GynaecologyFree in the app
Postmenopausal bleeding & hyperplasia
Exclude endometrial cancer.
Source: NICE NG12 (2026) · RCOG/BSGE GTG 67Pathway
- Age ≥55 with PMB: suspected cancer (2-week) referral; under 55: consider
- TVS: endometrium ≤4 mm reassuring (not on HRT)
- On HRT: ≤4 mm continuous combined / ≤7 mm sequential reassuring
- Thicker: biopsy ± hysteroscopy
Hyperplasia
| Without atypia | LNG-IUS first-line (or continuous oral progestogen) ≥6 months; biopsy 6-monthly until 2 negatives. |
|---|---|
| Atypical | Total hysterectomy (+ BSO if postmenopausal); LNG-IUS if fertility-sparing. |
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