What is the next step in management for a postmenopausal woman with vaginal bleeding and benign Papanicolaou smears?

The management of a postmenopausal woman presenting with vaginal bleeding often begins with imaging studies to assess the endometrial lining. In this situation, a transvaginal ultrasound is the preferred next step because it is non-invasive, readily available, and provides valuable information regarding the thickness of the endometrium.

In postmenopausal women, any new onset of vaginal bleeding is considered abnormal and warrants further evaluation to rule out potential endometrial pathology, including hyperplasia or carcinoma. A transvaginal ultrasound can help determine if there are any abnormalities such as endometrial thickness that may suggest a need for further investigation, like an endometrial biopsy or hysteroscopy.

While hysteroscopy can be used for direct visualization and potential biopsy of the endometrium, it is typically reserved for cases where the ultrasound indicates abnormal findings that warrant a closer look. After evaluating endometrial thickness with the ultrasound, appropriate management can then be tailored based on the results obtained.

In contrast, colposcopy is primarily used for the evaluation of cervical pathology, not for investigating intrauterine causes of bleeding. A CT scan of the abdomen may be useful in certain contexts but is not the first-line imaging modality for assessing vaginal bleeding in this scenario