It’s not just a matter of absolute thickness of the uterine endometrial lining but also the presence or absence of symptoms in these peri- and post-menopausal women. There’s no accepted upper limit of normal for endometrial thickness in women of any age. Studies have shown, however, that the risk of endometrial carcinoma is 1% or less if the thickness of the endometrial lining is 5 mm or less. As such, that becomes the upper limit of tolerance in peri- and postmenopausal women who present with abnormal peri-vaginal bleeding.

There are many causes of post-menopausal bleeding (PMB), including endometrial polyps, submucosal fibroids, endometrial atrophy and endometrial carcinoma. Up until the last decade or so, patients with PMB would typically undergo a variety of tests, including endometrial biopsy, dilatation and curettage (D&C), and/or hysteroscopy to evaluate for the cause of bleeding. This barrage of tests could escalate the cost of diagnosis in a hurry, especially considering that the vast majority of etiologies are benign. Presently, the initial test of choice is pelvic and transvaginal sonography which can easily distinguish between most causes of abnormal PMB. In equivocal cases, the addition of saline-infusion hysterosonography will usually delineate the cause, which may then require biopsy.

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