Question

A 45 year old lady presents with dysfunctional uterine bleeding and an ultrasound finding of 8 mm thick endometrium. What is the next step?

• A. Endometrial histopathology
• B. Hysterectomy
• C. OCP
• D. Follow up

Hint:

Perimenopausal bleeding with thick endometrium needs tissue diagnosis before any treatment.

Answer 1

The Correct Option is A

Step 1: Note the age and the bleeding. The patient is 45 years old (perimenopausal) and has abnormal uterine bleeding. In any woman above 40 years with abnormal uterine bleeding, endometrial carcinoma and hyperplasia must be excluded before treatment.
Step 2: Interpret the endometrial thickness. An endometrial thickness of 8 mm is increased and warrants tissue sampling in this age group to rule out hyperplasia or malignancy. Ultrasound alone cannot give a histological diagnosis.
Step 3: Establish the next step. The appropriate next investigation is to obtain endometrial tissue for histopathology, by endometrial biopsy or dilatation and curettage (ideally with hysteroscopic guidance). Histopathology determines whether the endometrium is normal, hyperplastic or malignant and guides further management.
Step 4: Eliminate the other options. Hysterectomy is premature without a tissue diagnosis. Starting OCP or hormonal therapy to control bleeding before excluding malignancy could mask a cancer. Mere follow up is unsafe in a perimenopausal woman with abnormal bleeding and thickened endometrium.
Conclusion: The next step is endometrial histopathology, so the answer is option A.