Hallow Dear, Thick endometrium revealed in ultrasonography at the age of 65 years does require thorough work up. I believe it is more than 4 mm in thickness. How was biopsy taken? The very fact report has come as insufficient sample, it requires methodical biopsy of the endometrium for sufficient biopsy from suspicious site. I would advise het to go for hysteroscopy; rather hysteromicroscopy by which the endometrium can be studies in situ and biopsy sample can be collected from the suspicious site. Thick endometrium at this age indicates that even at the age of 65 years, quite an amount of oestrogen hormone is circulating in the body. This can result in : 1. Endometrial cancer 2. Endometrial hyperplasia 3. Fibroid of the uterus (may be with some further changes in them). 4. Oestrogen producing Ovarian tumours. However, since ultrasonography has not mentioned any possible evidence of fibroid or ovarian tumour, we can rule them out. To differentiate between cancerous change in endometrium and benign growth of the endometrium, biopsy (sufficient from the suspicious site) of the endometrial tissue will be the key investigation. Please submit her for hysteromicroscopy. I would definitely like to guide you further on this issue if you provide me with reports of all the investigations. You may ask me Direct question. For the time being, this gives you guidelines for immediate action. Dr. Nishikant Shrotri