The use of new and old ultrasound techniques in the assessment of women with postmenopausal bleeding

Introduction Postmenopausal bleeding (PMB) is the most common symptom of the endometrium. Cervical cancer must also not be forgotten, especially in women with a thin endometrium. Therefore, all women presenting with PMB should undergo evaluation with transvaginal ultrasound to estimate the risk of endometrial cancer, and speculum examination/cervical cytology to rule out cervical pathology. Management strategies using ultrasound as the primary investigation tool have been shown to be more cost effective than those using endometrial biopsy for the investigation of PMB. In women with PMB, the primary aim is to estimate the risk of endometrial cancer, since women at low risk of cancer can be managed expectantly, whereas women at high risk must undergo endometrial biopsy. The secondary goal is to rule out the presence of focal lesions since this is of major importance to determine the most appropriate biopsy procedure. Finally, in women with an established diagnosis of endometrial cancer ultrasound can be used to assess the extension of the tumour. The focus of this short opinion piece is to discuss the clinical role of both established and novel ultrasound techniques in the assessment of women with PMB.