A 52-year-old postmenopausal woman presents with a 3-month history of vaginal bleeding. Transvaginal ultrasound shows an endometrial thickness of 14 mm. The MOST appropriate next step in management is:
- A Endometrial sampling (Pipelle biopsy or hysteroscopy with curettage) ✓
- B Reassure and repeat ultrasound in 6 months
- C Start hormonal replacement therapy and monitor
- D MRI pelvis for staging
Correct answer: A. Endometrial sampling (Pipelle biopsy or hysteroscopy with curettage)
Explanation
Postmenopausal bleeding is endometrial carcinoma until proven otherwise. An endometrial thickness >4 mm in a postmenopausal woman with bleeding is an indication for histological sampling. Endometrial biopsy (Pipelle) or hysteroscopy-directed biopsy/curettage is the gold standard for tissue diagnosis. MRI is used for staging after malignancy is confirmed, not as a first diagnostic step.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.