Intended for healthcare professionals

Endgames Picture quiz

Imaging investigation of postmenopausal bleeding

BMJ 2009; 338 doi: (Published 08 January 2009) Cite this as: BMJ 2009;338:a2787
  1. Anju Sahdev, consultant radiologist
  1. 1Barts and London NHS Trust, London EC1A 7BE
  1. anju.sahdev{at}

    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?


    Short answers

    • 1 Transvaginal ultrasound scan of the uterus.

    Fig 1 Transvaginal ultrasound shows endometrial thickening measuring 1 cm.

    • 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.

    Long answer

    1 Investigations

    Postmenopausal bleeding represents 5% of all gynaecology outpatient attendances.1 Transvaginal ultrasound is a …

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