From the Research
A 51-year-old postmenopausal woman with bleeding and an endometrial thickness of 1.5 cm on transvaginal ultrasound should be evaluated by a gynecologist or gynecologic oncologist within 1-2 weeks. This situation requires prompt attention but is not an emergency. Postmenopausal bleeding with endometrial thickness greater than 4mm warrants investigation, and 1.5 cm (15mm) is significantly thickened. The patient's history of breast cancer increases her risk for endometrial cancer, particularly if she took tamoxifen as part of her breast cancer treatment.
Key Considerations
- The patient's symptoms and history suggest a high risk for endometrial cancer, which is most treatable when caught early 1.
- Endometrial biopsy is a safe and efficient method to evaluate the endometrium for abnormal uterine bleeding and postmenopausal bleeding, with high sensitivity and specificity for diagnosing atypical hyperplasia and endometrial cancer in postmenopausal women 2, 1.
- The combination of postmenopausal bleeding, thickened endometrium, and breast cancer history represents significant risk factors that require thorough investigation.
Recommendations
- The next step would typically involve an endometrial biopsy to rule out endometrial hyperplasia or cancer.
- The patient should be advised to report any worsening symptoms such as heavy bleeding or severe pain before her appointment.
- While waiting for the appointment, the patient can use menstrual pads to manage bleeding and track the amount and frequency of bleeding to report to the specialist.
- Prompt evaluation is important because endometrial cancer is most treatable when caught early, and the combination of postmenopausal bleeding, thickened endometrium, and breast cancer history represents significant risk factors that require thorough investigation 1.