A 50-year-old woman presents with postmenopausal bleeding for 2 weeks. Transvaginal ultrasound shows endometrial thickness of 6 mm. What is the next most appropriate step?

• A Repeat ultrasound in 3 months
• B Outpatient endometrial sampling (Pipelle)
• C Hysteroscopy and directed biopsy ✓
• D Start progesterone therapy

Explanation

Any postmenopausal bleeding requires histological evaluation regardless of endometrial thickness. While an endometrial thickness of 4 mm or less in asymptomatic postmenopausal women has high negative predictive value for cancer, in symptomatic women with bleeding, tissue sampling is mandatory. Hysteroscopy with directed biopsy is the gold standard, especially when focal lesions are suspected.

Reference: Practical Guidelines in Advanced Gynaecological Endoscopy, 1st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.