Background

Endometrial cancer (EC) is the strongest obesity-associated malignancy and the fastest growing cancer of young women. Early identification of endometrial pathology in women with severe obesity may improve treatment options and help avoid hysterectomy. Data on underlying endometrial pathology in women pursuing metabolic/bariatric surgery is limited.

Methods

A 10-item questionnaire was implemented at two high-volume bariatric clinics to identify dysfunctional uterine bleeding, specifically combining tools designed to identify anovulatory/postmenopausal bleeding and heavy menstrual bleeding (SAMANTA). Initial data was collected from June-September 2022.

Results

Out of 804 eligible women presenting for surgical evaluation, 409 (51%) positive screens were referred for gynecologic evaluation to rule out endometrial hyperplasia/cancer. Fourteen percent of women explicitly noted “abnormal bleeding or spotting”, while 31% had a SAMANTA score of ≥3, indicating heavy menstrual bleeding.

Conclusions

Women presenting for metabolic/bariatric surgery have a high prevalence of dysfunctional menstrual bleeding and are high risk for EC. Standardized EC screening with appropriate gynecologic referral should be a routine part of the overall evaluation for patients with severe obesity. Follow-up is ongoing to quantify the prevalence of endometrial pathology in the preoperative population, as well as the potential effects of marked weight loss on cancer status, endometrial hyperplasia, and surgical outcomes.