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Endometrial hyperplasia — MCCQE Part 1 MCQ

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HardVaginal BleedingEndometrial hyperplasiaMCCQE Part 1

A 48-year-old woman with obesity presents with 7 months of heavy irregular uterine bleeding. Pregnancy test is negative, haemoglobin is 101 g/L, and pelvic examination is unremarkable. She has never used hormonal contraception. What is the most appropriate investigation?

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Correct answer: C — Endometrial biopsy

Abnormal uterine bleeding in a woman over 45, particularly with obesity, requires endometrial sampling to exclude hyperplasia or malignancy. A Pap test screens the cervix and does not assess the endometrium. CA-125 is not first-line for endometrial cancer evaluation. Reassurance would miss a potentially premalignant process.

Reference: SOGC abnormal uterine bleeding guidance