Any vaginal bleeding that occurs at least one year after the cessation of normal menstruation is defined as "postmenopausal bleeding". It is commonly associated with benign causes such as endometrial and cervical polyps, atrophic endometritis or vaginitis. However, in some women, the bleeding may be caused by endometrial carcinoma or cervical cancer and it is for this reason that women are advised to have their uterine cavity examined. Currently the most commonly performed examinations are transvaginal ultrasonography, endometrial biopsy and hysteroscopy. Dilation & curettage which was the standard technique is now largely reserved for rare cases when these new alternatives methods are contra-indicated or not feasible. Transvaginal ultrasonography is used to measure the thickness of endometrial tissue as an increased thickness is associated with uterine pathology. If the endometrium is thicker than 5mm, a further endometrial assessment with endometrial biopsy or hysteroscopy is advised. Endometrial biopsy is a simple procedure that can be performed without anaesthesia by a Specialist Gynaecologist. During an endometrial biopsy tissue is collected from inside uterine cavity by inserting a small tube through the cervix. The sensitivity of these sampling tubes for detecting pathologic tissue ranges from 88 to 97%. A visual assessment of the uterus can be performed using a Hysteroscope with and without anaesthesia. Hysteroscopy can be used to both to confirm transvaginal ultrasound findings and if necessary remove polyps. If there are any suspicious endometrial areas detected, a directed endometrial biopsy can be done via the hysteroscope.

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