Why is there an increased risk of endometrial carcinoma in nulliparous woman?

[Merely]

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I understand it has to do with endometrial hyperplasia but estrogen increases endometrial hyperplasia and there is a lot of estrogen produced during pregnancy so whats happening? Thanks

 

[WiseOne]

It's unopposed estrogen not just estrogen. That's why taking a combined OCP is protective against endometrial cancer. When you're pregnant, you're making a lot of progesterone (the "pro-gestational" hormone), so it cancels out any bad effect of estrogen.

 

[Merely]

It's unopposed estrogen not just estrogen. That's why taking a combined OCP is protective against endometrial cancer. When you're pregnant, you're making a lot of progesterone (the "pro-gestational" hormone), so it cancels out any bad effect of estrogen.

Let's say she's not pregnant, she still has 2 weeks of progesterone (luteal phase), so why does the pregnancy help?

 

[WiseOne]

because there is no proliferative phase during pregnancy. when you're not pregnant, yes you get 2 weeks of progesterone, but when you are pregnant you have progesterone all the time to negate estrogen, not just half the time.

 

[Stagg737]

because there is no proliferative phase during pregnancy. when you're not pregnant, yes you get 2 weeks of progesterone, but when you are pregnant you have progesterone all the time to negate estrogen, not just half the time.

The proliferation is the key to this cancer (like many cancers). The more periods of proliferation of endometrial cells a woman has, the more opportunities an abnormal cell(s) will have to proliferate. We were taught that the more menstrual periods a woman goes through in her life, the more likely she is to develop this cancer because of the increased proliferative phases. This explains not only why women with more pregnancies have lower chances of developing it (you're basically losing 8-9 proliferative phases per pregnancy), but also why women who go through puberty later and menopause earlier are less likely to develop it (because they have less total periods).

As Wiseone said, it's the unopposed estrogen that's the real underlying cause, but looking at number of proliferative periods helps give a more general understanding of how much time a woman will have unopposed estrogen. Note: the odds of a woman developing endometrial cancer also increases if she uses estrogen therapy during and after menopause as more unopposed estrogen is being introduced exogenously. This is a very simplified explanation, but it helped me get the overarching concept down.

 

[Merely]

Does this mean 10 kids less risk than 2 kids?

 

[Stagg737]

Does this mean 10 kids less risk than 2 kids?

Assuming all else is equal, yes.

 

[mehc012]

Does this mean 10 kids less risk than 2 kids?

Of endometrial CA? Sure. Of death via stress-induced hair-rippage? Nah.

 

[TooMuchResearch]

If you don't use it, you lose it?

 

[MSTP18]

If you don't use it, you lose it?

Is that a serious question?

 

[Spectre of Ockham]

Of death via stress-induced hair-rippage? Nah.

What a bunch of discriminatory BS. Large families are usually happier than the 2 parents one brat modern formula or 1 woman , 5 cats and 7 bottles of Xanax ultra-progressive dream.

 

[Dylasa]

What a bunch of discriminatory BS. Large families are usually happier than the 2 parents one brat modern formula or 1 woman , 5 cats and 7 bottles of Xanax ultra-progressive dream.

More likely, though, is the 1 woman, 2 children, 3 cats, 4 bottles Xanax/Wellbutrin/Pinot life.

 

[mehc012]

What a bunch of discriminatory BS. Large families are usually happier than the 2 parents one brat modern formula or 1 woman , 5 cats and 7 bottles of Xanax ultra-progressive dream.

Yes, I'm very discriminatory for joking that kids can be stressful. Because no parent has ever said that, ever.
And because my comment somehow implied that I would like to deny services or rights to women with multiple children.

 

[MSTP18]

What a bunch of discriminatory BS. Large families are usually happier than the 2 parents one brat modern formula or 1 woman , 5 cats and 7 bottles of Xanax ultra-progressive dream.

Look at the snowflake melting!