My wife is post menopause. A few months ago she had moderate bleeding
for a few days. She tried to see her family physician, but could only be seen by PA. PA, after full exam, said “can’t find anything, and no infection, see Gyno.”

After about 30 phone calls to find a Gyno (she hasn’t seen one for 20 years) saw a Gyno who took pap smear (clean), said “can’t find anything but slight infection ” gave her 3 day scrip for Bactrim, and sent her for Trans vaginal sonogram..

Radiology department which gave sonogram said “no viable abnormalities” so Gyno asked for biopsy.

When pushed, Gyno does not seem to have any reason for biopsy other than defensive medicine. We are uninsured and biopsy is not only expensive, it is not without risk, so my wife is not going for biopsy, but would like to know if there is really much chance of there being something which did not show on two exams, pap smear, and sonogram, which would have much likelihood of being found with a simple biopsy

?

Dr. Joshua’s Answer:

Evidence-based meta-analyses (in English: the results of reliable studies combined) show that the risk of endometrial cancer in post-menopausal women who have bleeding is about 10%. Therefore, vaginal ultrasound is recommended. Your wife’s ultrasound did not show any visible tumors; that’s good. However, it’s not sufficient - the thickness of the endometrium should be measured. If the vaginal ultrasound shows that the endometrium is no more than 3 mm thick, the risk of cancer after that becomes about 0.4%. I’m assuming she is not on hormone replacement therapy (HRT). If she is or has been on HRT, the corresponding max thickness of the endometrium is 5mm.?

So: if the ultrasound shows that the endometrium (the inner wall of the womb) is less than 3mm thick, the likelihood that she has cancer is about 0.4 %. If you consider this an acceptable risk, and if your doctor agrees, there is no need for biopsy as long as the bleeding does not occur again. However, if the endometrium is thicker, or if your wife or your doctor don’t consider this level of risk acceptable, a biopsy is in order, but the biopsy is not very sensitive either - it is best combined with hysteroscopy (the endometrium is inspected with a scope).

Hope this helps