Is Blood in the Urine a Symptom of Endometrial Cancer?

Blood in the urine (hematuria) is not a typical first symptom of endometrial (uterine) cancer. The most common early sign of endometrial cancer is abnormal vaginal bleeding, especially bleeding after menopause; urinary symptoms like difficulty urinating or pain with urination can occur but are less common. ^{[1] [2]} Abnormal vaginal bleeding after menopause warrants prompt medical evaluation because a notable proportion of cases are related to uterine cancer. ^[2]

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Typical Symptoms of Endometrial Cancer

• Abnormal vaginal bleeding or discharge (including postmenopausal bleeding) is the hallmark symptom. ^[1]
• Pelvic pain and pain during intercourse may appear, more often in later stages. ^[1]
• Urinary difficulties (trouble urinating or pain when urinating) can be present, but they are not the most common initial sign. ^{[1] [2]}

Key point: Vaginal bleeding is the primary warning sign, especially after menopause, and should be evaluated without delay. ^{[1] [2]}

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Can Endometrial Cancer Cause Hematuria?

• Direct hematuria from endometrial cancer is uncommon and usually suggests advanced disease with spread (metastasis) to the bladder. ^[3]
• When endometrial cancer invades the bladder, symptoms can include blood in the urine and urinary frequency. ^[3]

In other words: Hematuria is more likely when the cancer has spread beyond the uterus rather than in early-stage disease. ^[3]

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Distinguishing Hematuria from Vaginal Bleeding

Blood seen during urination can come from different sources:

• Urinary tract (bladder, kidneys, ureters, urethra) → true hematuria.
• Gynecologic source (vagina/uterus) → vaginal bleeding that may be mistaken for hematuria.

If you notice blood, especially after menopause, medical evaluation is essential, and clinicians will determine whether it comes from the urine, vagina, rectum, or uterus. ^[4] It’s important to clarify the source because misattributing blood in urine to a urinary tract infection or postmenopausal uterine bleeding can delay correct diagnosis, including for bladder cancer. ^[5]

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What To Do If You Notice Blood

• Postmenopausal bleeding of any amount should be checked promptly to rule out uterine causes, including endometrial cancer. ^{[4] [2]}
• Visible blood in urine should be treated as a potentially serious sign and evaluated with a complete urologic work‑up (urinalysis, imaging such as CT urography, and cystoscopy) to identify the source and rule out urinary malignancy. ^[6]

Takeaway: Any unexplained bleeding requires timely assessment, and your clinician may involve both gynecologic and urologic evaluations to pinpoint the cause. ^{[4] [6]}

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Less Common Urinary Presentations

While most endometrial cancer presents with abnormal vaginal bleeding, there are less common scenarios:

• Urinary difficulties or retention can occur due to cervical stenosis or mass effect, leading to delayed recognition of uterine bleeding. ^{[7] [8]}
• Bladder involvement by metastatic spread may cause hematuria and other urinary symptoms, reflecting advanced disease. ^[3]

Clinical nuance: Urinary symptoms alone are rarely the first clue, but they can accompany or obscure the typical gynecologic signs. ^{[1] [7]}

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Summary Table: Bleeding Source and Likely Causes

Symptom	Most Likely Source	Common Causes	Relation to Endometrial Cancer
Vaginal bleeding (especially after menopause)	Gynecologic	Endometrial cancer, benign endometrial changes	Primary early symptom; prompt evaluation needed. [1] [2]
Blood in urine (hematuria)	Urinary tract	UTI, stones, bladder/kidney tumors	Uncommon in early endometrial cancer; may occur if cancer invades the bladder (advanced). [6] [3]
Pelvic pain	Gynecologic/other	Advanced gynecologic disease, other pelvic conditions	More typical in later stages rather than early onset. [1]
Pain/difficulty urinating	Urinary or gynecologic	Infection, obstruction, mass effect	Reported but less common; warrants evaluation. [1] [7]

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Bottom Line

• Blood in urine is not a common early symptom of endometrial cancer. ^[1]
• Abnormal vaginal bleeding is the key early sign and should prompt gynecologic evaluation. ^[2]
• Hematuria requires a urologic work‑up, as it can indicate urinary tract conditions or, less commonly, advanced gynecologic cancer with bladder involvement. ^{[6] [3]}
• If you notice any bleeding, seek medical care to differentiate the source and address potentially serious causes. ^{[4] [5]}