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If you or a loved one received a diagnosis of endometrial cancer, you may be concerned about whether other relatives are at high risk of this disease. Many risk factors appear to play a role in the development of endometrial cancer, some of which you can influence and some of which may be outside your control.
In this article, we’ll discuss factors that raise the risk of developing endometrial cancer. Knowing your individual risk can help you make healthier decisions and encourage other family members to understand their risk as well.
Estrogen is a sex hormone that’s mainly produced by the ovaries. A person’s body starts making more estrogen at the onset of their menarche (the first menstrual period). Estrogen levels tend to decrease at the start of menopause, typically between ages 45 and 55.
Doctors and researchers have found that changes in estrogen levels throughout life affect the risk of endometrial cancer. A healthy balance of estrogen and another hormone, progesterone, keeps the endometrium (uterine lining) healthy. Too much estrogen can throw off your hormonal balance and can trigger endometrial cells to grow out of control and possibly become cancerous.
Below are eight risk factors and how they may lead to endometrial cancer. Many of these factors relate to estrogen levels. Some people have one or more of these factors, while others diagnosed with endometrial cancer may not have any. Your doctor or gynecologist can help you better understand your individual risk.
Endometrial cancer is the most common type of gynecologic cancer in the United States. Estrogen levels also affect breast and ovarian cancer, and these three cancers share many known risk factors.
If you’ve had breast cancer, you may be at risk of developing endometrial cancer. Doctors and researchers have found that tamoxifen, a drug used as breast cancer treatment, specifically increases the risk of endometrial cancer.
Tamoxifen blocks breast cancer cells from using estrogen. The drug can also trigger cells in the uterus to grow and divide too quickly, leading to abnormal growths and, in some cases, endometrial cancer. The longer a person takes tamoxifen, the higher their risk of uterine cancer.
Ovarian tumors can also affect estrogen levels. A type called granulosa cell tumors may overproduce large amounts of estrogen, causing the cells in the uterine lining to grow and divide uncontrollably.
A person who is postmenopausal and begins experiencing vaginal bleeding should make an appointment with their doctor or gynecologist. This symptom could be a sign of endometrial or ovarian cancer.
Read about new treatments for endometrial cancer.
Hormone replacement therapy (HRT) is used to relieve menopause symptoms. Estrogen therapy may be prescribed to help treat hot flashes and night sweats and prevent the loss of bone density that can lead to osteoporosis. Studies show that taking estrogen alone can increase the risk of endometrial cancer.
If you’re interested in trying HRT for menopause symptoms, your doctor will likely prescribe a combination of estrogen and progestin, a synthetic form of progesterone. Unlike estrogen-only therapies, this combination doesn’t increase the risk of endometrial cancer. You may notice increased vaginal bleeding — if you’re concerned about this side effect, talk to your doctor.
You may have heard that oral contraceptives (birth control pills) also influence your risk of cancer. Birth control pills have actually been found to lower the risk of endometrial cancer.
Studies show that having more menstrual cycles during your lifetime can raise your risk of endometrial cancer. This is because the more cycles you have, the longer the tissues in your uterus are exposed to estrogen.
If you started puberty early and entered menopause late, you’re more likely to develop this cancer. However, if you began getting your period early but also have early menopause, your risk isn’t affected very much.
When you’re pregnant, your body starts making more progesterone than estrogen. This change in your hormonal balance helps lower your risk of endometrial cancer. One study from Denmark found that pregnancy lowered the chances of developing this cancer by nearly half.
Researchers have also found that not becoming pregnant or being infertile (unable to have children) raises a person’s risk of developing endometrial cancer. Researchers who pooled the results of 14 studies reported that women who never gave birth were 1.76 times more likely to develop this cancer compared with those who had given birth.
Infertility is associated with a slight increase in risk of developing endometrial cancer. A handful of studies have linked some types of fertility treatment with an even higher risk. However, more research from larger studies is needed to confirm these findings.
A high body mass index (BMI) is a key factor in the risk of developing endometrial cancer. BMI is a measure used to classify individuals as underweight, normal weight, overweight (25-29.9), or obese (30 or higher). While a high BMI can indicate excess body fat, it is not always reflective of body composition, as muscle mass or other factors may contribute.
Excess fat tissue, however, increases risk by altering hormone levels. Research shows that fat converts androgens into estrogens, and the more estrogen produced, the higher the risk of endometrial cancer.
According to the American Cancer Society, individuals with an overweight BMI have an elevated risk of endometrial cancer compared with those in the “normal” range of 18.5 to 24.9. The risk is even higher for those in the obese range. Some research has found that the risk is more than two‑fold and up to seven‑fold depending on the type of endometrial cancer and other factors.
Diabetes is another risk factor for endometrial cancer. It’s linked to changes in hormones and the way the body uses energy. People with diabetes often have higher levels of insulin, a hormone that can sometimes help cancer cells grow. Diabetes can also lead to more inflammation in the body, which might increase the risk of cancer.
Diabetes and obesity often go hand in hand, which can make the risk even higher. Many people with diabetes find it harder to eat healthy or stay active, both of which can lower cancer risk. Scientists are still studying exactly how diabetes and endometrial cancer are connected, but managing blood sugar and staying active are good steps to reduce risk.
If a close family member, such as a parent, sibling, or grandparent, has had endometrial cancer, you’re more likely to develop it too. According to one meta-analysis of 16 studies published in the journal Obstetrics & Gynecology, women with a family history of endometrial cancer are nearly twice as likely to develop the condition as those without a family history.
Certain mutations (changes) in DNA may be passed down in families. Many of these changes affect genes that help repair damaged DNA or control how quickly cells grow and divide.
It’s also common for families with a history of endometrial cancer to have a type of colon cancer known as hereditary nonpolyposis colorectal cancer, or Lynch syndrome. Overall, women have a 3 percent risk of developing endometrial cancer during their lifetime, according to the American Cancer Society. For those with Lynch syndrome, this risk is between 40 percent and 60 percent.
It’s important to note that having a family history of endometrial cancer or Lynch syndrome doesn’t guarantee that you’ll have these conditions as well.
If you have a loved one living with endometrial cancer, read about ways you can support them.
Sometimes, abnormal thickening of the uterine lining, called endometrial hyperplasia, can occur. Most types of hyperplasia are not cancer and may go away on their own or respond well to hormone therapy. However, a specific type called atypical hyperplasia — which happens when the body has more estrogen than progesterone — can raise the risk of developing endometrial cancer.
There are two forms of atypical hyperplasia: simple and complex. According to a 2024 review in the journal Diagnostics, people with atypical hyperplasia have about a 20 percent to 50 percent chance of progressing to endometrial cancer if the condition is not treated. This risk is higher in those with obesity, long-term exposure to unopposed estrogen, or certain gene changes such as in the PTEN or KRAS genes.
Abnormal vaginal bleeding is the most common symptom of atypical hyperplasia. If you’re diagnosed with this condition, your doctor or gynecologist will recommend treatment to lower your cancer risk — often with hormone therapy or, in some cases, surgery.
Read about potential symptoms of endometrial cancer.
On MyEndometrialCancerTeam, people share their experiences with endometrial cancer, get advice, and find support from others who understand.
What questions do you have about risk factors for endometrial cancer? Let others know in the comments below.
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