A 61-year-old postmenopausal woman presents with a single episode of vaginal bleeding. Transvaginal ultrasound shows an endometrial thickness of 3 mm and a thin, regular endometrial echo. She has no other symptoms. What is the MOST appropriate next step?

• A Endometrial biopsy
• B Reassurance and follow-up ultrasound in 6 months ✓
• C Diagnostic hysteroscopy with directed biopsy
• D CT scan of abdomen and pelvis

Explanation

In postmenopausal bleeding, an endometrial thickness below 4 mm on transvaginal sonography has a negative predictive value exceeding 99% for endometrial carcinoma, so expectant management with reassurance is appropriate when bleeding is isolated. Biopsy or hysteroscopy is reserved for thickness of 4 mm or more, persistent or recurrent bleeding, or failure to visualise the cavity. Imaging of the abdomen adds nothing when the endometrium is thin.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.