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?
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.
Paps smear and follow up
Myomectomy
Endometrial biopsy
CA 125 levels
Post menopausal bleeding