What is an endometrial biopsy

Endometrial biopsy is a procedure performed to obtain a small tissue sample from the lining of the uterus, called the endometrium. After the endometrial biopsy, the endometrial tissue is examined under a microscope to identify the presence of abnormal cells, cancer or the effects of hormones on the endometrium. Endometrial biopsy also helps determine the cause of abnormal menstrual periods, and can be used to screen for endometrial cancer. Endometrial biopsy is sometimes used as part of the diagnostic work-up of women who have been unable to become pregnant.

The endometrial biopsy instruments may feel cold. You may feel some cramping when the cervix is grasped. You may have some mild cramping as the instruments enter the uterus and the sample is collected.

Other related procedures used to evaluate and treat endometrial problems include dilation and curettage (D & C), hysteroscopy, and endometrial ablation.

Endometrial biopsy indications

An endometrial biopsy may be recommended for women with abnormal menstrual bleeding, bleeding after menopause, or absence of uterine bleeding. Biopsy results may indicate cell changes related to hormone levels, or the presence of abnormal tissues, such as fibroids or polyps, which can lead to abnormal bleeding. Endometrial biopsy may also be used to check for uterine infections, such as endometritis.

An endometrial biopsy may also be used to check the effects of hormone therapy or to detect the presence of abnormal cells or cancer. Endometrial cancer is the most common cancer of the female reproductive organs. Endometrial biopsy is no longer recommended as a routine part of the evaluation and treatment of infertility (inability to conceive).

There may be other reasons for your health care provider to recommend an endometrial biopsy.

Endometrial biopsy is done to find the cause of:

• Abnormal menstrual periods (heavy, prolonged, or irregular bleeding)
• Bleeding after menopause
• Bleeding from taking hormone therapy medicines
• Thickened uterine lining seen on ultrasound
• Endometrial cancer
• Infertility for women who have been unable to become pregnant
• Other conditions under which the endometrial biopsy may be performed:
  • Abnormal bleeding if a woman is taking the breast cancer medicine tamoxifen
  • Abnormal bleeding due to changes in hormone levels (anovulatory bleeding)

How to prepare for the endometrial biopsy

Before the endometrial biopsy:

• Tell your doctor about all the medicines you take. These include blood thinners such as warfarin, clopidogrel, and aspirin.
• You may be asked to have a test to make sure you are not pregnant.
• In the 2 days before the procedure, do not use creams or other medicines in the vagina.
• Do NOT douche. (You should never douche. Douching can cause infection of the vagina or uterus.)
• Ask your provider if you should take pain medicine, such as ibuprofen or acetaminophen, just before the procedure.
• Generally, no prior preparation, such as fasting or sedation, is required. However, your health care provider may recommend that you take a pain reliever 30 minutes before the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
• Notify your health care provider if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
• Notify your health care provider of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
• Notify your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• Your health care provider may request that you keep a record of your menstrual cycles. You may need to schedule the procedure for a specific time of your cycle.
• If a sedative is given before the procedure, you will need someone to drive you home afterwards.
• You may want to bring a sanitary napkin to wear home after the procedure.
• Based on your medical condition, your doctor may request other specific preparation.

Endometrial biopsy procedure

Endometrial biopsy procedure may be done with or without anesthesia in a doctor’s office, on an outpatient basis, or as part of your stay in a hospital. The anesthetic medicine that allows you to sleep during the procedure.

Generally, an endometrial biopsy follows this steps:

1. You will be asked to undress completely or from the waist down and put on a hospital gown.
2. You will be instructed to empty your bladder prior to the procedure.
3. You will lie on an examination table, with your feet and legs supported in stirrups, similar to having a pelvic examination.
4. Your health care provider gently inserts an instrument (speculum) into the vagina to hold it open so that your cervix can be viewed. The cervix is cleansed with an antiseptic solution.
5. Your health care provider may numb the cervix using a small needle to inject medication, or a numbing spray may be applied to your cervix.
6. The cervix may then be gently grasped with a type of forceps called a tenaculum to hold the uterus steady. You may feel some cramping when the tenaculum is applied.
7. A thin, rod-like instrument, called a uterine sound, may be inserted through the cervical opening to determine the length of the uterus and location for biopsy. This may cause some cramping. The sound will then be removed.
8. A thin tube, called a catheter, will be inserted through the cervical opening into the uterus. The catheter has a smaller tube (internal piston) inside it. The health care provider will withdraw the inner tube creating suction at the end of the catheter. The health care provider will then gently rotate and move the tip of the catheter in and out to collect small pieces of endometrial tissue. This may cause some cramping.
9. The amount and location of tissue removed depends on the reason for the endometrial biopsy.
10. The catheter and speculum will be removed and the tissue will be placed in a preservative.
11. The endometrial tissue will be sent to a lab for examination. There, it is examined under a microscope.
12. If you had anesthesia for the procedure, you are taken to a recovery area. Nurses will make sure you are comfortable. After you wake up and have no problems from the anesthesia and procedure, you are allowed to go home.

Endometrial biopsy recovery

After the endometrial biopsy procedure, you may rest for a few minutes before going home. If you received any type of sedative, you will need someone to drive you home.

You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping and spotting or vaginal bleeding for a few days after the procedure. Take a pain reliever for soreness as recommended by your health care provider. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

You may be instructed not to douche, use tampons, or have intercourse for two to three days after an endometrial biopsy, or for a period of time recommended by your health care provider.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

You may resume your normal diet unless your health care provider advises you differently.

Your health care provider will advise you on when to return for further treatment or care.

Notify your health care provider if you have any of the following:

• Excessive bleeding, or bleeding longer than two days after the procedure
• Foul-smelling drainage from your vagina
• Fever and/or chills
• Severe lower abdominal pain

Your health care provider may give you additional or alternate instructions after the endometrial biopsy procedure, depending on your particular situation.

Endometrial biopsy side effects

As with any surgical procedure, side effects may occur. Some possible complications may include, but are not limited to, the following.

Endometrial biopsy side effects include:

• Pelvic infection
• Causing a hole in (perforating) the uterus or tearing the cervix (rarely occurs)
• Prolonged bleeding
• Slight spotting and mild cramping for a few days.

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their health care provider.

If you are pregnant or suspect that you may be pregnant, you should notify your health care provider. Endometrial biopsy during pregnancy may lead to miscarriage.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your health care provider prior to the procedure.

Certain factors or conditions may interfere with an endometrial biopsy. These factors include, but are not limited to, the following:

• Acute vaginal or cervical infections
• Acute pelvic inflammatory disease
• Cervical cancer

Endometrial biopsy results interpretation

Endometrial biopsy is normal if the cells in the sample are not abnormal.

Abnormal endometrial biopsy results

Abnormal menstrual periods may be caused by:

• Uterine fibroids
• Fingerlike growths in the uterus (uterine polyps)
• Infection
• Hormone imbalance
• Endometrial cancer or precancer (hyperplasia)