Tamoxifen and postmenopausal bleeding — DRCOG MCQ
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Correct answer: E — Urgent endometrial assessment through the postmenopausal-bleeding pathway
The best answer is “Urgent endometrial assessment through the postmenopausal-bleeding pathway”. Postmenopausal bleeding requires urgent endometrial assessment, and tamoxifen increases the risk of endometrial pathology. A normal pelvic examination does not assess the endometrial cavity. The pathway determines the need for transvaginal ultrasound, hysteroscopy and sampling, stopping tamoxifen or treating presumed atrophy must not replace investigation. The key distinction is between an investigation suitable for initial risk stratification and a finding that already meets an urgent suspected-cancer pathway. Persistent symptoms, postmenopausal bleeding, a suspicious mass or relevant family history must not be dismissed by one reassuring test. Referral and subsequent imaging or tissue diagnosis answer different stages of the pathway.
Reference: NICE NG12: Suspected cancer recognition and referral: https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer