Question 18

A 55 yo menopausal patient is referred to you for an endometrial thickness of 7 mm seen on ultrasound. She has no significant past medical or family history. She takes no medications. She is asymptomatic and has had no bleeding. What is the best next step?

Answer Choices:

Endometrial biopsy

Hysteroscopy

Expectant management

Sonohysterography

Repeat ultrasound

Correct Answer:

Expectant management

Explanation:

  • The significance of a thickened endometrial lining in an asymptomatic patient remains unclear

  • Generally, if endometrial thickness is less than 11 mm without bleeding, the risk of endometrial cancer is low

  • Evaluation of the endometrium is recommended for all cases of postmenopausal bleeding

  • In these women, a stripe of 4 mm or less has 99% NPV for endometrial cancer

  • Sonohyst can be done for focal findings on ultrasound

  • Hysteroscopy performed for focal ultrasound findings or persistently symptomatic patients despite negative biopsy and ultrasound.