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The First-Line Investigation of Postmenopausal Bleeding: Transvaginal Ultrasound Scanning and Endometrial Biopsy May Be Enough
  1. Fadi Alfhaily, MBChB, MSc, DFFP, MRCOG* and
  2. Ayman A. A. Ewies, MBChB, MSc, MRCOG, MD
  1. *Colchester Hospital University NHS Foundation Trust, Essex, and
  2. Ipswich Hospital NHS Trust, Suffolk, UK.
  1. Address correspondence and reprint requests to Fadi Alfhaily, MBChB, MSc, DFFP, MRCOG, Senior Specialist Registrar in Obstetrics and Gynecology, Colchester Hospital University NHS Foundation Trust, Turner Rd, Colchester, Essex, CO4 5JL. E-mail: fadinm{at} or fadi.alfhaily{at}


Postmenopausal bleeding is a common problem in clinical practice with significant implications; however, the diagnostic strategies often vary among different centers. In the recent years, there was a trend to adopt less invasive procedures without compromising efficacy and safety. There is continuous debate about the different available modalities for investigation, and a large number of studies were conducted to define their roles. Some authors recommended that hysteroscopy should be the standard investigation procedure for women with postmenopausal bleeding. Nonetheless, there is a strong evidence to suggest that transvaginal ultrasound scanning, with or without endometrial biopsy, is a safe and more cost-effective initial tool in investigating these women. This commentary highlights this important issue and discusses the role of these different modalities.

  • Endometrial biopsy
  • Endometrial cancer
  • Hysteroscopy
  • Postmenopausal bleeding
  • Transvaginal ultrasound scanning

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