A 45 yr old lady presented with recurrent uterine bleeding. On transvaginal USG thickness of endometrium was found to be 8 mm. What should be the next step in the management of this patient ?

Ans. is 'a' i.e., Histopathology Uterine bleeding in a 45 year old may also occur due to endometrial carcinoma.Transvaginal ultrasound is used to assess the endometrial thickness.Endometrial thickness depends upon the stage of the menstrual cycle.Immediately after menstruation the endometrium is homogenous, 1-4 mm thick.As the oestrogen concentration increases, endometrium proliferates and its thickness increases to 7-10 mm.After ovulation the echogenicity of endometrium increases and it becomes hyper echogenic throughout with a thickness of 8-16 mm.Transvaginal ultrasound is usually the first investigation in case of dysfunctional uterine bleeding.TVS measures endometrial thickness. The exact cut off values for endometrial thickness measurement in premenopausal women to predict endometrial neoplasia are subject to continuing debate.The British "RCOG" Guideline development group analyzed a number of studies and concluded that 10-12 mm was a reasonable cut off when using TVS preferably undertaken in follicular phase, as a method prior to more invasive procedures of endometrial assessment.In the question, the endometrial thickness is 8mm but the stage of the cycle is not mentioned.The endometrial thickness of the patient does not fulfill the criteria meted out by RCOG but still she should undergo further endometrial evaluation as her age is 45 years.Women aged 40 years or more with vaginal bleeding should have an endometrial biopsy to exclude endometrial carcinoma.According to Shaw's "It is essential to rule out endometrial carcinoma in premenopausal women with menorrhagia ",Also know