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Postmenopausal bleeding — DRCOG MCQ

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HardGynaecological OncologyPostmenopausal bleedingDRCOG

A 59-year-old has one episode of vaginal bleeding 6 years after menopause. She uses no HRT. Speculum examination shows atrophy but no cervical lesion and the bleeding has not recurred. What is the correct next step?

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Correct answer: D — Refer on the suspected endometrial-cancer pathway despite a single resolved episode

The best answer is “Refer on the suspected endometrial-cancer pathway despite a single resolved episode”. Any unexplained postmenopausal bleeding in this age group warrants suspected endometrial-cancer referral, even if it occurred once and has stopped. Atrophy is common but should not be assumed without completing the pathway. Cervical screening is not a diagnostic test for postmenopausal bleeding, and CA125 assesses a different clinical question.

Reference: NICE NG12: Suspected cancer recognition and referral: https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer