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I wanted to get some input and get a general consensus on post menopausal bleeding work up.
Hypothetical case:
65 year old- one episode of post menopausal bleeding/spotting a month ago. Normal BMI (<30), No DM or tamoxifen use. Otherwise healthy
TVUS shows a small uterus with an endometrial stripe of 8mm. Pelvic exam normal. Pap smear neg for malignancy. In office endometrial biopsy path report comments on benign endometrium with no evidence of hyperplasia, atypia, or malignancy.
Does this end the work up or does this patient require a D+C with hysteroscopy? I've heard some conflicting things from attendings, some of whom comment that the in office biopsy's value is to rule in cancer and a negative result doesn't mean much. Others say with only one episode of bleeding, they would reassess only if the bleeding persisted.
I guess my confusion lies in the fact that the stripe is thickened and although a using a pipelle to biopsy is a useful test, I was under the impression that it sampled a very small portion of the cavity and would miss any focal lesions.
Hypothetical case:
65 year old- one episode of post menopausal bleeding/spotting a month ago. Normal BMI (<30), No DM or tamoxifen use. Otherwise healthy
TVUS shows a small uterus with an endometrial stripe of 8mm. Pelvic exam normal. Pap smear neg for malignancy. In office endometrial biopsy path report comments on benign endometrium with no evidence of hyperplasia, atypia, or malignancy.
Does this end the work up or does this patient require a D+C with hysteroscopy? I've heard some conflicting things from attendings, some of whom comment that the in office biopsy's value is to rule in cancer and a negative result doesn't mean much. Others say with only one episode of bleeding, they would reassess only if the bleeding persisted.
I guess my confusion lies in the fact that the stripe is thickened and although a using a pipelle to biopsy is a useful test, I was under the impression that it sampled a very small portion of the cavity and would miss any focal lesions.