Design: This is a video demonstration.

Setting: This demonstration takes place in a tertiary academic center’s clinic and operating room.

Patients or Participants: This video describes a single patient with a septate uterus and postmenopausal bleeding. Consent was obtained.

Interventions: Ultrasound guided hysteroscopy was performed to ensure both endometrial cavities of the anomalous uterus were sampled.

Measurements and Main Results: The patient underwent ultrasound guided hysteroscopy with successful identification and sampling of each uterine cavity. Final pathology revealed inactive endometrial glands, negative for atypia or malignancy from the right endometrial cavity and benign endometrial polyp and smooth muscle from the left endometrial cavity.

Conclusion: Uterine septa are the most frequently encountered uterine anomaly. They are most frequently described as they relate to pregnancy implications. However, literature on sampling the endometrium in this population is limited. In this video, we describe helpful diagnostic and intraoperative techniques to successfully sample the endometrium of a patient with a septate uterus and postmenopausal bleeding. We highlight the utilization of ultrasound guided hysteroscopy to identify each endometrial cavity, which can be used in many forms of uterine anomalies.