Doctor Explains The Link Between PCOS And Endometrial Cancer: Understanding The Risks

Polycystic Ovary Syndrome (PCOS) is a common condition that affects the normal functioning of a woman’s ovaries. Symptoms include irregular periods, high androgen (male hormone) levels, and polycystic ovaries, which show characteristic appearances on ultrasound. While the exact cause of PCOS remains unknown, it often runs in families and is thought to be linked to abnormal hormone levels, particularly elevated insulin. 

Dr. Vaishali Paliwal, M.S, FMAS, M.Ch Gynaecological Oncology, MRCOG, Associate Consultant – Gynecological Oncology at Max Saket Superspeciality Hospital in Delhi, explains, "Women with PCOS have nearly four times the risk of developing endometrial cancer, commonly known as cancer of the uterus, compared to the general population." 

The rise in endometrial cancer incidence, particularly in India, is attributed to the obesity pandemic and the increasing adoption of Western lifestyles. Factors that raise the risk of uterine cancer—such as obesity, anovulatory cycles, insulin resistance, childlessness, and diabetes—are also long-term complications of PCOS. 

Why Women with PCOS Are at a Higher Risk: 

-Unopposed Oestrogen: In women with PCOS, irregular periods result from anovulatory cycles, where the ovaries fail to release eggs. This lack of ovulation leads to a deficiency of progesterone, causing the uterine lining to overgrow, increasing the risk of carcinogenic changes and ultimately endometrial cancer. 

-Hyper-insulinemia: Insulin resistance, common in women with PCOS, forces the body to produce higher insulin levels. Insulin promotes growth, and uterine cancer cells express insulin growth factor receptors, indicating a possible role in cancer development. 

-Obesity: Around 70% of women with PCOS are obese, which elevates oestrogen and insulin levels, creating a complex metabolic environment that increases the risk of endometrial cancer. 

A recent meta-analysis confirms and quantifies the elevated risk of endometrial cancer in women with PCOS. 

Screening & Prevention Strategies: 

Currently, there are no standardized screening or prevention protocols specifically for women with PCOS. However, Dr. Paliwal advises women at high risk for uterine cancer—especially those with a family history—to undergo annual gynecological exams, abdominal ultrasounds, and uterine biopsies every two years. Women with PCOS experiencing abnormal bleeding should seek medical advice promptly. 

Management & Treatment: 

Most cases of uterine cancer are diagnosed early, with abnormal bleeding being the primary symptom. Treatment typically involves surgery, often sufficient in early-stage cases, but may require additional hormone therapy, chemotherapy, or radiotherapy. For young women, fertility-preserving treatments are available in select cases.  

While not every woman with PCOS will develop endometrial cancer, it's crucial to maintain regular monitoring and collaborate closely with a gynecologist. Leading a healthy lifestyle, including proper diet and exercise, can also play a key role in reducing cancer risk.