility and acceptability of early cancer screening and prevention methods. We are recruiting postmenopausal people with a uterus to fill out a risk questionnaire - those who are found to have increased risk factors will be invited to continue in further aspects of the study. For more information or to participate in the RESToRE Study, please click here.
Facebook: Uterine Health Research Lab
Instagram: @uterinehealth
Twitter: @uterinehealth
Website: uterinehealth.ca