A 47-year-old woman presents to the GP with a 6-month history of heavy menstrual bleeding and a 3-month history of intermenstrual bleeding. Pelvic ult...

Question

A 47-year-old woman presents to the GP with a 6-month history of heavy menstrual bleeding and a 3-month history of intermenstrual bleeding. Pelvic ultrasound shows a normal uterus with an endometrial thickness of 16 mm. She has a BMI of 24 kg/m² and no diabetes. Which is the single most appropriate next step?

Accepted Answer

Refer for endometrial biopsy (Pipelle) - the combination of HMB, IMB, and a thickened endometrium warrants histological assessment before initiating treatment

Answer

Start the LNG-IUS and rescan in 6 months

Answer

Prescribe tranexamic acid

Answer

Reassure as endometrial thickness of 16 mm is normal premenopausally

Answer

Prescribe the combined oral contraceptive pill

uk-drcog MCQ (SBA): HMB with IMB and Thickened Endometrium - Biopsy First