Endometrial cancer screening: who, tests and results
Endometrial cancer starts in the endometrium, the lining of the uterus, and is the most common type of uterine cancer. Most cases occur after menopause, and the average age at diagnosis is around 60. (MedlinePlus, 2026) Here is who is screened, why bleeding is checked, and what the tests and results mean.
Who is screened
- Average risk, no symptoms: there are no screening tests or exams to find endometrial cancer early. ACS recommends that at menopause you be told about the risks and symptoms and strongly encouraged to report any vaginal bleeding, discharge or spotting to your doctor. (ACS, early detection) NCI says there is no standard or routine screening test. (NCI) Endometrial cancer is not on the USPSTF list of A and B recommendations. (USPSTF)
- Increased risk: ACS recommends that people at increased risk be told of their risk and advised to see their doctor whenever they have any abnormal vaginal bleeding. This includes risk from age, late menopause, never giving birth, infertility, obesity, diabetes, high blood pressure, estrogen treatment or a breast cancer medicine that raises the risk. (ACS, early detection) NCI says ultrasound is not useful for screening people who take that medicine but have no symptoms; it should be used in those who have vaginal bleeding. (NCI)
- Lynch syndrome (HNPCC): people with Lynch syndrome have a very high risk of endometrial cancer. ACS recommends offering a yearly endometrial biopsy starting at age 35 to anyone with Lynch syndrome who can get endometrial cancer, to those likely to carry such a gene change, and to those from families with a tendency to colon cancer who have not had genetic testing; their doctors should discuss its risks, benefits and limits. (ACS, early detection) Testing and the schedule for other cancers are on Lynch syndrome screening.
The other checks after menopause are on screenings after menopause.
Why bleeding is checked
Abnormal vaginal bleeding is the most common symptom of endometrial cancer: a change in periods, bleeding between periods, or bleeding after menopause. Non-cancer problems can also cause it, but it is important to have a doctor check any irregular bleeding right away. Non-bloody discharge after menopause may also be a sign. Pain or a feeling of fullness in the pelvis, and losing weight without trying, are more common in later stages. (ACS, signs) NCI says most endometrial cancers (85%) are diagnosed at an early stage because of symptoms, and survival rates are high. (NCI PDQ)
What the tests involve
- Pelvic exam: it can find some advanced uterine cancers but is not very useful for finding early endometrial cancer. (ACS, early detection) See pelvic exam: who needs one.
- Pap test: it screens for cervical cancer and is not effective for endometrial cancer, although it can sometimes find abnormal glandular cells caused by it. (ACS, early detection) (ACS, tests) See Pap and HPV test results.
- Transvaginal ultrasound: a probe covered with a condom and gel is placed in the vagina while you lie on your back with your knees bent. It may be mildly uncomfortable but should not hurt, and there is no radiation. (MedlinePlus ultrasound) Salt water may be put into the uterus to see the lining more clearly (saline infusion sonohysterography). (ACS, tests)
- Endometrial biopsy: a thin instrument is passed through the cervix into the uterus to take a small piece of the lining, which is examined under a microscope. (MedlinePlus biopsy) ACS calls it the most used diagnostic test for endometrial cancer, very accurate for those past menopause, and says it can be done in the doctor's office. (ACS, tests) Risks include infection, prolonged bleeding and, rarely, a hole in the uterus or a tear in the cervix. (MedlinePlus biopsy)
- Hysteroscopy and D&C: a thin telescope lets the doctor see inside the uterus and take tissue; a D&C scrapes tissue from inside the uterus. (ACS, tests)
What the results mean, in plain words
These are general descriptions from the sources, not a reading of your own report.
| Result | What the sources say |
|---|---|
| Ultrasound: normal | MedlinePlus says a normal transvaginal ultrasound means the pelvic structures are normal. (MedlinePlus ultrasound) |
| Ultrasound: thicker lining or a mass | The images can show whether the uterus contains a mass, or whether the lining (endometrium) is thicker than usual, which can be a sign of endometrial cancer. To find out exactly what kind of change is present, a doctor must take out some tissue to look at under a microscope. (ACS, tests) |
| Biopsy: normal | The biopsy is normal if the cells in the sample are not abnormal. NCI notes that a test result can appear normal even though cancer is present. (MedlinePlus biopsy) (NCI) |
| Biopsy: hyperplasia without atypical cells | Endometrial hyperplasia means an increased number of cells and glandular structures in the lining of the uterus. ACS lists it among the benign (not cancer) conditions of the endometrium. (ACS, what it is) |
| Biopsy: atypical hyperplasia | The risk of cancer in the lining of the uterus is higher when hyperplasia has atypical cells and complex glands. ACS says the most common type of endometrial cancer sometimes develops from atypical hyperplasia, and MedlinePlus calls hyperplasia a precancer. (ACS, what it is) (MedlinePlus biopsy) |
| Biopsy: cancer | The lab report will usually describe the type and grade of the cancer, and may include the results of the first screening test for Lynch syndrome. If cancer is found, imaging tests may be done to see if it has spread (staging). (ACS, tests) (MedlinePlus, 2026) |
| Not enough tissue, or unclear | If the biopsy sample does not give enough tissue, or suggests cancer but the result is unclear, a dilation and curettage (D&C), with or without hysteroscopy, must be done. (ACS, tests) |
| Other findings | Abnormal biopsy results may also be caused by uterine fibroids, polyps, infection or a hormone imbalance. (MedlinePlus biopsy) |
Your doctor decides what your result means for you. This page does not give treatment advice. If a result worries you, see after an abnormal screening result for questions to ask.
