Is fertility-sparing possible at 40 with endometrial cancer?

Question

Hello doctor,

I am 40 and was recently diagnosed with early endometrial cancer after a biopsy. I still have not had children, and that is my biggest worry right now. My MRI shows disease limited to the uterus, and the biopsy says grade 1.

Is fertility-sparing treatment possible in a 40-year-old woman with endometrial cancer?
How safe is it compared to surgery?
What kind of follow-up is needed if the uterus is preserved?

I am scared of delaying definitive treatment, but I am also scared of losing the chance to become a mother.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

In selected patients with early endometrial cancer, fertility-sparing treatment can sometimes be considered. This option is usually offered when the cancer is grade 1, confined to the endometrium, and imaging shows that the disease is limited to the uterus without deep invasion or spread.

In such carefully selected cases, hormonal treatment using high-dose progesterone therapy or a progesterone-releasing intrauterine device may be used to control the disease while preserving the uterus.

This approach requires very careful monitoring. Patients usually undergo regular follow-up with pelvic examinations, imaging when needed, and repeat endometrial sampling every few months to assess the response to treatment.

If the cancer responds well, pregnancy may be attempted under the guidance of a gynecologist or fertility specialist. After completion of childbearing, definitive surgery is generally recommended to reduce the long-term risk of recurrence.

It is important to understand that fertility-sparing therapy is considered only in carefully selected early cases and must be done under the close supervision of a gynecologic oncology team.

Surgery remains the standard and most definitive treatment, but hormonal management may provide a temporary option for women who strongly wish to preserve fertility.

You should discuss the details of eligibility, benefits, and risks with your treating gynecologic oncologist so that the safest plan can be made according to your specific case.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.