This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Post menopausal bleeding, Subject name: Gynaecology & Obstetrics
A Post-Menopausal woman complains of spotting per vaginum after 5 years of menopause. USG reveals endometrial thickness of 7 mm and an intramural fibroid of size 3cm. Next step in management is? 
Select and explain. 
A. Paps smear and follow up, B. Myomectomy, C. Endometrial biopsy, D. CA 125 levels
C: Endometrial biopsy
Answer: C: Endometrial biopsy 
Explanation: Postmenopausal bleeding with increased endometrial thickness, could be case of endometrial malignancy hence a biopsy is necessary here USG findings suspicious of endometrial cancer in Post-Menopausal women: Endometrial thickness > 4 mm Polypoidal endometrial mass Fluid in uterine cavity Only a paps smear will not be sufficient as endometrial pathology is necessary to be ruled out here. Myomectomy is not suggested in menopausal women and it is unlikely that a fibroid could be a cause of post menopausal bleeding.