A 67-year-old woman is brought to the office by her daughter, who recently noticed blood stains on the patient's undergarments. The patient has moderate Alzheimer dementia and cannot provide a detailed history, but she denies any pelvic pain. Her last menstrual period was 15 years ago. Current medications include donepezil. Vital signs are within normal limits. Pelvic examination reveals thin, pale vaginal mucosa and a small amount of dark blood at the cervical os. There are no vulvar or vaginal lesions. Transvaginal ultrasound demonstrates an endometrial thickness of 8 mm. Which of the following is the most appropriate next step in management?
- Endometrial biopsyAnswer
- BTopical estrogen therapy
- CRepeat transvaginal ultrasound in 3 months
- DPapanicolaou test
- EReassurance and routine follow-up
Answer
Endometrial biopsy
The correct answer is to perform an endometrial biopsy. Any bleeding in a postmenopausal woman is considered abnormal and should raise immediate suspicion for endometrial cancer. The initial evaluation can begin with either an endometrial biopsy or a transvaginal ultrasound. When an ultrasound reveals an endometrial thickness greater than 4 mm, a biopsy must be performed to obtain tissue for histologic evaluation. In this patient, the 8 mm endometrial stripe makes tissue sampling mandatory.
Step-by-Step Solution
Key Concept
In a postmenopausal woman presenting with vaginal bleeding and an endometrial stripe >4 mm on transvaginal ultrasound, an endometrial biopsy is explicitly indicated to rule out endometrial carcinoma.