The pipelle endometrial biopsy (EB) is accurate, safe, economical and acceptable to patients, clinicians and pathologists. Transvaginal sonography can reduce the number of EBs needed, and when both techniques are used together the sensitivity and specificity in the diagnosis of endometrial adenocarcinoma reach 100%. Hysteroscopy and dilatation and curettage are indicated in the minority of patients under the age of 40 years.