Endometrial Cancer: Symptoms, Treatment, and Concerns

Endometrial cancer issues?

Hello, Dr.
Huang.
Here’s the situation: In May, I went to the hospital because I had prolonged menstrual bleeding for over a week.
At the end of May, an ultrasound revealed endometrial hyperplasia.
On June 1, I underwent a dilation and curettage (D&C) procedure.
The nurse provided me with post-operative care instructions and mentioned that my menstrual period would return in about a month.
However, on June 3, the hospital notified me of abnormal test results and asked me to return for a follow-up.
On June 6, it was confirmed that I have endometrial cancer, but it is well-differentiated and classified as stage 1A.
At that time, I informed the doctor that I wanted to preserve my uterus, so the doctor advised me to start high-dose progesterone therapy.
I recalled what the nurse said, so I asked the doctor if I would get my period, and the doctor said not at the moment.
However, on July 3, my period came.
Is this normal? Additionally, I experienced some abdominal pain during this menstrual cycle, which I didn’t have before.
Is this a side effect of the progesterone? Should I continue taking the progesterone?

Ya Ya, 20~29 year old female. Ask Date: 2021/07/03

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
Generally, when using high doses of progesterone, menstruation does not occur.
However, if it has been taken for many days and there is still some spotting, it may be considered to stop the medication to allow for menstruation.
2.
Progesterone use may cause dizziness, which is usually tolerable.
Since you are a patient with endometrial cancer, it is important to discuss this with your physician.

Reply Date: 2021/07/03

More Info

Endometrial cancer, also known as uterine cancer, is a type of cancer that begins in the lining of the uterus (the endometrium). It is crucial to understand the symptoms, treatment options, and potential concerns associated with this condition, especially in light of your recent diagnosis and treatment.

Symptoms of Endometrial Cancer
The most common symptom of endometrial cancer is abnormal vaginal bleeding, which can include bleeding between periods, heavy periods, or bleeding after menopause. Other symptoms may include pelvic pain, pain during intercourse, and unexplained weight loss. In your case, the prolonged menstrual bleeding you experienced prior to your diagnosis is a typical symptom that led to further investigation.

Treatment Options
The treatment for endometrial cancer typically depends on the stage of the cancer, the grade (which indicates how aggressive the cancer is), and the patient's overall health and preferences. In your situation, since you were diagnosed with well-differentiated endometrial cancer (Grade 1) at Stage 1A, the treatment plan often includes:
1. Surgery: The primary treatment for endometrial cancer is usually a hysterectomy, which involves the removal of the uterus and often the cervix, ovaries, and fallopian tubes. Since you expressed a desire to preserve your uterus, your doctor may have opted for a conservative approach, which can include hormonal therapy.

2. Hormonal Therapy: In cases where patients wish to preserve their fertility or uterus, high-dose progestins (like the yellow hormone you mentioned) are often prescribed. This treatment aims to counteract the effects of estrogen, which can promote the growth of endometrial cancer cells.

3. Follow-Up Care: Regular follow-ups are essential to monitor for any signs of recurrence. This may include pelvic exams, imaging tests, and possibly additional biopsies.

Concerns and Side Effects
Regarding your question about the return of your menstrual cycle after starting hormonal therapy, it is not uncommon for patients on progestin therapy to experience changes in their menstrual patterns. The return of menstruation could indicate that your body is responding to the hormonal treatment, but it can also be a sign of breakthrough bleeding, which is not unusual in patients undergoing hormonal therapy.

The abdominal pain you are experiencing during menstruation could be related to the hormonal changes induced by the progestin. Hormonal treatments can sometimes lead to side effects such as cramping or discomfort, similar to what some women experience during their normal menstrual cycles. However, if the pain is severe or accompanied by other concerning symptoms (such as heavy bleeding or unusual discharge), it is crucial to consult your healthcare provider for further evaluation.

Continuing Treatment
As for whether you should continue taking the progestin, this decision should be made in consultation with your healthcare provider. They will consider your current symptoms, the effectiveness of the treatment, and any potential side effects. It is essential to communicate openly with your doctor about your experiences and any concerns you may have regarding your treatment plan.

Conclusion
In summary, understanding endometrial cancer involves recognizing its symptoms, treatment options, and potential side effects. Your experience with prolonged bleeding and subsequent treatment with high-dose progestins is a common approach for managing early-stage endometrial cancer, especially when patients wish to preserve their reproductive capabilities. Regular follow-ups and open communication with your healthcare provider are vital to ensure the best possible outcomes and to address any concerns that may arise during your treatment journey.

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