Endometrial Biopsy - What to Expect

An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find any problems in the endometrium. It also lets your doctor check to see if your body's hormone levels that affect the endometrium are in balance, or to check for cancer.

The lining of the uterus changes throughout a woman's menstrual cycle. Early in the menstrual cycle, the lining grows thicker until a mature egg is released from an ovary (ovulation). If the egg is not fertilized by a sperm, the lining is shed during normal menstrual bleeding.

There are several ways to do an endometrial biopsy. Your doctor may use:

• A soft, straw-like device (pipelle) to suction a small sample of lining from the uterus. This method is fast and is not very painful.
• A sharp-edged tool called a curette. Your doctor will scrape a small sample and collect it with a syringe or suction. This is called a dilation and curettage (D&C). A D&C may be done to control heavy uterine bleeding (hemorrhage) or to help find the cause of bleeding. This is done with general or regional anesthesia.
• An electronic suction device (Vabra aspiration). This method can be uncomfortable.
• A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus. A brush may be used to remove some of the lining before the washing is done.

When a woman is having a hard time becoming pregnant, an endometrial biopsy may be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer. An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your doctor to look through a small lighted tube at the lining of the uterus.

Why It Is Done

An endometrial biopsy is done to:

•  Check for cancer. For example, an endometrial biopsy may be done to help determine the cause of some abnormal Pap test results.
•  Find the cause of heavy, prolonged, or irregular uterine bleeding. It is often done to find the cause of uterine bleeding in women who have gone through menopause.
• See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

How to Prepare

Tell your doctor if you:

• Are or might be pregnant. An endometrial biopsy is not done during pregnancy.
• Are taking any medicines.
• Are allergic to any medicines.
• Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).
• Have been treated for a vaginal, cervical, or pelvic infection.
• Have any heart or lung problems.

Do not douche, use tampons, or use vaginal medicines for 24 hours before the biopsy. You will empty your bladder just before your biopsy.

You may want to take a pain reliever, such as ibuprofen (Advil or Motrin), 30 to 60 minutes before having the biopsy. This can help decrease any cramping pain that can be caused by the biopsy.

You will need to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form.

If you are having a dilation and curettage (D&C) and will go to sleep (general anesthesia) for the test, do not eat or drink anything for 8 hours before the test. If you are taking any medicines, ask your doctor what medicines you can take the day of the test.

How It Is Done

Endometrial biopsy

An endometrial biopsy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. The sample will be looked at by a pathologist. The biopsy can be done in your doctor's office.

• Your cervix may be numbed with a spray or injection of local anesthetic.
• You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).
• Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum. The cervix is washed with a special solution and may be grasped and held in place with a clamp called a tenaculum.
• The tool to collect the sample is guided through the cervix into the uterus. The tool may be moved up and down to collect the sample. Most women have some cramping during the biopsy.
• An endometrial biopsy takes 5 to 15 minutes.

Dilation and curettage (D&C)

A D&C is usually done in a hospital or clinic. Most women do not need to stay overnight but can go home the same day.

• Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. Your cervix will be gently spread open (dilated). Depending on the reason for the D&C, your doctor may use a tool called a hysteroscope to look inside the uterus. A small spoon-shaped instrument (curette) is then guided through the cervix and into the uterus. The top layer of the lining of the uterus is carefully scraped off and removed (along with any other tissue that looks abnormal) for biopsy.
•  If you have general anesthesia, you will be watched by a nurse in the recovery room until you are fully awake.
• You can do most of your normal activities in a few days. Do not lift anything heavy for a few days after the test. Do not douche or have sex for one week after the test.

How It Feels

Endometrial biopsy

If you have not had any pain medicine, you may feel a sharp cramp as the tool is guided through your cervix. You may feel more cramping when the biopsy sample is collected. Most women find that the cramping feels like a really bad menstrual cramp. Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy. An endometrial biopsy usually causes some vaginal bleeding. You can use a pad for the bleeding or spotting.

Dilation and curettage (D&C)

If general anesthesia is used during a D&C, you will be asleep and feel nothing. After the test, you will feel sleepy for a few hours. You may be tired for a few days after the test. You may also have a mild sore throat if a tube (endotracheal tube, or ET) was placed in your throat to help you breathe during the test. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.

Risks

There is a small chance that the cervix or uterus could be punctured during the biopsy. Bleeding or a pelvic infection is also possible.

After the test

You may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy. Do not douche. You may have to avoid sex or using tampons for several days. Ask your doctor when you can have sex or use tampons again.

Follow any instructions your doctor gave you. Call your doctor if you have:

Heavy vaginal bleeding (more than a normal menstrual period), a fever, belly pain, and/or bad-smelling vaginal discharge.

Results

• An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). Lab results from a biopsy may take several days to get back.
• Normal: No abnormal cells or cancer is found. For women who have menstrual cycles, the lining of the uterus is at the right stage for the time in the menstrual cycle when the biopsy was done.
• Abnormal: A noncancerous (benign) growth, called a polyp, is present.
• Overgrowth of the lining of the uterus (endometrial hyperplasia) is present.
• Cell changes that may lead to cancer are present.
• For women who have menstrual cycles, the lining of the uterus is not at the right stage for the time in the menstrual cycle when the biopsy was done. More tests may be needed.

What Affects the Test

Reasons you may not be able to have the endometrial biopsy or why the results may not be helpful include:

• If a vaginal or cervical infection is present. The infection could spread to the uterus if an endometrial biopsy is done.
• If the endometrial biopsy sample is not large enough to see abnormal cells. Another test may be needed.

What To Think About

• An endometrial biopsy is not done during pregnancy.
• More of the uterine lining can be sampled during a dilation and curettage (D&C) than during an endometrial biopsy. Another test, called a hysteroscopy, is usually done with a D&C so that your doctor can see the lining of your uterus. A hysteroscopy may also be done instead of a D&C. For more information, see the medical test Hysteroscopy.
• An endometrial biopsy is not usually done during or after menopause unless a woman has abnormal vaginal bleeding. Some doctors may do a biopsy before prescribing hormone replacement therapy (HRT).