Abnormal uterine bleeding (AUB) is a common gynaecological presentation that can range from benign hormonal disturbances to malignant endometrial pathology. Among the various risk factors implicated, obesity has emerged as a major determinant linking AUB to endometrial hyperplasia and carcinoma. The pathophysiological nexus between obesity and endometrial cancer lies in chronic unopposed estrogen exposure resulting from peripheral aromatization of androgens in adipose tissue, coupled with insulin resistance, hyperinsulinemia, and chronic inflammation. These mechanisms contribute to endometrial proliferation, atypia, and malignant transformation, particularly in postmenopausal and anovulatory women.
Clinical evaluation of AUB in obese women necessitates a high index of suspicion, with early utilization of transvaginal ultrasonography and endometrial sampling to exclude neoplastic lesions. Management strategies must be individualized, balancing fertility preservation, metabolic control, and oncologic safety. Medical therapies, including progestin-based regimens and levonorgestrel intrauterine systems, play key roles in controlling bleeding and reversing hyperplasia in low-risk patients. In contrast, definitive surgical interventions, such as hysterectomy, remain indicated for recurrent, refractory, or high-grade lesions.
However, obesity poses significant diagnostic, therapeutic, and anaesthetic challenges. Technical limitations during imaging, reduced accuracy of endometrial sampling, and increased perioperative morbidity complicate management. Furthermore, the rising prevalence of obesity globally underscores an urgent need for preventive strategies, including weight reduction, metabolic optimization, and early screening for endometrial pathology among high-risk populations.
In conclusion, the intersection of abnormal uterine bleeding, obesity, and endometrial cancer represents a critical domain in women’s health. Addressing this triad requires an integrated multidisciplinary approach emphasizing early detection, personalized management, and preventive interventions to mitigate morbidity and improve reproductive and oncologic outcomes.