You notice vaginal bleeding, but you’re not expecting a menstrual period. Could it be cancer? Or something else? It’s important to be aware of the symptoms of endometrial cancer so you can get a diagnosis and treatment as soon as possible. Research shows that if you’re diagnosed at an early stage of cancer, you have better chances of successful treatment.

Learn about the four most common symptoms of endometrial cancer you should watch for, and when a biopsy may be recommended.

1. Abnormal Vaginal Bleeding or Discharge

Endometrial cancer (also known as uterine cancer) occurs when cancer grows in the lining of the uterus, called the endometrium. About 90 percent of women diagnosed with endometrial cancer experience abnormal vaginal bleeding, according to the American Cancer Society. Tumors can cause bleeding because cancer cells can grow into blood vessels or damage nearby blood vessels, leaving them fragile.

Unusual bleeding may look different depending on whether you have gone through menopause or not.

Vaginal Bleeding After Menopause

Menopause is the biological process during which a person stops having a menstrual period. The average age of menopause in the United States is 51 years old, and the average age of women diagnosed with endometrial cancer is 60 years old, according to the American Cancer Society. It’s not common for someone younger than 45 years to be diagnosed with this form of cancer.

If you’re postmenopausal, any vaginal bleeding is considered abnormal, and you should see your doctor or gynecologist as soon as possible. You should also watch for any unusual vaginal discharge, such as watery discharge, with or without blood in it.

Unusual Vaginal Bleeding Before Menopause

If you haven’t yet gone through menopause, unusual vaginal bleeding is any bleeding that isn’t normal for you. This will look different for each person. Some examples of unusual bleeding include:

• Heavier periods than normal
• Bleeding or spotting between periods
• Unusual discharge with your period that may have an unpleasant smell
• Bleeding after sex

Unusual vaginal bleeding can have a wide range of causes, and your doctor can help determine what’s causing yours. It's important to contact your doctor or gynecologist to get any unusual vaginal bleeding checked right away.

2. Abdominal or Pelvic Pain

Endometrial cancer can cause abdominal pain, lower back pain, or pelvic pain. If the tumor has grown large enough, you may also be able to feel an unusual mass or lump.

Pain is more common in later-stage endometrial cancer. However, as the tumor grows, it may compress nerves or the organs around it, causing pain. You may also experience pain during sex, especially if the cancer has spread to the cervix or vagina.

There are many reasons that you may experience pelvic pain, but if you don’t know what’s causing the pain, you should talk to your doctor about it.

3. Unexplained Weight Loss

About 40 percent of people diagnosed with any type of cancer report unexpected weight loss when they were first diagnosed. Losing weight without trying is a common symptom of many types of cancer. Cancer cells grow and divide much faster than the normal cells of your body, so they need more energy. This is why you may lose weight while still eating the same amount you usually do. Cancer can also cause you to eat less if it grows large enough to push on your stomach and make you feel full.

If you notice that you’ve lost weight without trying, especially if you have other signs of endometrial cancer, such as vaginal bleeding, talk to your doctor right away.

4. Difficulty With Urinating or Defecating

When endometrial cancer grows, it may spread to nearby organs, such as your bladder or rectum.

If cancer spreads to your bladder, you may notice that it’s difficult or painful when you urinate (pee). You might also notice blood or small clots in your urine or on the toilet paper.

If cancer spreads to your rectum, you may notice bleeding from your rectum, difficulty with defecation (pooping), or blood in your stool (poop).

Other conditions can cause these symptoms too, but you should talk to your doctor as soon as possible if you experience difficult or painful urination or defecation.

When Do You Need a Biopsy?

Your doctor may perform an endometrial biopsy if you’re having symptoms that may point to endometrial cancer. A biopsy can help either confirm or rule out a diagnosis of endometrial cancer.

The American Cancer Society recommends that people learn about the risk factors and symptoms of endometrial cancer when they begin menopause.

Factors that increase your risk of endometrial cancer include:

• Being obese
• Taking estrogen after menopause
• Taking tamoxifen (a hormone therapy commonly used to treat breast cancer)
• Starting menstruation at an early age
• Never having been pregnant
• Being older
• Undergoing radiation therapy in the pelvic region
• Having a family history of endometrial cancer

Hereditary Non-Polyposis Colon Cancer

People who have hereditary non-polyposis colon cancer (HNPCC) — also called Lynch syndrome — have a very high cancer risk. HNPCC is a family cancer syndrome that can be passed down by your parents. If you have several family members with colon cancer or endometrial cancer, ask your doctor about genetic counseling.

For people who have HNPCC or several family members with colon cancer, the American Cancer Society recommends that you get tested for endometrial cancer with an endometrial biopsy once a year starting at age 35. Preventive surgery may be recommended.

What Should You Expect During an Endometrial Biopsy?

During the test, you will undress from the waist down and lie on a table with your feet in stirrups, the same way you do when you have a pelvic exam. Your doctor will use an instrument called a speculum to open your vagina so they can see your cervix. After cleaning your cervix with a special solution, your doctor may use an instrument — called a tentaculum — to grasp your cervix to hold your uterus still.

A thin tube is then inserted through your cervix into your uterus to take a tissue sample from your uterine wall using suction. The procedure is usually relatively fast and takes between five and 10 minutes. Most people will experience cramping similar to menstrual cramps during and after the procedure.

The tissue sample is sent to a laboratory where a pathologist (a doctor who specializes in examining tissue) will view it under a microscope.

Understanding Biopsy Results

Your result from the biopsy may be normal, or it may show abnormal cells that could be the result of endometrial cancer, polyps, or a hormone imbalance. If your results are inconclusive, your doctor may want to take a larger sample with a procedure called a dilation and curettage.

If your results show that you have endometrial cancer, the tissue sample may be used for biomarker testing to see which treatment options might be best for you.

Talk With Others Who Understand

On MyEndometrialCancerCenter, the site for people with endometrial cancer and their loved ones, people come together to gain a new understanding of endometrial cancer and connect with others who understand life with endometrial cancer.

Are you living with endometrial cancer? Have you noticed any symptoms of endometrial cancer? Have you had a biopsy to check for endometrial cancer? Share your experiences in the comments below, or start a conversation by posting on your Activities page.