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You have some kind of gynecologic problem and the doctor suggested an endometrial biopsy. What now?


endometrial-biopsy-procedure.jpgWhen you undergo an endometrial biopsy, your gynecologist removes a small sample of the lining of the uterus. Then, the sample is examined for abnormal cells under a microscope. Endometrial biopsy is a safe and accepted method which helps your doctor to determine if the endometrium is going through its normal stages of change during the menstrual cycle and to determine if cancerous conditions are present.[1]

Endometrial Biopsy: An Overview

The endometrium is the lining of the uterus and it changes throughout a woman's menstrual cycle.

There are different methods of conducting an endometrial biopsy. One of the most common techniques is endometrial biopsy with a pliable instrument. The doctor uses a pliable instrument to suction a small amount of endometrial tissue from the uterus. This method of endometrial biopsy is faster and causes less discomfort than the other methods.

The endometrial biopsy can also be done with an instrument called a curette, with a manual suction device attached. In this method, a small sample of the lining of the uterus is removed by scraping and collecting it into a syringe or another container.

The third method is rather uncomfortable. Your doctor removes a tissue sample from the uterine lining with an electric suction device. This method is called vabra aspiration.

Endometrial washing uses a spray of liquid to wash off some of the tissue that lines the uterus. Sometimes this procedure is performed when a woman is having difficulty becoming pregnant. An endometrial biopsy may be done to determine whether the endometrium is being properly prepared by estrogen and progesterone to support a pregnancy.

When women experience uterine bleeding, an endometrial biopsy may also be done to determine the cause of abnormal uterine bleeding, to check for excessive growth of the endometrium, or to check for possible endometrial cancer.

Reasons for an Endometrial Biopsy Procedure

The most common reason for endometrial biopsy is to detect cancerous conditions. Other reasons may be:

  • Determining the cause of abnormally heavy, prolonged, or irregular uterine bleeding, often in women who have gone through menopause
  • To determine whether the endometrium is going through the normal menstrual cycle changes.

Indications for endometrial biopsy include: 

  • Abnormal uterine bleeding 
  • Postmenopausal bleeding
  • Cancer screening 
  • Detection of precancerous hyperplasia and atypia
  • Endometrial dating 
  • Follow-up of previously diagnosed endometrial hyperplasia
  • Evaluation of uterine response to hormone therapy
  • Evaluation of a patient with one year of amenorrhea
  • Evaluation of infertility and an abnormal Papanicolaou smear (PAP smear) with atypical cells favoring endometrial origin [2]

Contraindications for an Endometrial Biopsy Procedure 

Contraindications for endometrial biopsy include: 

  • Pregnancy 
  • Acute pelvic inflammatory disease
  • Clotting disorders (coagulopathy) 
  • Acute cervical or vaginal infections
  • Cervical cancer 
  • Conditions possibly prohibiting endometrial biopsy
  • Severe cervical stenosis and severe pelvic relaxation with uterine descensus [2]

Certain conditions may interfere with an endometrial biopsy. These conditions include, but are not limited to acute vaginal or cervical infections, acute pelvic inflammatory disease, and cervical cancer.

How Is the Test Performed?

Endometrial biopsy is an office procedure. The endometrial biopsy is obtained through the use of an endometrial suction catheter that is inserted through the cervix into the uterine cavity.

Before the endometrial biopsy, tell your doctor if you are or might be pregnant. You should know that endometrial biopsy can’t be done during pregnancy. Endometrial biopsy during pregnancy may lead to miscarriage. It is important to tell your doctor if you have or you recently had a vaginal, cervical, or pelvic infection.

You shouldn’t use tampons, vaginal medications, or vaginal sprays or powders for at least 24 hours before having this test. Notify your doctor if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents.

You may want to take a pain reliever containing ibuprofen 30 to 60 minutes before having the biopsy. The pain reliever can help decrease the severity of cramping pain that the procedure causes.

Before the procedure, you will need to sign a consent form that says you understand the risks of endometrial biopsy and agree to have the test done. Before you sign, read the form carefully and ask questions if something is not clear.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, or the way it will be done.

You will be asked to undress from the waist down. You should empty your bladder before the procedure.  

During the procedure, the cervix may be numbed by using an anesthetic spray or an injection of local anesthetic. Your doctor will tell you to lie on your back on an examination table with your feet raised and supported by stirrups. In this position, the doctor will examine your vagina and cervix. The doctor will insert a speculum into your vagina to spread the walls of the vagina apart to expose the cervix. Then the cervix is grasped and held in place with a clamp called a tenaculum. Your cervix will be cleansed with an antiseptic solution. The doctor may numb the area using a small needle to inject medication, or a numbing spray may be applied to your cervix.

The doctor will take a sample with the instrument. During sample collection, you will likely feel uterine cramping or lower pelvic pain. After the sample is collected, the instrument and the clamp and speculum are removed from the vagina.

After this procedure, you will probably feel a sharp cramp as the instrument or device is guided through your cervix. Also, you may feel more cramping when the biopsy sample is collected. This pain can be decreased by taking ibuprofen before the procedure.

Because an endometrial biopsy usually causes some vaginal bleeding, you will need to use a menstrual pad. If you have prolonged bleeding that is heavier than your normal menstrual period, you should report it to your doctor. 

You should avoid heavy lifting for a few days after the procedure to prevent excessive bleeding. 

You shouldn’t have intercourse for 3 to 7 days after this test. You may be asked to take your temperature daily for 3 days after the test. You should call your doctor if you develop a fever.

Complications

There is a possibility of causing damage to the cervix during an endometrial biopsy, but this is rare. Other complications include excessive bleeding during or after the procedure. In some cases, you can develop a pelvic infection. [2]

Results

You will usually have results from an endometrial biopsy within a few days. Sometimes it takes more than a week. The results can be normal (no abnormal or cancerous cells or tissue are found), abnormal (polyps, endometrial hyperplasia, cancerous changes).

Endometrial biopsy can be painful for older women. Contraindications to endometrial biopsy include pregnancy, acute pelvic inflammatory disease, and acute cervical or vaginal infections.

This procedure is not routinely done during or after menopause unless a woman has vaginal bleeding. If an endometrial biopsy is recommended, you should ask your doctor what the reasons are. You should discuss any concerns with your doctor before the procedure.