Is the risk of endometrial cancer high with PCOS at 28?

Question

Hello doctor,

I am 28 and I’ve had PCOS since I was a teenager. I have periods once every three to four months. Lately I have been spotting in between periods. Ultrasound revealed an endometrium thickness of 15 mm. My fasting insulin is high, and my BMI is 31.I looked on the internet and became very worried.

Can a 28-year-old woman get endometrial cancer from PCOS?
Is cancer still rare at this age, or does PCOS increase the risk a lot?
Should I be on progesterone regularly?
Also, how often should scans or biopsies be done to stay safe?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

PCOS (polycystic ovarian syndrome) increases the lifetime risk of endometrial cancer two to threefold, but cancer at age 28 is still very rare. The thickened lining (15 mm) is a sign of endometrial hyperplasia, a buildup of lining from unopposed estrogen (because you do not ovulate regularly). Most hyperplasia at this age is without atypia (low-risk), not cancer. The high insulin and BMI fuel this process.I suggest you do the following -1.

Endometrial biopsy is the only way to know if the hyperplasia is simple (low-risk) or has atypia (precancer). Given 15mm and risk factors, a biopsy is essential.2. You need regular progesterone to shed the lining and prevent buildup. Options include the following:Cyclical progesterone (for example, Medroxyprogesterone 10 to 14 days every month).Hormonal IUD (intrauterine device) for long-term protection, especially with obesity.3.

Since fasting insulin is high, Metformin can improve Insulin resistance and may help restore ovulation and protect the lining.4. Even a five to 10 percent weight loss improves ovulation and reduces cancer risk.After starting progesterone, a repeat ultrasound is usually done in three to six months to ensure the endometrial lining has thinned (ideally to less than 5 mm). If a biopsy shows no atypia, it generally needs to be repeated only if bleeding recurs or the lining thickens again.

If atypia is found, closer follow-up and stronger treatment will be required.You are young, and this is highly manageable. The goal is to protect your uterus now while preserving fertility. Please see a gynecologist this week for the biopsy and to start progesterone. You are doing the right thing by being proactive.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.