For irregular vaginal bleeding, which patient should undergo endometrial biopsy?

• A. Postmenopausal with regular cycles
• B. Younger than 40
• C. Older than 45 with risk factors (nulliparity, DM, peri/postmenopausal, obesity)
• D. Postmenopausal without bleeding

Answer: (C)

When evaluating irregular vaginal bleeding, the concern is to rule out endometrial hyperplasia or cancer, especially in women at higher risk. Endometrial biopsy provides tissue for definitive diagnosis and is most warranted in someone older than 45 who also has risk factors such as nulliparity, obesity, diabetes, or peri/postmenopausal status. These factors increase estrogen exposure or carcinogenic risk to the endometrium, so obtaining a sample helps detect pathology early and guide treatment.

In younger patients under 40, irregular bleeding is more often due to anovulatory cycles from hormonal imbalance, so the initial workup focuses on less invasive tests and observation unless risk factors or persistent bleeding prompt biopsy. A postmenopausal patient with regular cycles isn’t a typical presentation for endometrial pathology, and a postmenopausal patient without bleeding isn’t suggested for endometrial sampling. Therefore, the scenario that best warrants an endometrial biopsy is age over 45 with risk factors.