You have not mentioned your symptoms. You are 48 years old. It is safe to presume that you don't want any more children. The only investigation report available is your sonography which shows endometrial thickness 20.5 mm. It is definitely much more than the normal thickness of endometrium. It is called endometrial hyperplasia. It can turn out to be cancer or it may turn into cancer subsequently . Diagnostic D&C is mandatory in your case. If it turns out that the endometrium is not cancerous then you should go for a hysterectomy straight away. If it is cancer then you will have to go to a Cancer Surgeon. There is no place for a simple D&C or a myomectomy in your case. (In fact where are the myomas ?)

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The thickened endometrium definitely warrants a biopsy or dnc Decision regarding further treatment can be decided only after the biopsy A malignancy would warrant radical hystrectomy