Other testing includes endometrial sampling if examination and ultrasonography are inconclusive in patients with any of the following: Age > 45 Unopposed estrogen exposure (as occurs in women with a high body mass index or polycystic ovary syndrome) Risk factors for gynecologic cancer Endometrial thickening > 4 mm in postmenopausal patients Sampling can be done by endometrial biopsy or, if the cervical canal requires dilation, by dilation and curettage (D & C).