PCOS and Endometrial Cancer: What Women Need to Know

While women with PCOS have not been shown to be at a higher risk for developing breast or ovarian cancer, they are at an increased risk for endometrial cancer, this according to findings of a large population-based cohort study of over 8,000 women with PCOS. This study, published in the Journal of Medicine found that women with PCOS have an overall 17-fold higher risk of developing endometrial cancer. An alarming finding was that the majority of women with endometrial cancer were under the age of 50. Earlier reports showed women with PCOS and endometrial hyperplasia have four times greater risk of developing endometrial cancer than women without PCOS. Endometrial cancer can be prevented. Here’s what women with PCOS need to know about endometrial cancer and how to reduce their risk.

What is Endometrial Cancer?

Endometrial cancer is common, ranking fifth among all cancers in women. Around 80% of endometrial cancers are estrogen driven. Estrogen causes the endometrium (lining of the uterus) to thicken so that it could nourish a baby if pregnancy occurs. If there’s no pregnancy, estrogen falls and progesterone is stimulated. This causes the uterine lining to shed. By the end of the menstural cycle, the endometrial lining is shed from the uterus and becomes the menstrual blood flow (AKA: your period). Over time, if a woman has irregular or absent periods and the uterine lining doesn’t shed regularly (or at all), the lining can build creating an environment for cancer cells to grow. These cancerous cells can also spread to other areas of the body. This is why early detection and treatment of endometrial cancer are critical.

Common Signs and Symptoms

Some women may report no symptoms of endometrial cancer until the cancer spreads. The most common symptoms are:

  • Abnormal vaginal bleeding (heavy bleeding or bleeding between periods)
  • Vaginal discharge that may range from pink and watery to thick, brown, and foul smelling
  • Difficult or painful urination
  • An enlarged uterus
  • Pain during intercourse
  • Weight loss

Endometrial Cancer and PCOS

There are several reasons why women with PCOS are at an increased risk for developing endometrial cancer. One major factor involves hormone stimulation. Chronic estrogen stimulation seen in PCOS women can often cause endometrial overgrowth, leading to endometrial hyperplasia and endometrial cancer. The hormone imbalance of high estrogen and testosterone seen in those with PCOS causes anovulation, resulting in the uterine lining failing to shed each month. The buildup of uterine lining creates an environment for cancer cells to grow.  Other risk factors for endometrial cancer are weight cycling, bearing no children, infertility, type 2 diabetes, and high blood pressure.

Ways to Reduce your Risk for Endometrial Cancer

If you do have PCOS, there are many effective ways to reduce your risk for endometrial cancer. Most of these ways are lifestyle related, meaning you have the control over them. The following are ways to reduce your risk for endometrial cancer.

Get Screened

Early detection and treatment for endometrial cancer is crucial and can save your life. While it may be nice to not get your periods, it’s not normal. Not getting periods regularly increases your risk for endometrial cancer. Have your doctor screen you for endometrial cancer. Screening may include measuring or analyzing a sample of your uterine lining. PapSEEK is a newly developed pap test that uses a unique style brush to collect samples of the uterine lining rather than cervical samples taken with a traditional pap test.

Legumes for PCOS

Eat Antioxidant Rich Foods

There are many reasons why government guidelines, including those of the American Cancer Center, recommend eating fruits and vegetables. One of those reasons is because fruits and vegetables act as antioxidants to protect cells from cancer. Eating legumes is also associated with reduced risk for endometrial cancer.

As for fat, diets high in saturated fat were associated with a higher risk for getting endometrial cancer. The opposite was found with monounsaturated fats. The higher the intake of monounsaturated fats (olive oil, avocado, nuts) was significantly associated with lower endometrial cancer risk.

Include Soy Foods

Yes, soy! Soy has been viewed an evil food for women with PCOS. While soy does act very weakly as a phytoestrogen, you would have to eat a ton of soy to mimic the actual effects of estrogen. Moderate consumption of soy, a few times a week, does not mess with your hormones! In fact, research shows that eating moderate amounts of soy foods not only lowers cholesterol and can improve fertility among women with PCOS, but it may also reduce the risk for endometrial cancer. A review of 13 studies published in the Journal of the Academy of Nutrition and Dietetics found that soy intake was associated with a reduced risk of endometrial cancer. For more about soy and PCOS, including recommended food sources, click here.

Stop Dieting

Diets don’t work for women with PCOS (or anyone for that matter). Dieting may result in weight loss and temporary improvement in symptoms and fertility, but most always results in weight gain. This cycle of  yo-yo dieting of losing weight and regaining it and losing weight and regaining it, has been shown to worsen metabolic and cardiovascular health. Emerging research also shows that weight cycling is also associated with an increased risk for endometrial cancer.

A study published in the Journal of Epidemiology found that for each 5 kg weight gain, the endometrial cancer risk increased 1.2 times. History of weight cycling increased risk independent of weight and other factors. Also interesting findings from this study were that women with endometrial cancer were more likely than cancer free controls to have first gotten their periods in puberty at an early age and reached menopause at later ages, both stages that are commonly seen in the PCOS population.

