Postmenopausal bleeding is a red flag in gynecologic care, requiring a careful and structured diagnostic approach. While the most common etiology is benign atrophic endometrium, serious underlying causes such as endometrial hyperplasia or carcinoma must be excluded. A thorough history, risk assessment, and physical examination are key, particularly in women with obesity, hormone therapy use, or known genetic predispositions. Transvaginal sonography (TVS) is the first-line investigation, but its ability to reliably rule out malignancy is limited.
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