A 58-year-old woman with 8 years of amenorrhoea and no hormone therapy use presents with a single episode of postmenopausal bleeding. Transvaginal ultrasound shows an endometrial thickness of 11 mm. What is the most appropriate next step?
- A Reassure and repeat ultrasound in 6 months
- B Start cyclical progestogen and review
- C Endometrial sampling by pipelle biopsy ✓
- D Serum CA-125 and pelvic MRI
Correct answer: C. Endometrial sampling by pipelle biopsy
Explanation
Postmenopausal bleeding always requires exclusion of endometrial carcinoma. Endometrial thickness of 4 mm or less on transvaginal scan has a high negative predictive value and allows reassurance without biopsy; this patient measures 11 mm, well above the cut-off, so histological sampling is mandatory. Suppressing bleeding with progestogen would mask malignancy, and CA-125 has no role in evaluating endometrial pathology.
Reference: Williams Gynecology, 3rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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