Endometrial Evaluation in Women with Postmenopausal Bleeding

Target Population: Women's healthcare providers

Background and Objective

Although postmenopausal vaginal bleeding is common — and endometrial cancer is the most common gynecologic malignancy in U.S. women — the great majority of women with postmenopausal bleeding do not harbor uterine neoplasia. Nonetheless, prompt initial evaluation is important.

Key Recommendations

• Transvaginal ultrasound (TVUS) is appropriate for initial evaluation of postmenopausal bleeding. If the endometrium has a sonographically measured thickness ≤4 mm, further evaluation might not be necessary. If bleeding persists or recurs, endometrial sampling is indicated.

• Obesity, uterine position, o…