A 61-year-old postmenopausal woman with no other complaints undergoes transvaginal ultrasound during assessment of an adnexal cyst. Endometrial thickness measures 3 mm, double layer. What is the appropriate next step regarding the endometrium?
- A Endometrial biopsy to exclude carcinoma
- B Hysteroscopy with directed biopsy
- C No endometrial sampling required ✓
- D Repeat ultrasound after three months of cyclical progestogen
Correct answer: C. No endometrial sampling required
Explanation
An endometrial thickness of 4 mm or less on transvaginal scan in a postmenopausal woman has a negative predictive value above 99 percent for endometrial carcinoma, and sampling can be omitted. This threshold underpins the investigation of postmenopausal bleeding: biopsy is indicated when thickness exceeds 4 mm. Hysteroscopy is reserved for persistent bleeding with a thin endometrium, focal lesions, or inadequate outpatient sampling.
Reference: Williams Gynecology, 3rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.