A 65-year-old woman presents to the office for follow-up regarding vaginal bleeding.

Persistent postmenopausal bleeding requires thorough evaluation. An inadequate endometrial biopsy result does not rule out pathology. Hysteroscopy allows for direct visualization and targeted biopsy and is the gold standard when biopsy is non-diagnostic.

Toronto Notes 2023 – Gynecology, “Abnormal Uterine Bleeding and Endometrial Cancer” Section:

“Persistent bleeding with insufficient biopsy requires further evaluation, preferably via hysteroscopy and directed biopsy. This is especially important in patients on HRT or with risk factors for endometrial pathology.”

MCCQE1 Objectives (Obstetrics & Gynecology > 82-9: Postmenopausal Bleeding):

“Candidates must investigate abnormal bleeding in postmenopausal women with hysteroscopy when endometrial sampling is non-diagnostic.”

Changing hormones (A), reducing progestin (E), or performing colposcopy (C) are not appropriate without confirming the cause of bleeding.

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