NEW CPU: PMB Bleed Eval

NEW CPU: PMB Bleed Eval

From Dr. Chapa’s OBGYN Clinical Pearls by Dr. Chapa’s Clinical Pearls

April 18, 2026 · 19 min

About this episode

This episode discusses the updated ACOG guidelines on the evaluation of postmenopausal bleeding, specifically the role of transvaginal ultrasonography.

In the ACOG CO 734 from 2018, it states, “Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer”. But medicine moves fast. This is NO LONGER the guideline. In this episode, we will summarize the new ACOG CPU on the primary evaluation of a patient with postmenopausal vaginal bleeding. Is ultrasound still the single first line test used for evaluation? Listen in for details. 1. Updated Guidance Regarding The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Individuals With Postmenopausal Bleeding 2. The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding

Topics covered

  • postmenopausal bleeding
  • transvaginal ultrasonography
  • endometrial evaluation

Keywords

  • ACOG CO 734
  • guideline update
  • negative predictive value
  • endometrial cancer

Mentioned in this episode

Products: the ACOG CO 734

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