Imaging investigation of postmenopausal bleedingBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.a2787 (Published 08 January 2009) Cite this as: BMJ 2009;338:a2787
- Anju Sahdev, consultant radiologist
- 1Barts and London NHS Trust, London EC1A 7BE
A 72 year old woman presented with a two month history of postmenopausal vaginal bleeding. Relevant medical history included insulin dependent diabetes, hypertension, and recent breast cancer. She had been taking tamoxifen for three years.⇓
1 What imaging investigation is shown in the picture⇑?
2 What abnormality is shown?
3 In a postmenopausal woman, what conditions produce these appearances?
4 What does the patient need next?
1 Transvaginal ultrasound scan of the uterus⇓.
2 Endometrial thickening measuring 1 cm. An acceptable postmenopausal endometrial thickness should be less than 5 mm.
3 Benign endometrial polyps, endometrial hyperplasia, endometrial cancer.
4 The patient requires referral to a cancer centre or unit for full gynaecological evaluation and endometrial sampling to establish the nature of the endometrial thickening.
Postmenopausal bleeding represents 5% of all gynaecology outpatient attendances.1 Transvaginal ultrasound is a …