A 48-year-old woman with heavy menstrual bleeding has failed medical treatment. Which single indication makes an endometrial biopsy appropriate?

Answer: A. Age over 45 with treatment failure (assessing for endometrial pathology)

Indications for endometrial biopsy

Endometrial sampling assesses for hyperplasia or carcinoma.

Indications

• Postmenopausal bleeding.
• Age over 45 (especially with treatment failure or persistent symptoms).
• Treatment failure at any age.
• Women with risk factors for endometrial carcinoma (for example obesity, PCOS/chronic anovulation, tamoxifen, unopposed oestrogen).

This case

• A 48-year-old (over 45) with treatment failure meets the criteria.

So age over 45 with treatment failure makes biopsy appropriate.