Specifically, it is done if women have any of the following: Bleeding pattern, other symptoms, or a pelvic examination suggesting a structural lesion or pelvic organs cannot be examined adequately Risk factors for endometrial cancer (eg, obesity, diabetes, hypertension, polycystic ovary syndrome, chronic eugonadal anovulation, other conditions associated with prolonged unopposed estrogen exposure) Age ≥ 45 (earlier if women have risk factors) Bleeding that continues despite use of empiric hormone therapy Transvaginal ultrasonography can detect structural abnormalities, including most polyps, fibroids, other masses, ovarian abnormalities, adenomyosis, and endometrial thickening.