A 58-year-old female presents to the clinic to discuss the results of recent imaging. Two weeks prior, she reported a single episode of blood-tinged vaginal discharge. She underwent menopause at age 50 and takes no medications. A transvaginal ultrasound was subsequently ordered, which demonstrates an endometrial stripe thickness of mm. Today, her vital signs are within normal limits. Speculum examination reveals a normal-appearing cervix with no active bleeding. Which of the following is the most appropriate next step in the management of this patient?
- Endometrial biopsyAnswer
- BRepeat transvaginal ultrasound in 6 months
- CHysteroscopy with dilation and curettage
- DCervical cytology and human papillomavirus testing
- EInitiation of topical vaginal estrogen
Answer
Endometrial biopsy
The correct answer is an endometrial biopsy. Any vaginal bleeding in a postmenopausal woman must be aggressively evaluated to rule out endometrial cancer. The initial workup can involve either an endometrial biopsy or a transvaginal ultrasound. In this patient, a transvaginal ultrasound has already been performed and demonstrates an endometrial stripe of mm. Because an endometrial thickness mm is considered abnormal in a postmenopausal patient, definitive histologic evaluation is mandatory. An office-based endometrial biopsy is the safest, most effective, and standard immediate next step to obtain this tissue.
Step-by-Step Solution
Key Concept
In patients presenting with postmenopausal bleeding, a transvaginal ultrasound demonstrating an endometrial thickness greater than mm requires immediate histologic evaluation, typically via an office-based endometrial biopsy.