What Happens During an Endometrial Biopsy?
The endometrium is the lining of the uterus. An endometrial biopsy is a procedure in which a doctor removes a small tissue sample of the endometrium for examination under a microscope. The endometrial tissue from the lining of the uterus is checked for the presence of abnormal cells, such as cancer cells, to diagnose endometrial cancer. Endometrial biopsies can also provide clues about the cause of certain symptoms, such as abnormal uterine bleeding. Please continue reading to learn more about what happens during an endometrial biopsy procedure.
Why do doctors order an endometrial biopsy?
A family medicine physician, gynecologist, or gynecologic oncologist might order endometrial sampling for a variety of reasons, such as:
- Menstrual irregularities, such as prolonged or heavy periods, abnormal menstrual periods, irregular bleeding, or lack of menstrual periods
- Postmenopausal bleeding
- Pap test results showing abnormal cells
- Thickened uterine lining (endometrial hyperplasia) or other abnormalities seen on transvaginal ultrasonography
- Abnormal bleeding while taking hormone therapy medicines (for example, the breast cancer medicine tamoxifen)
- To remove uterine polyps and examine them for signs of cancer
- To make a diagnosis of endometrial carcinoma or uterine cancer
- To find out if abnormalities in the lining of the uterus (endometrium) are contributing to infertility
How to prepare for an endometrial biopsy?
There is no special preparation required before an endometrial biopsy. You should give your healthcare provider a complete list of all the medicines you are taking. Some medications, for example, blood thinners, can increase the risk of bleeding during medical procedures. Your provider will tell you if you need to stop any of your medications before the procedure. They may also give you a medicine called misoprostol (Cytotec) to take the night before your procedure. This medicine helps to soften the cervix and makes endometrial sampling easier.
What tests are done before an endometrial biopsy?
Your provider may perform a bimanual examination (pelvic exam) before an endometrial biopsy. This involves placing an instrument called a tenaculum to keep the cervix steady and uterus steady. It is followed by the insertion of two fingers in sterile gloves into the vaginal cavity while the doctor palpates the lower abdomen from the outside. An instrument called a uterine sound may be used to assess uterine size. They may also do a Pap smear at this time.
These pre-procedure exams help doctors evaluate the size and position of the uterus, which can influence the angle of catheter tip insertion through the internal cervical os (cervical opening), the ability to get adequate tissue during an endometrial biopsy procedure, and the diagnostic accuracy of the procedure.
What to expect during an endometrial biopsy?
An endometrial biopsy procedure is done in a doctor’s office and takes less than 15 minutes to complete. You lie on your back with your feet in stirrups, similar to a pelvic exam. The procedure involves inserting an endometrial suction catheter through the cervical canal into the uterine cavity to remove a small piece of tissue from the uterine wall.
How painful is an endometrial biopsy?
It is common to have mild cramping and discomfort during an endometrial biopsy, similar to menstrual cramps. This can be significantly reduced by taking a nonsteroidal anti-inflammatory drug such as ibuprofen or naproxen before the procedure. Some people find the procedure to be slightly more painful. Again, an over-the-counter pain medicine can help keep you comfortable. In some cases, doctors use topical anesthesia (numbing medicine) to make the procedure less painful.
How long does it take to recover from an endometrial biopsy?
You can go home the same day of the procedure after resting in the doctor’s office for a short period. If you receive a sedative, you will need someone to drive you home.
Some mild cramping and slight spotting are common after an endometrial biopsy. It’s a good idea to wear a sanitary pad for a few days in case there is any vaginal bleeding.
You can take a pain reliever recommended by your healthcare provider for any discomfort. Keep in mind that aspirin and certain other pain relievers can increase the risk of bleeding.
Your provider will ask you to avoid douching, using tampons, or having sexual intercourse for 2-3 days after your endometrial biopsy. They will also ask you to avoid strenuous physical activity and heavy lifting for a few days. You can expect to be back to all normal activities in about a week. Unless your provider tells you otherwise, you can eat a normal diet after an endometrial biopsy.
What are the risks of an endometrial biopsy?
A serious complication from an endometrial biopsy rarely occurs but can include pelvic infection, uterine perforation, and a bacterial infection of the blood (bacteremia).
You should call your doctor right away if you develop the following symptoms after an endometrial biopsy:
- Fever and chills
- Increasing lower abdominal pain
- Severe cramping lasting more than 2 days
- Foul-smelling vaginal discharge
- Vaginal bleeding that lasts for more than 2 days or is heavier than your usual menstrual period
Who should not have an endometrial biopsy?
Pregnant women should not have an endometrial biopsy. This procedure is also contraindicated in patients with untreated cervical, vaginal, or uterine infections and patients with certain bleeding disorders.
Is an endometrial biopsy a big deal?
Endometrial biopsies are common office procedures that are generally low-risk and safe. An endometrial biopsy can provide a lot of useful information to your healthcare providers from the presence or absence of abnormal tissues in the sample. It can help in the timely diagnosis of serious medical conditions of the female reproductive organs, including malignant diseases, and ensure you get the timely and appropriate treatment to maximize your chances of a good outcome. Endometrial biopsies are particularly useful in diagnosing abnormal uterine bleeding in postmenopausal women.
As with all invasive procedures, an endometrial biopsy does carry some risks. However, if you don’t have any risk factors and follow your doctor’s instructions, an endometrial biopsy should not cause any problems.
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