Postmenopausal bleeding warrants workup to exclude endometrial pathology including cancer, typically with transvaginal ultrasound and endometrial sampling.

• A. It is benign in most cases; no testing needed.
• B. It warrants workup to exclude endometrial pathology with transvaginal ultrasound and endometrial sampling.
• C. It always indicates cervical cancer; proceed to hysterectomy.
• D. It should be managed with hormonal therapy without imaging.

Answer: (B)

Postmenopausal bleeding raises concern for endometrial pathology, including cancer, so it needs a careful workup rather than dismissal as a benign finding. The first noninvasive step is transvaginal ultrasound to measure the endometrial thickness. If the endometrium is thick enough to raise suspicion—commonly a threshold around 4–5 mm in many guidelines—the next step is sampling of the endometrium to obtain tissue for histology, which can diagnose hyperplasia, atypia, or cancer. This approach helps identify serious pathology early while avoiding unnecessary procedures in truly low-risk cases. Relying on hormonal therapy without imaging or assuming a cancer diagnosis without objective testing would be inappropriate, and assuming cervical cancer or requiring immediate hysterectomy ignores the broad differential and the need for tissue diagnosis. While most postmenopausal bleeding is not cancer, the possibility must be evaluated with imaging and sampling to guide proper management.