No more dieting doesn’t mean giving up on PCOS. What can you do instead of dieting to improve PCOS? Eat well, move your body, get adequate sleep for you, and handle stress better. Not sure where to start? The PCOS Workbook: Your Guide to Complete Physical and Emotional Health can help you.  

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Regulate Your Periods

By regulating your menstrual cycle you will be able to shed the uterine lining and prevent the buildup of tissue that leads to cancer. In addition to the lifestyle changes mentioned above, taking Ovasitol and perhaps metformin or birth control pills may help reduce your risk.

Try Ovasitol

Ovasitol for PCOS

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The majority of women with PCOS who take Ovasitol see an improvement in menstrual regulation within 3 months. If you aren’t familiar with Ovasitol, it is a pseudovitimain of the b-vitamin family that is involved in insulin regulation. There are 2 main types of inositol: Myo and d-chiro (DCI) inositol. It is believed that women with PCOS have a defect in their ability to properly use inositol. Check out my video here that explains it best. Myo inositol gets converted into DCI but in PCOS, this is happening way to fast resulting in too much DCI and not enough MYO. MYO is the inositol that is shown to improve egg quality and ovulation. Supplementing with the ideal 40:1 ratio helps to restore hormone balance in PCOS women. Ovasitol is particularly good option for those wanting to avoid taking OCPs or Metformin to regulate their periods.

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Metformin

There is evidence to support that treatment with metformin results in decreased incidence, progression, and even cancer-related mortality of different human cancers, including endometrial cancer.  Metformin isn’t just for reducing insulin levels but has been shown to improve menstrual regularity among women with PCOS.

Supplement with Progesterone

If you don’t get your periods regularly, talk to your doctor about supplementing with progesterone to balance hormones. Progesterone acts as a protective factor against estrogen-driven uterine cell growth and proliferation. Women with PCOS typically have a lower levels of progesterone or a progesterone deficiency. For some women, taking progesterone alone may induce periods.

Consider Birth Control Pills

While I’m not a fan of birth control pills for women with PCOS (you can read why here) taking them can reduce the risk for endometrial cancer. If you have tried all the other methods listed above and still aren’t getting your periods, you may want to consider OCPs as a last resort.

Combined treatment with metformin and progesterone-based oral contraceptives has successfully reversed early stages of endometrial cancer. Progesterone-based oral contraceptives are used to inhibit endometrial hyper-proliferation and improve menstrual regularity. However, approximately 30% of women with PCOS fail to respond to this treatment.

Surgery

Surgical procedures, including total hysterectomy and bilateral salpingo-oophorectomy, are considered  effective treatments for early stage endometrial cancer.

Bottom line: Women with PCOS are at an increased risk for endometrial cancer. It’s not normal to not get your periods. If you don’t have regular periods, talk to your doctor. He or she can measure your uterine lining and discuss ways to reduce your risks of endometrial cancer. Early detection is key!

References

  1. Ding DC, Chen W, Wang JH, Lin SZ. Association between polycystic ovarian syndrome and endometrial, ovarian, and breast cancer: A population-based cohort study in Taiwan.  Medicine (Baltimore). 2018 Sep;97(39):e12608
  2. Zhong XS, Ge J, Chen SWAssociation between Dietary Isoflavones in Soy and Legumes and Endometrial Cancer: A Systematic Review and Meta-Analysis. J Acad Nutr Diet. 2018 Apr;118(4):637-651.
  3. Zhao J, Lyu C, Gao J. Dietary fat intake and endometrial cancer risk: A dose response meta-analysis. Medicine (Baltimore). 2016 Jul;95(27):e4121.
  4. Shao R, Li X, Billig H1. Promising clinical practices of metformin in women with PCOS and early-stage endometrial cancer. BBA Clin. 2014 Jul 25;2:7-9.
  5. Nevadunsky N.S., Van Arsdale A., Strickler H.D et al. Metformin use and endometrial cancer survival. Gynecol. Oncol. 2014;132:236–240.
  6. Li X1, Guo YR2, Lin JF. Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance. J Cancer. 2014 Jan 28;5(3):173-81. doi: 10.7150/jca.8009. eCollection 2014.
  7. ITrentham-Dietz A et al. Weight change and risk of endometrial cancer. Int J Epidemiol. 2006;35(1):151-8
  8. Wang Y, et al “Evaluation of liquid from the Papanicolaou test and other liquid biopsies for the detection of endometrial and ovarian cancers” Sci Transl Med 2018
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Comments (3)
  • Michele

    November 3, 2018 at 8:05 pm

    This post reminded me to make my appointment for my annual exam and I asked about the PapSEEK. My doctor’s office had not heard of it, but thanked me for asking about it so they could look into it. I likely won’t be able to get it for this appointment, but I am definitely going to talk to my doctor about watching for endometrial cancer. Thanks for the tip!

  • Angela Grassi

    November 5, 2018 at 1:53 pm

    So great to hear! The PapSEEK may be very new so a lot of doctors aren’t trained in it yet.

  • femiint fertility

    November 5, 2018 at 12:27 am

    its good information .. thanks for sharing

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