Case challenge · Imaging / Gynecology / Ultrasound · teaching

Postmenopausal Bleeding · Endometrial Imaging Assessment · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on ACOG 2026 update

Case #1Imaging / Gynecology / Ultrasound

📋 Case data

Symptomatic PMB or asymptomatic thickeningSymptomatic PMB (with bleeding)
TVUS endometrial assessment (2026 ACOG)Endometrium >4 mm / poorly seen / fluid / persistent or recurrent bleeding / high-risk factors (most patients)

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 2 · Symptomatic PMB or asymptomatic thickening

Postmenopausal bleeding (PMB) or asymptomatic incidental endometrial thickening?

💡 PMB = uterine bleeding ≥12 months after the last period; ~90% of endometrial cancers present with PMB, PMB raises endometrial cancer risk ~64-fold; TVUS alone misses 5–12% of cancers (including thin-endometrium high-grade/serous/clear cell). Measure endometrial thickness excluding any fluid.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.