Which type of endometrial biopsy is typically recommended for unexpected postmenopausal bleeding?

In the context of unexpected postmenopausal bleeding, a hysteroscopic biopsy is particularly relevant because it allows for direct visualization of the uterine cavity, which is essential in assessing abnormalities that may be causing the bleeding. Hysteroscopy can identify conditions such as endometrial hyperplasia or carcinoma by enabling the clinician to directly access the endometrium and obtain targeted biopsies. This is critical for an accurate diagnosis and appropriate management.

Transvaginal ultrasound is helpful for assessing the endometrial thickness and may guide whether a biopsy is needed, but it does not provide a definitive tissue diagnosis. Similarly, an office uterine biopsy may be sufficient in some cases but lacks the comprehensive visualization that hysteroscopy offers. A colposcopic biopsy is specifically used for cervical assessment and would not be the appropriate choice for evaluating the endometrium.

Therefore, a hysteroscopic biopsy is the most suitable option when dealing with postmenopausal bleeding, as it offers both diagnostic clarity and the potential for immediate intervention if necessary.