Menopausal women, in addition to having to deal with the symptoms of menopause such as hot flashes, easy irritability, difficulty sleeping, it is important to continue their regular visits to the obstetrician-gynecologist. Entering an age in which reproductive possibilities become minimal does not remove the responsibility of every woman to be interested in and monitor the state of the reproductive system. The truth is that preventive examinations are, if not more important, then as important as before, because then the majority of malignant neoplasms of the genital tract are diagnosed. One of them is endometrial carcinoma. About 90% of endometrial carcinoma cases are in women over 50. The disease is becoming more and more frequently diagnosed. For example, in the UK, endometrial cancer is the fourth most common cancer among women. The disease is glandular cells from the lining of the uterus that lose control over their division. They begin to lose characteristics of normally functioning cells and their number increases uncontrollably. Thus, the tumor mass spreads in the neighborhood. The prolonged effect of high doses of estrogens without balancing their effect by progesterone (gestagens) increases the risk of developing endometrial carcinoma. This means that the main risk factors include: 1. Late menopause – after the age of 52; 2. Obesity – it turns out that adipose tissue is not inert. It actively releases bioactive substances that change our body. Estrogens are one of them. Therefore, obesity in the postmenopausal age is a serious risk factor for estrogen-sensitive carcinomas, such as endometrial. During this period, instead of hormonal calm due to the silenced neuro-hormonal axis, the obese organism undergoes an estrogen wave from the adipose tissue, which no longer has functional significance. 3. Single-metrial hyperplasia – thickening of the uterine lining. It is still a benign process, but because of the risk of degeneration, further diagnostic investigation is necessary until carcinoma is ruled out. 4. Polycystic ovarian syndrome – a disease in which anovulatory cycles often occur, which means that there is no stimulus for progesterone formation. 5. Others: diabetes mellitus type 2, taking tamoxifen, using estrogen-only oral contraceptives. The disease may be asymptomatic at first. Postmenopausal bleeding may be the only symptom. Therefore, any such episode necessarily requires seeking medical help. Sometimes the bleeding happens to be in the perimenopausal period, when the menstrual cycle is still there, but it is irregular. So it can be skipped. Therefore, regular visits to an obstetrician-gynecologist are important. The diagnosis is made by transvaginal ultrasound and histological verification of the malignant process. Any thickening of the uterine lining of more than 5 mm in a menopausal woman detected on ultrasound,requires the exclusion of endometrial carcinoma. Material for examination from the uterine cavity can be taken by curettage or during hysteroscopy. Hysteroscopy with biopsy is the preferred method today because it allows viewing the entire uterine cavity, localizing the process, and performing a targeted biopsy. NEWS_MORE_BOX Treatment is surgical and depends on the spread of the process and the involvement of adjacent organs and lymph nodes. The uterus is usually removed along with the fallopian tubes and both ovaries (total hysterectomy with bilateral slapping-oophorectomy). The operation can be performed through an incision through the abdominal wall or laparoscopically. If lymph nodes are affected, they are also removed. In cases where surgical treatment is not possible due to medical indications, external and internal radiotherapy can be used in the uterine cavity. Chemotherapy shows a minimal positive result. The good news is that, detected in time in the early stages of development, endometrial carcinoma has a very good prognosis. Survival of 20 years is observed in about 80% of cases. This means that regular health care and a good relationship between patient and doctor should last a long time to give its fruitful results.
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