A woman is considered menopausal when a year has past since her last period. Any bleeding after the menopause is regarded as abnormal. This is referred to as postmenopausal bleeding (PMB). Although in majority of cases there is no underlying pathology, PMB may be associated with cancer. The prevalence of endometrial cancer in women with PMB is 3-10%, so referral for investigation is considered mandatory. Unlike other malignancies affecting women, endometrial cancer often presents at an early stage and to increase survival, accurate and timely diagnosis is paramount.
Investigation of PMB using traditional inpatient dilatation of the cervix and curettage of the endometrium has been replaced by outpatient evaluation using Endometrial biopsy (EB), Ultrasonography (USS) and Outpatient hysteroscopy (OPH). There is now compelling evidence that women presenting for the first time with PMB should undergo initial evaluation with an USS or EB. The choice between initial testing with ultrasound or EB will depend upon the patient’s age, disease prevalence and the availability of high quality ultrasound. We use a threshold of 4 mm endometrial thickness to define abnormal results.