Perimenopause vs Endometrial Cancer Symptoms: What to Watch For
Perimenopause and endometrial cancer share symptoms like irregular bleeding. Learn the key differences, red flags, and when to seek urgent assessment.
Why This Comparison Matters
Irregular periods and pelvic discomfort are expected during perimenopause, which can make it easy to dismiss symptoms that deserve medical attention. Endometrial cancer, the most common gynaecological cancer in the UK, shares several features with the hormonal changes of perimenopause. Understanding where they overlap and where they clearly diverge can help you decide when to wait, when to monitor, and when to seek urgent assessment. This is not about creating alarm but about being informed.
Symptoms That Appear in Both Conditions
Both perimenopause and endometrial cancer can produce irregular or unpredictable bleeding. In perimenopause, cycles become shorter, longer, heavier, or lighter as oestrogen and progesterone fluctuate. Pelvic discomfort, bloating, and a sense of pressure in the lower abdomen are also common to both. Fatigue, mood changes, and disrupted sleep appear in perimenopause and can accompany cancer-related anaemia from heavy blood loss. The challenge is that these shared symptoms often feel identical from the inside, making self-diagnosis unreliable.
Red Flags That Point Toward Endometrial Cancer
Certain bleeding patterns fall outside normal perimenopausal variation and require prompt investigation. Postmenopausal bleeding, any bleeding that occurs twelve or more months after your last period, is the clearest red flag and should never be attributed to perimenopause. Extremely heavy and prolonged bleeding, particularly when soaking more than a pad an hour for several consecutive hours, is another warning sign. Bleeding or spotting between periods that is new or worsening, blood-tinged vaginal discharge with no obvious infection, and pelvic pain that is persistent rather than cyclical all warrant assessment rather than watchful waiting.
Risk Factors for Endometrial Cancer
Knowing your personal risk profile matters. Endometrial cancer is linked to prolonged oestrogen exposure without opposing progesterone. Key risk factors include obesity (adipose tissue converts androgens to oestrogen), polycystic ovary syndrome, never having been pregnant, late menopause, tamoxifen use, diabetes, and a family history of Lynch syndrome or other hereditary colorectal cancer syndromes. Women with any of these factors alongside irregular bleeding should have a lower threshold for seeking medical review rather than assuming symptoms are perimenopausal.
How Endometrial Cancer Is Investigated
If your GP suspects endometrial pathology, the first-line investigation is usually a transvaginal ultrasound. This measures endometrial thickness: a lining thicker than 4 mm in a postmenopausal woman, or unusually thick in a perimenopausal woman with abnormal bleeding, raises concern. An endometrial biopsy, often done in an outpatient clinic using a thin pipelle device, is the definitive test. It samples the uterine lining directly and provides tissue for pathology. Hysteroscopy (a camera passed into the uterus) may also be used, sometimes with biopsy at the same time. These investigations are usually straightforward and completed within a two-week urgent referral pathway in the UK.
When to See Your GP Without Delay
You should seek medical review promptly rather than waiting for your next routine appointment in several situations: any bleeding after menopause, bleeding that requires changing a pad or tampon every hour for two or more consecutive hours, new spotting or discharge between periods that lasts more than a week, or pelvic pain that is not linked to your cycle. You do not need to be certain something is wrong to ask for an assessment. GPs would always rather investigate and reassure than have a patient delay. Early-stage endometrial cancer has very high survival rates precisely because it tends to cause noticeable bleeding early in its course.
Tracking Symptoms to Support Your Consultation
Whether your symptoms turn out to be perimenopausal or require further investigation, keeping a detailed record is valuable. Note the dates, duration, and flow of any bleeding, as well as associated symptoms like pelvic pain or discharge. If you use an app like PeriPlan to log symptoms and track patterns over time, you can bring this data to your GP or gynaecologist, giving them a clearer picture than memory alone provides. A well-documented symptom history helps clinicians distinguish a normal perimenopausal pattern from something that needs investigation, and it ensures that nothing gets missed in a short consultation.
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