In a postmenopausal patient with vaginal bleeding, an endometrial stripe greater than 4 mm on transvaginal ultrasound is associated with suspicion for

• A. Endometrial cancer
• B. Ovarian cyst
• C. Cervical cancer
• D. Pelvic inflammatory disease

Answer: (A)

When a postmenopausal patient has vaginal bleeding, the endometrium should be thin. A transvaginal ultrasound showing an endometrial stripe thicker than 4 mm signals possible abnormal endometrial proliferation, most concerning for endometrial cancer. Bleeding in the postmenopausal period with a relatively thick endometrium prompts tissue sampling to confirm or rule out cancer (endometrial biopsy). The other conditions listed—an ovarian cyst, cervical cancer, or pelvic inflammatory disease—do not explain a thickened endometrium in this setting and are not primarily diagnosed by endometrial stripe measurements.