Gynecologic Cancer Awareness Month: What Every Woman in Midlife Should Know
By: Dr. Jackie Piasta, DNP, WHNP-BC, MSCP
Every September, Gynecologic Cancer Awareness Month reminds us of an often-overlooked truth: cancers of the uterus, ovaries, cervix, vulva, and vagina collectively affect over 100,000 women in the U.S. each year. For women in their 40s, 50s, and beyond, these cancers are especially relevant as risks increase with age, environmental factors, and genetics.
The good news: many gynecologic cancers are preventable or treatable when detected early. Awareness is your first line of defense.
Understanding Gynecologic Cancers
Gynecologic cancers include five primary types:
Uterine (Endometrial) Cancer
The most common gynecologic cancer.
Typically arises from the endometrium (lining of the uterus).
Most cases occur after menopause but can appear in perimenopause.
Ovarian Cancer
Often called the “silent killer” because symptoms are vague and nonspecific.
High-grade serous ovarian cancer is the most common and aggressive type.
Median diagnosis age is mid-60s, but risk rises significantly after 50.
Cervical Cancer
Caused primarily by persistent infection with high-risk strains of human papillomavirus (HPV).
Once a leading cause of cancer death in women, now largely preventable with Pap tests, HPV testing, and vaccination.
Vulvar Cancer
Rare but increasingly recognized.
Often linked to HPV, but also associated with chronic vulvar conditions like lichen sclerosus.
Vaginal Cancer
The rarest of the group.
Often presents with abnormal bleeding or discharge.
Risk Factors in Midlife and Beyond
Many risk factors converge during the perimenopause and menopause transition:
Age: The strongest risk factor. Most cases occur in women >50.
Hormonal influences:
Long-term exposure to unopposed estrogen (from obesity, PCOS, or estrogen-only therapy without progesterone) increases uterine cancer risk.
Early menarche, late menopause, and nulliparity also increase lifetime estrogen exposure.
Genetics:
BRCA1/2 mutations elevate ovarian and breast cancer risk.
Lynch syndrome significantly raises uterine and colon cancer risk.
HPV infection: Persistent infection with high-risk strains drives cervical, vulvar, and vaginal cancers.
Lifestyle: Obesity, sedentary lifestyle, smoking, and poorly controlled diabetes increase risks across multiple cancer types.
Immune status: Immunosuppression (e.g., HIV, chronic steroids) elevates risk for HPV-related cancers.
Symptoms You Should Never Ignore
Many symptoms overlap with menopause changes, which can delay diagnosis. Knowing when to investigate further is essential:
Uterine (Endometrial) Cancer:
Any bleeding after menopause.
Heavy, prolonged, or irregular bleeding in perimenopause.
Watery or blood-tinged discharge.
Ovarian Cancer:
Persistent bloating or abdominal swelling.
Feeling full quickly when eating.
Pelvic or abdominal pain.
Frequent urination or bowel changes.
Key point: These symptoms must persist daily for >2 weeks to be concerning.
Cervical Cancer:
Abnormal vaginal bleeding (between periods, after sex, or postmenopausal).
Pelvic pain or pain with intercourse.
Unusual vaginal discharge.
Vulvar Cancer:
Persistent itching, pain, or burning.
Non-healing sores or lumps.
Changes in skin color, thickness, or texture.
Vaginal Cancer:
Abnormal bleeding or discharge.
A palpable mass or pelvic pain.
Clinical pearl: Any new postmenopausal bleeding warrants discussion and potential immediate evaluation.
Prevention and Screening
Pap Smear and HPV Testing
Pap testing begins at age 21; HPV testing is integrated after 30.
If both Pap and HPV tests are negative, screening can be extended to every 5 years.
After hysterectomy for benign reasons (with cervix removed), Pap smears may no longer be needed.
HPV Vaccination
Safe and effective up to age 45.
Even if you’ve had HPV exposure, vaccination can protect against additional strains.
Genetic Testing and Counseling
Strong family history of breast, ovarian, uterine, or colon cancer may warrant BRCA or Lynch syndrome testing.
Preventive strategies may include earlier screening, transvaginal ultrasound, or even prophylactic surgery.
Lifestyle Strategies
Maintaining a healthy weight lowers uterine and ovarian cancer risk.
Quitting smoking reduces risk for cervical, vaginal, and vulvar cancers.
Regular physical activity supports hormone balance and immune health.
Why Awareness Matters in Midlife
The menopause transition is a time of shifting hormones and changing symptoms. Heavy or irregular bleeding, bloating, and pelvic discomfort are often attributed to “just perimenopause.” But dismissing these changes can delay diagnosis.
Midlife is also when:
Genetic risk factors may surface with family history updates.
Preventive care (Pap/HPV, mammogram, colonoscopy) needs to be current.
Proactive conversations about long-term hormone use and cancer risk are essential.
The Bottom Line
Gynecologic cancers affect thousands of women each year—but many cases are preventable or detectable early with the right screening and awareness.
This Gynecologic Cancer Awareness Month, empower yourself with knowledge:
Know your family history.
Stay current with screening.
Pay attention to persistent, unusual symptoms.
Advocate for a thorough evaluation if something doesn’t feel right.
At our practice, we believe in proactive, personalized prevention, because catching cancer early or preventing it altogether is the most powerful tool we have.
