skip to main content

Postcoital bleeding with suspicious cervix — DRCOG MCQ

Instant feedback + full explanation. One question, done properly.

HardGynaecological OncologyPostcoital bleeding with suspicious cervixDRCOG

A 56-year-old with a uterus has used continuous combined HRT for 18 months and had been amenorrhoeic for a year. New spotting prompts transvaginal ultrasound, which shows a fully visualised uniform endometrium measuring 5 mm. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Arrange urgent endometrial assessment because the continuous-combined-HRT threshold is 4 mm

The best answer is “Arrange urgent endometrial assessment because the continuous-combined-HRT threshold is 4 mm”. The endometrium is fully visualised and uniform, but at 5 mm it exceeds the 4 mm reassuring threshold for unscheduled bleeding on continuous combined HRT. The UK joint guideline therefore recommends urgent endometrial assessment through the appropriate cancer pathway. The 7 mm threshold applies to sequential HRT, so using it here would misclassify risk. Merely changing or stopping HRT must not delay assessment once the regimen-specific threshold is exceeded, and heterogeneity is not required before referral.

Reference: British Menopause Society joint guideline: Management of unscheduled bleeding on HRT: https://thebms.org.uk/publications/bms-joint-guidelines/management-of-unscheduled-bleeding-on-hormone-replacement-therapy-hrt/