Endometrial Biopsy

(Biopsy-Endometrium)

Procedure Overview

What is an endometrial biopsy?

An endometrial biopsy is a procedure performed to obtain a small tissue sample from the lining of the uterus, called the endometrium. After the biopsy, the endometrial tissue is examined under a microscope to identify the presence of abnormal cells, or the effects of hormones on the endometrium.

Other related procedures used to evaluate and treat endometrial problems include dilation and curettage (D & C), hysteroscopy, and endometrial ablation. Please see these procedures for additional information.

The menstrual cycle:

With each menstrual cycle, the endometrium prepares itself to nourish a fetus, as increased levels of estrogen and progesterone help to thicken its walls. If fertilization does not occur, the endometrium, coupled with blood and mucus from the vagina and cervix (the lower, narrow part of the uterus located between the bladder and the rectum) make up the menstrual flow (also called menses) that leaves the body through the vagina. After menopause, menstruation stops and a woman should not have any bleeding.

What are female pelvic organs?

The organs and structures of the female pelvis are:

• endometrium - the lining of the uterus
• uterus - also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds it’s lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
• ovaries - two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced
• cervix - the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body
• vagina - the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia).
• vulva - the external portion of the female genital organs

Reasons for the Procedure

An endometrial biopsy may be performed for several reasons. In the evaluation and treatment of infertility (the inability to conceive), a biopsy of endometrial cells several days before menstruation can show the endometrial response to the hormones estrogen and progesterone and can determine if ovulation has occurred.

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.

An endometrial biopsy may also be used to check the effects of hormone replacement therapy or to detect the presence of abnormal cells or cancer. Endometrial cancer is the most common cancer of the female reproductive organs.

There may be other reasons for your physician to recommend an endometrial biopsy.

Risks of the Procedure

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

• bleeding
• pelvic infection
• puncture of the uterine wall with the biopsy device - rare

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

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

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician 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

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Generally, no prior preparation, such as fasting or sedation, is required. However, your physician 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 physician.
• Notify your physician if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
• Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
• Notify your physician 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 physician 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 upon your medical condition, your physician may request other specific preparation.

During the Procedure

An endometrial biopsy may be performed in a physician’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Generally, an endometrial biopsy follows this process:

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 as for a pelvic examination.
4. Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
5. Your cervix will be cleansed with an antiseptic solution.
6. The physician may numb the area using a small needle to inject medication, or a numbing spray may be applied to your cervix.
7. A type of forceps, called a tenaculum, may be used to hold the cervix steady for the biopsy. You may feel some cramping when the tenaculum is applied.
8. 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.
9. 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 physician will withdraw the inner tube creating suction at the end of the catheter. The physician 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.
10. The amount and location of tissue removed depends on the reason for the endometrial biopsy.
11. The catheter and speculum will be removed and the tissue will be placed in a preservative.
12. The endometrial tissue will be sent to a lab for examination.

After the Procedure

After the 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 physician. 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 physician.

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

You may resume your normal diet unless your physician advises you differently.

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

Notify your physician 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 physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

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