Is an endometrial biopsy necessary at this time?

Patient: Is an endometrial biopsy necessary at this time?56 yr-old postmenopausal on continuous BHRT. BHRT doubled last March. Spotting in Sept and Dec. BHRT adjusted in early Jan, reducing estrogen by 50%. No spotting since. TVUS performed. Results show no endometrial thickening (3mm) and normal uterus. Three small fibroids detected. No other symptoms.Thank you.

Doctor: Hi,Thanks for the query.I understand your concern.Usually, any type of postmenopausal bleeding should be thorou ghly evaluated.So, your doctor might have advised endometrial biopsy as part of evaluation.Better to go for endometrial biopsy as this can rule out any other possible cause of postmenopausal bleeding apart from hormone replacement therapy.If you want to avoid endometrial biopsy, please repeat the ultrasound after 2 to 3 months.If repeat ultrasound confirms the absence of endometrial thickening and if you do not get bleeding again, you can continue with HRT and regular follow up examinations.Hope this helps.Take care.