Gynecology \u00b7 Screening
Endometrial thickness after menopause: the 4mm threshold
Transvaginal ultrasound is the first test for postmenopausal bleeding. Endometrial thickness \u22644mm has 99% negative predictive value for cancer. Above 4mm \u2014 or persistent bleeding regardless of thickness \u2014 triggers biopsy.
Key points
- TVUS first for PMB
- Biopsy if >4mm with bleeding
- Hysteroscopy for focal lesions
Frequently asked questions
What is a normal postmenopausal endometrial thickness?
≤4mm without bleeding; ≤4mm with bleeding is reassuring but persistent bleeding still needs biopsy.
When is biopsy required?
Endometrial thickness >4mm with bleeding, or persistent bleeding at any thickness.
Does HRT change the threshold?
Yes — combined continuous HRT can slightly increase measured thickness.
Considering a physician-supervised longevity protocol? Kindr Health evaluates peptide therapy as part of personalized perimenopause and menopause care.
Request your Longevity Consult →Explore Kindr Health
Related: FDA peptide review July 2026 briefing · Peptide therapy hub · Longevity service
Written and medically reviewed by the Kindr Health Clinical Team · Published 2026-06-19 · Last reviewed 2026-07-01. Compounded medications are prepared by FDA-registered 503A pharmacies and are not FDA-approved drug products.