What is the best diagnostic approach to postmenopausal vaginal bleeding in women taking hormonal replacement therapy (HRT)?

Evidence-Based Answer Independent of hormonal therapy, the workup for a postmenopausal woman with vaginal bleeding should be either an endometrial biopsy or transvaginal ultrasound (TVUS) followed by endometrial biopsy or hysteroscopy as indicated (SOR: C, consensus opinion guideline). The incidence of endometrial carcinoma is lower in women with postmenopausal bleeding on HRT compared with those not on HRT (SOR: B, cross-sectional study and a retrospective study).