A 64yo woman has been on HRT for 9yrs. She had regular withdrawal bleeds until 3 yrs ago and
since then has been taking a no bleed prep. Recently she noticed a brown vaginal discharge.
Choose the single most appropriate initial inv?
a. Cervical smear
b. High vaginal swab
c. TFT
d. Transvaginal US
Q. 1. What is the key?
Q. 2. Why this test will be done?
Ans. 1. The key is D. Transvaginal US.
Ans. 2. To determine the endometrial thickness!
In a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her
endometrium is thick (> 5 mm) and < 0.07% if her endometrium is thin (≤ 5 mm).
In postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6.7% if the
endometrium is thick (> 11 mm) and 0.002% if the endometrium is thin (≤ 11 mm).