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Postmenopausal bleeding investigation — DRCOG MCQ

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HardGynaecological OncologyPostmenopausal bleeding investigationDRCOG

A 52-year-old with heavy menstrual bleeding also has persistent intermenstrual bleeding. She has no pelvic mass on examination. Which investigation is most appropriate?

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Correct answer: D — Outpatient hysteroscopy with biopsy if indicated

The best answer is “Outpatient hysteroscopy with biopsy if indicated”. Persistent intermenstrual bleeding raises concern for endometrial pathology. NICE recommends outpatient hysteroscopy when the history suggests polyps, submucosal fibroids or endometrial pathology, with biopsy considered during hysteroscopy for women at higher risk. Ablation should not precede cavity assessment.

Reference: NICE NG88: Heavy menstrual bleeding: https://www.nice.org.uk/guidance/ng88/chapter/recommendations