Why screening people without symptoms is not routine
NCI says there is no evidence that screening by ultrasound reduces deaths from endometrial cancer, and inadequate evidence that screening by biopsy does. Screening people without symptoms leads to unnecessary extra biopsies because of false-positive results, with anxiety and biopsy complications. (NCI PDQ) Side effects of the tests can include discomfort, bleeding, infection and, rarely, puncture of the uterus. (NCI)
In the UK: referral for bleeding
NICE recommends a suspected cancer pathway referral for endometrial cancer for women, and trans men and non-binary people with female reproductive organs, aged 55 and over with unexplained post-menopausal bleeding that cannot be attributed to HRT. Under 55, it says to consider that referral. It also says to consider an urgent, direct access ultrasound scan at 55 and over for unexplained vaginal discharge (first time, or with thrombocytosis or haematuria), or for visible haematuria with low haemoglobin, thrombocytosis or high blood glucose. (NICE NG12)
When to contact a provider
MedlinePlus says: (MedlinePlus, 2026)
Contact your provider for an appointment if you have any of the following:
- Any bleeding or spotting that occurs after the onset of menopause
- Bleeding or spotting after intercourse or douching
- Bleeding lasting longer than 7 days
- Irregular menstrual cycles that occur twice per month
- New discharge after menopause has begun
- Pelvic pain or cramping that does not go away
Where they differ:
- Average risk: ACS and NCI say there is no screening test; (ACS, early detection) (NCI) MedlinePlus says there is no effective screening test, but that periodic pelvic exams, Pap smears, vaginal ultrasounds and endometrial biopsy may be considered in some cases for women with risk factors. (MedlinePlus, 2026)
- Lynch syndrome: ACS recommends offering a yearly biopsy from age 35; (ACS, early detection) NCI's patient page says experts suggest a yearly transvaginal ultrasound beginning as early as age 25. (NCI)
- Bleeding after menopause: ACS says to have any bleeding checked right away; (ACS, signs) NICE sets an age line, with referral via a suspected cancer pathway at 55 and over and consideration of referral under 55. (NICE NG12)
Questions people ask
Is there a routine screening test for endometrial cancer?
No. ACS says there are no screening tests or exams to find endometrial cancer early in people at average risk who have no symptoms, and NCI says there is no standard or routine screening test. ACS recommends that at menopause you be told about the risks and symptoms and strongly encouraged to report any vaginal bleeding, discharge or spotting. (ACS, early detection) (NCI)
Does a Pap test check for endometrial cancer?
Not reliably. ACS says Pap and HPV tests are not effective for endometrial cancer, although a Pap test can sometimes find early endometrial cancers. NCI says Pap tests are not used to screen for it, but results sometimes show signs of an abnormal endometrium. (ACS, early detection) (NCI)
Does bleeding after menopause mean cancer?
Not always. ACS says non-cancer problems can also cause abnormal bleeding, but it is important to have a doctor check any irregular bleeding right away, and for those past menopause to report any vaginal bleeding, spotting or abnormal discharge. (ACS, signs)
Why not screen everyone with an ultrasound?
NCI says there is no evidence that screening by ultrasound reduces deaths from endometrial cancer, and that screening people without symptoms leads to unnecessary extra biopsies because of false-positive results. Most endometrial cancers (85%) are diagnosed at an early stage because of symptoms. (NCI PDQ)
What does an endometrial biopsy feel like?
MedlinePlus says you may feel some cramping when the cervix is grasped and as the sample is collected. The discomfort is usually mild, though for some women it can be severe, and the test and the pain are short. Slight spotting and mild cramping can last a few days. (MedlinePlus biopsy)
I have Lynch syndrome. Is endometrial screening different for me?
Yes. ACS recommends that anyone with Lynch syndrome (HNPCC) who can get endometrial cancer be offered a yearly endometrial biopsy starting at age 35, after discussing its risks, benefits and limits. NCI says experts suggest yearly transvaginal ultrasound for women who have or are at risk for HNPCC, beginning as early as age 25. (ACS, early detection) (NCI)