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Endometrial hyperplasia — DRCOG MCQ

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HardGynaecologyEndometrial hyperplasiaDRCOG

A 52-year-old with BMI 38 and type 2 diabetes has persistent irregular heavy bleeding. Ultrasound shows endometrial thickness 12 mm. What investigation should be arranged?

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Correct answer: D — Endometrial biopsy within a hysteroscopy pathway

The best answer is “Endometrial biopsy within a hysteroscopy pathway”. Persistent irregular bleeding with obesity and diabetes raises the risk of endometrial pathology. NICE recommends considering endometrial biopsy at hysteroscopy for high-risk women; blind biopsy is not recommended for heavy menstrual bleeding, and cervical screening does not assess the endometrium.

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