A 56-year-old woman with postmenopausal bleeding undergoes transvaginal sonography. Which endometrial thickness measurement provides the strongest justification for withholding endometrial sampling?

• A Less than 8 mm
• B Less than 6 mm
• C No thickness threshold is acceptable; every woman with bleeding must be sampled
• D Less than 4 mm ✓

Explanation

An endometrial thickness of 4 mm or less on transvaginal ultrasound in a postmenopausal woman has a negative predictive value for endometrial cancer approaching 99 percent, allowing sampling to be deferred. The commonly quoted 5 mm threshold is slightly less specific. Thickness above 4 mm, or bleeding persisting despite a thin endometrium, still mandates tissue diagnosis. Option C reflects real caution but contradicts the validated evidence base examined internationally.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.