<p style="text-align: justify;">Numerous papers have recommended nonintervention for postmenopausal bleeding when the endometrial thickness on transvaginal ultrasound is four millimeters or less because the reported risk of endometrial cancer is very low. A case of  adenocarcinoma arising in a three millimeter thick endometrium is presented. Occasionally, clinical judgment and suspicion are important in caring for the patient despite recommended guidelines and protocols.</p>