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Postmenopausal bleeding — ABIM Board MCQ

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HardWomen's Health/Men's HealthPostmenopausal bleedingABIM Board

A 61-year-old woman had one episode of postmenopausal bleeding six months ago; transvaginal ultrasound then showed a 3-mm endometrial stripe. She now has recurrent spotting. Pelvic examination shows no cervical or vaginal source. Which next step is most appropriate?

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Correct answer: C — Obtain endometrial tissue despite the previously thin endometrial stripe

The best answer is “Obtain endometrial tissue despite the previously thin endometrial stripe”. A thin endometrial stripe has a high negative predictive value during an initial episode, but recurrent or persistent bleeding still requires histologic assessment because rare endometrial cancers can present with a thin lining. Endometrial biopsy, with hysteroscopic evaluation if sampling is nondiagnostic, is appropriate rather than relying repeatedly on ultrasound.

Reference: ACOG Committee Opinion: Postmenopausal Bleeding: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/the-role-of-transvaginal-ultrasonography-in-evaluating-the-endometrium-of-women-with-postmenopausal-bleeding