A Post-Menopausal woman complains of spotting per vaginum after 5 years of menopause. USG reveals endometrial thickness of 7 mm and an intramural fibroid of size 3cm. Next step in management is?
Paps smear and follow up
Myomectomy
Endometrial biopsy
CA 125 levels
Postmenopausal bleeding with increased endometrial thickness, could be case of endometrial malignancy hence a biopsy is necessary here USG findings suspicious of endometrial cancer in Post-Menopausal women: Endometrial thickness > 4 mm Polypoidal endometrial mass Fluid in uterine cavity Only a paps smear will not be sufficient as endometrial pathology is necessary to be ruled out here. Myomectomy is not suggested in menopausal women and it is unlikely that a fibroid could be a cause of post menopausal bleeding.
Post menopausal bleeding