In this study, we conducted a comparative analysis of demographic, histopathological, and sonographic characteristics between pre- and postmenopausal women diagnosed with endometrial cancer, while also examining sonographic and anthropometric features in 'low' and 'intermediate/high-risk' cases, stratified by menopausal status. Our analysis, based on data from the International Endometrial Tumor Analysis (IETA) 4 cohort comprising 1538 women (161 premenopausal, 1377 postmenopausal) with biopsy-confirmed endometrial cancer, revealed that premenopausal women, compared to their postmenopausal counterparts, exhibited lower parity (median 1, IQR 0-2 vs. 1, IQR 1-2, p = 0.001), a higher family history of colon cancer (16% vs. 7%, p = 0.001), and smaller waist circumferences (median 92 cm, IQR 82-108 cm vs. 98 cm, IQR 87-112 cm, p = 0.002). Premenopausal women more often had a regular endometrial-myometrial border (39% vs. 23%, p < 0.001), a visible endometrial midline (23% vs. 11%, p < 0.001), and undefined tumor (73% vs. 84%, p = 0.001). Notably, despite experiencing a longer duration of abnormal uterine bleeding (median 5 months, IQR 3-12 vs. 3 months, 2-6, p < 0.001), premenopausal women more often had 'low' risk disease (78% vs. 46%, p < 0.001). Among sonographic and anthropometric features, only an irregular endometrial-myometrial border was associated with 'intermediate/high' risk in premenopausal women. Conversely, in postmenopausal women, multiple features correlated with 'intermediate/high' risk disease. Our findings emphasize the importance of considering menopausal status when evaluating sonographic features in women with endometrial cancer.

Center of Obstetrics and Gynecology Faculty of Medicine Vilnius University Hospital 08661 Vilnius Lithuania

Department of Clinical Science and Education Karolinska Institute Södersjukhuset Sjukhusbacken 10 118 83 Stockholm Sweden

Department of Development and Regeneration KU Leuven 3000 Leuven Belgium

Department of Gynaecology Obstetrics and Neonatology General University Hospital and 1st Faculty of Medicine Charles University Apolinářská 18 128 51 Prague Czech Republic

Department of Gynecological Oncology European Institute of Oncology IRCCS 20141 Milan Italy

Department of Life Science and Public Health Catholic University of Sacred Heart Largo Agostino Gemelli 00168 Rome Italy

Department of Obstetrics and Gyneacology Queen Charlotte's and Chelsea Hospital Imperial College London London W12 0HS UK

Department of Obstetrics and Gynecology Catholic University of the Sacred Heart 00168 Rome Italy

Department of Obstetrics and Gynecology Södersjukhuset 118 83 Stockholm Sweden

Department of Obstetrics and Gynecology University Hospital Leuven 3000 Leuven Belgium

Department of Women and Child Health Division of Gynecologic Oncology Fondazione Policlinico Universitario A Gemelli IRCCS 00168 Rome Italy

Institute for the Care of Mother and Child Prague and 3rd Faculty of Medicine Charles University 147 00 Prague Czech Republic

UO Gynecology Department of Medicine and Surgery IRCCS San Gerardo University of Milan Bicocca 20126 Milan Italy

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