Question

A 33-year-old woman presents to the gynaecology OPD with heavy menstrual bleeding for 6 months. Clinical examination shows no abnormality and ultrasound is also normal. She was tried on non-hormonal treatment, which failed. What is the next step in management?

• A. Hormonal therapy
• B. Endometrial sampling
• C. Hysterectomy
• D. Endometrial ablation

Hint:

Get a tissue diagnosis before you start any hormones.

Answer 1

The Correct Option is B

Clinical pearl: in heavy menstrual bleeding, never give blind hormones after non-hormonal treatment fails. Sample first.
Why option 2 wins: with a normal exam and a normal scan, the only thing left to clarify the cause is the endometrium itself. Endometrial sampling shows hyperplasia, polyp, or carcinoma and confirms the hormonal pattern, letting you treat correctly afterwards.
Eliminating the rest: hormonal therapy (option 1) is premature because it distorts the endometrium and ruins the histology you still need. Hysterectomy (option 3) is irreversible and unjustified without a diagnosis. Endometrial ablation (option 4) is also premature and is contraindicated until malignancy is excluded by biopsy.
Bottom line: tissue before treatment. Ref: Dutta Gynaecology, 6th ed.