Which menopausal woman should be evaluated for endometrial biopsy?

The woman on a continuous-combined hormone therapy (HT) regimen reporting spotting should be evaluated for an endometrial biopsy due to the potential concerns associated with irregular bleeding patterns. Continuous-combined HT involves the administration of both estrogen and progestin, which should generally prevent the occurrence of irregular bleeding if the therapy is effective. However, any instance of spotting or breakthrough bleeding in someone on this type of regimen can raise suspicion for endometrial abnormalities, particularly when it is unrelated to the expected bleeding pattern or timing of hormone administration.

Endometrial biopsy is indicated as it allows for the evaluation of the endometrial lining to rule out any pathological conditions such as hyperplasia or malignancy, especially since postmenopausal bleeding is considered a potential warning sign for endometrial cancer. Therefore, such symptoms should not be overlooked, and further investigation through biopsy is warranted to ensure proper diagnosis and management.

In the other scenarios, while irregular bleeding can also warrant evaluation, the specific context of continuous-combined HT leading to unexpected spotting makes the need for an endometrial biopsy particularly pressing in that case.