Postmenopausal bleeding

Caused by endometrial cancer about 10% of patients.

Ultrasound measured endometrial thickness of 4-5 mm or less almost completely excludes endometrial carcinoma.

Endometrial biopsy has a 95% sensitivity for the detection of endometrial cancer.

PMB occurs in approximately 90% of women diagnosed with endometrial cancer, making this symptom a sensitive indicator to prompt diagnostic testing.
Strategies to evaluate postmenopausal bleeding include: endometrial biopsy, uterine dilatation and curettage, or use of transvaginal ultrasound.
Transvaginal ultrasound is the only non-invasive choice in the current algorithm for evaluation and is used to measure endometrial thickness that must meet a certain threshold of 4 mm to prompt one of the invasive tests, that is biopsy or dilation and curettage.

Transvaginal ultrasound has a 99% to 100% negative predictive values
with this diagnostic strategy.
The presence of uterine fibroids can distort the endometrial cavity, resulting in poor visualization of the endometrium on transvaginal ultrasound.
Non-Endometrioid cancers can be focal lesions thatbare less likely to cause global hypertrophy of the endometrium that is captured on ultrasound measurement.
Because of the high prevalence of fibroids and non-endometrioid histology types among black women,  in comparison with white women, transvaginal ultrasound screening guidelines for postmenopausal bleeding have worse performance for black women contributing to racial inequality in endometrial cancer outcomes.

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