Endometrial cancer has become the most common gynaecological cancer in Singapore, and increasingly, it’s affecting younger women who haven’t completed their families. If you are under 40 and facing this diagnosis, you are part of a growing group. About 3-14% of endometrial cancer cases occur in women of your age. Learn about fertility preservation in endometrial cancer patients in this article.

Could Fertility Preservation Be Right For You?

Not everyone with endometrial cancer, but many women are excellent candidates. Let’s help you understand if this path might be available to you. You might be a good candidate if you have:

• Early-stage disease (Stage IA) where the cancer is confined to the inner lining of your uterus
• Grade 1 (well-differentiated) cancer – this means the cancer cells still look relatively similar to normal cells
• Endometrial hyperplasia with atypia – a precancerous condition that hasn’t yet become cancer
• A strong desire to have children and are willing to commit to close monitoring
• No evidence of cancer spread to other parts of your body

  Having certain conditions doesn’t automatically disqualify you, but they require extra consideration.

1. Obesity (BMI over 30) – this can affect how well you respond to treatment, but weight management support can help.
2. Polycystic Ovary Syndrome (PCOS) or metabolic syndrome
3. Grade 2 tumours – these may still be treatable but require close monitoring

  Your doctor will also consider newer molecular testing that can help predict how your specific tumour might respond to treatment. This personalised approach helps ensure you get the most appropriate care for your unique situation.

Your Treatment Options

The Most Common Approach

Most women start with high-dose progesterone pills which work by counteracting the oestrogen that feeds endometrial cancer. The two main medications are:

• Medroxyprogesterone acetate (MPA): Usually 400-600mg daily
• Megestrol acetate (MA): Usually 160-320mg daily

  You will typically take these medications for six to twelve months. Think of it as giving your body a chance to reverse the cancerous changes while preserving your uterus. Success rates vary widely (18-100%), but when combined with careful patient selection and monitoring, most women see positive results.

Combination Treatments

Some women benefit from combining oral progesterone with a progesterone-releasing IUD (Mirena). This combination approach has shown even better results, with success rates of 55-87.5%. The IUD delivers progesterone directly to your uterine lining while the oral medication works throughout your body.

Additional Supportive Treatments

Depending on your individual situation, your doctor might also recommend:

1. Metformin: Especially helpful if you have insulin resistance or diabetes
2. Hysteroscopic resection: Removing the abnormal tissue before starting medication
3. GnRH agonists: To temporarily suppress your ovarian function

What to Expect Month by Month

Understanding what lies ahead can help you feel more prepared and in control. Here’s what the journey of fertility preservation in endometrial cancer patients might look like:

Getting Started (Months 1-2)

Your journey begins with comprehensive testing to ensure fertility preservation is safe for you. This includes:

• An MRI scan to see exactly where the cancer is located
• Blood tests to check your overall health
• A consultation with both an oncologist and a fertility specialist
• Discussion about egg or embryo freezing if desired

  During this time, you might feel overwhelmed by the amount of information and decisions. It’s perfectly normal to need time to process everything. Many women find it helpful to bring a loved one to appointments and to write down questions as they arise.

Active Treatment (Months 3-9)

Once you start treatment, you’ll have regular check-ups every three months. During these visits, your doctor will perform an endometrial biopsy to see how you’re responding. What you might experience during treatment:

• Weight gain – this is temporary and related to the progesterone
• Mood changes – some women feel more emotional or experience mood swings
• Irregular bleeding – this often improves as treatment continues
• Fatigue – your body is working hard to heal

  In Singapore, our experience shows that most women see complete response within at least 10 months. Some respond faster, others need a bit more time. Your body is unique, and your response will be too.

The Waiting and Watching

One of the hardest parts can be the waiting between check-ups. Many women describe feeling like they’re “in limbo” during this time. These feelings are completely valid. Consider joining a support group or speaking with a counsellor who understands what you’re going through.

Planning for Pregnancy

Once your doctor confirms you’ve achieved complete remission, it’s time to think about pregnancy—and we encourage you not to wait too long.

Why Timing Matters

After successful treatment, your window for pregnancy is precious. The cancer can return, so most doctors recommend trying to conceive as soon as you’re cleared. This might feel rushed, especially when you’re still processing everything you’ve been through, but remember — this is what you’ve been working toward.

Your Pregnancy Options

Natural conception: Some women conceive naturally after treatment. In fact, we’ve had patients in Singapore who became pregnant spontaneously and delivered healthy babies. Assisted reproduction (IVF): Many women benefit from IVF to maximise their chances of pregnancy quickly. Singapore has excellent IVF facilities, and your oncologist can work closely with fertility specialists to optimise your care.

During Pregnancy

If you become pregnant, you’ll be monitored as a high-risk pregnancy–not because the cancer affects your baby (it doesn’t), but to ensure you receive the best possible care. Many women who’ve been through fertility-sparing treatment go on to have normal, healthy pregnancies and babies.

Facing the Reality of Recurrence

We need to have an honest conversation about recurrence. While treatment can be very successful, the cancer can return. This might sound frightening, but remember:

1. Recurrence doesn’t mean failure. Many women can be successfully re-treated
2. Re-treatment often works. About 70-85% of women respond to a second round of treatment.
3. You have options. Even if re-treatment isn’t suitable, you’ve bought precious time for family planning

If Cancer Returns

If you experience recurrence before completing your family, you might still be able to have another round of fertility-sparing treatment. Studies show that using the same medication that worked initially often yields the best results. However, this decision requires careful discussion with your medical team.

Making Your Decision

This is a deeply personal decision, and only you can make it. Here are some questions to discuss with your medical team and loved ones.

Medical questions

1. What is my exact diagnosis and stage?
2. What are my chances of successful treatment?
3. How will my treatment affect my timeline for having children?
4. What are my options if treatment doesn’t work?

Personal questions to consider

1. How important is biological parenthood to me?
2. Am I prepared for the intensive monitoring required?
3. Do I have the support system I need?
4. What are my alternative family-building options?

Practical questions

1. How much will the treatment cost, and what’s covered by insurance?
2. How will the treatment affect my work and daily life?
3. Where can I find emotional support during this journey on fertility preservation in endometrial cancer patients?

 

A Message of Hope

If you’ve made it through here, you’re already showing the strength and determination needed for this journey. Yes, facing endometrial cancer while wanting to preserve your fertility is challenging. There will be difficult days, moments of doubt, and times when you question your decisions. But remember, many women have walked this path before you and emerged with their dreams intact. Some have had the families they hoped for. Others have found different paths to fulfilment. If you are looking for medical guidance on how to navigate this journey, you can reach out to a gynaecology clinic in Singapore. Whatever path you choose, know that you’re making the best decision you can with the information and options available to you. There is hope, there are options, and there is support available every step of the way.