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Postmenopausal bleeding — USMLE Step 3 MCQ

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HardOB/GYN (Prenatal / Contraception / Screening)Postmenopausal bleedingUSMLE Step 3

A 61-year-old has a second episode of painless postmenopausal bleeding. During the first episode 8 months ago, transvaginal ultrasonography showed a 3-mm endometrial stripe and bleeding stopped without biopsy. Pelvic examination now shows no source. What is the best next step?

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Correct answer: A — Obtain endometrial histology during assessment of this recurrent bleeding episode now

The best answer is “Obtain endometrial histology during assessment of this recurrent bleeding episode now”. A thin stripe has a high negative predictive value during an initial bleeding episode, but persistent or recurrent postmenopausal bleeding requires histologic evaluation because uncommon endometrial cancers can occur with a thin endometrium. Cervical screening does not evaluate the endometrium.

Reference: ACOG: Transvaginal Ultrasonography in 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