It means biopsy should be done irrespective of endometrial thickness?

Post menopausal bleeding is a type of Abnormal uterine bleeding right?

In indications of endometrial biopsy you gave Any woman with AUB age more than 45 yrs – Biopsy is needed. But also you said for Post menopausal bleeding 4mm thickness is needed before biopsy. Why?? Any Post menopausal bleeding will be above 45 yrs – so it means biopsy shd be done irrespective of endometrial thickness?

Yes. Because perimenopausal age group, common causes of bleeding are endometrial hyperplasia and Ca.

So to rule out Malignancy Bx needed

After menopause : continuous hypoEstrogenic condition cause atrophy of endometrium normally causing senile/atrophic Endometritis ( m/c cause of PMB ) . So we don’t have to do directly endometrial biopsy in every post menopausal female coming with PMB : so first we do TVS and check for Endometrial thickness and if it is above 4mm means this is abnormal and we much rule out Endometrial Ca

In premenopausal age : We always do directly Endometrial Biopsy if

  1. age is >45 and c/o AUB

  2. age <45 but belong to high risk like Any Hyper-Estrogenic state like PCOS

To detect early cancerous change so that we can act early because maximum causes of Hyper-Estrogenic condition can occur during this age only which can later on lead to Endometrial Ca after menopause . There’s nothing called senile atrophic Endometritis in this age so always confirm with histology .

How do we define perimenopausal age group?