An endometrial biopsy is a procedure to evaluate potential causes of abnormal uterine bleeding. A doctor will use specialized tools to sample cells in the endometrium, or uterine lining.
An endometrial biopsy is a simple procedure that a person can undergo in a doctor’s office. It is an outpatient procedure with few side effects, and is very useful in diagnosing certain conditions.
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This article will go over what an endometrial biopsy is, as well as what it is used for, what recovery looks like, and more.
An endometrial biopsy is a procedure to take a small tissue sample of the lining of the uterus. A healthcare professional will then examine that sample under a microscope to check for abnormal cells.
This procedure is necessary if a person is experiencing signs of abnormal bleeding. A person may need to undergo an endometrial biopsy if they are experiencing:
- no uterine bleeding for 3 months or more prior to menopause
- excessive or prolonged bleeding during their menstrual cycle
- uterine bleeding after menopause
A gynecologist will also perform an endometrial biopsy to examine the endometrial tissue after a person has undergone hormone therapy treatment for endometrial cancer, or to see if cancerous or pre-cancerous cells are present.
According to The American College of Obstetricians and Gynecologists (ACOG), doctors usually perform an endometrial biopsy to diagnose or rule out conditions that fall under the acronym PALM-COEIN, which stands for:
- Polyp: An endometrial polyp is a small, benign growth in the lining of the uterus.
- Adenomyosis: This is a condition in which the inner lining of the uterus grows into the muscular wall of the uterus, the myometrium.
- Leiomyoma, or uterine fibroids: Uterine fibroids are benign tumors, or growths of the muscular wall of the uterus.
- Malignancy and hyperplasia: The most common reason a healthcare professional will perform an endometrial biopsy is to test for endometrial cancer. They will also look for hyperplasia. This refers to the thickening and precancerous changes of the uterus lining, which can lead to cancer in some cases.
- Coagulopathy: This is a medical condition in which the body’s ability to form clots is abnormal.
- Ovulatory dysfunction: This is a medical term that describes a group of conditions where there is a disruption in the process of ovulation.
- Endometrial: This refers to conditions that can affect the endometrium, which is the inner lining of the uterus. One example is endometriosis.
- Iatrogenic: This means that it occurs due to medical intervention, such as medication or surgery.
The N stands for “not otherwise classified.”
Abnormal uterine bleeding is the most common indication for endometrial biopsy. Examples of abnormal uterine bleeding in non-pregnant people, according to ACOG, include:
- an episode of severe, heavy bleeding that requires immediate evaluation
- episodes of heavy bleeding that occur over the course of 6 months, such as heavy or prolonged periods
- uterine bleeding in post-menopausal people
A doctor may also recommend the procedure to evaluate the status of medical treatments, such as hormones or cancer treatments, to see if cancerous cells are present.
An endometrial biopsy is usually an in-office procedure. Before beginning, a doctor should discuss the potential risks and benefits of the procedure.
Is it safe?
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Doctors perform an endometrial biopsy using sterile equipment, which helps to keep a patient safe and minimize the chance of experiencing complications.
If a person is concerned, they can talk with a healthcare professional about any potential side effects and complications.
How to prepare
A person does not usually have to make special preparations, such as refraining from eating or drinking, before the procedure. However, a doctor may ask a person to take a pregnancy test to ensure that they are not pregnant.
A healthcare professional will also suggest that a person empties their bladder.
During the procedure
The procedure for an endometrial biopsy is as follows:
- A person will lie down on the exam table, with their feet and legs supported.
- A doctor will then perform a physical exam to understand the person’s pelvic anatomy. They will also assess the orientation of the uterus to find out its size, whether masses are present, or if pain occurs.
- The doctor will then place a speculum into the vagina to make it easier to see the cervix.
- Using an antiseptic solution, they will clean the cervix.
- They will then use a numbing spray or inject a numbing solution into the area. This step is optional and not always performed.
- The doctor will use an instrument to hold the cervix steady. This may cause some cramping.
- They will then insert a uterine sound, which is a rod-like instrument, into the cervical opening. This is to find the location for the biopsy. A person can expect to feel some cramping. After this, they will remove the uterine sound.
- The doctor will insert a catheter through the cervical opening and into the uterus. Inside the catheter is a small tube. The doctor will withdraw the inner tube, creating a light suction.
- They will then withdraw the catheter and place the contents into a specimen cup.
- The doctor will carefully remove the instrument that held the cervix steady, and ensure that there is no bleeding from where the cervix was stabilized.
- They will remove the speculum.
After the procedure, a person should rest for a few minutes before heading home.
A person may want to wear a sanitary pad, as bleeding may occur. This is normal, and should subside after a few days.
A person can also take painkillers. However, aspirin may increase the chance of bleeding.
After an endometrial biopsy, a person should avoid:
- having sex for 2–3 days
- using tampons
- strenuous or heavy lifting
There are some rarer side effects that indicate the need to seek immediate medical attention after an endometrial biopsy. These include:
- cramping that lasts more than 2 days
- foul-smelling discharge
- heavy bleeding
- pain that gets worse instead of better
These symptoms can indicate a severe or unexpected side effect after an endometrial biopsy, such as uterine perforation or pelvic infection.
A doctor will send the endometrial tissue samples to a laboratory for further testing.
They may also take a blood sample to test for bleeding disorders. According to ACOG, an estimated 20% of people with abnormal uterine bleeding have an underlying medical condition that causes bleeding.
If the endometrial biopsy does reveal pre-cancerous or cancerous cells, a doctor will discuss next steps with the person. These steps vary widely based on the cancer type and how advanced it is.
The American Cancer Society offers a guide to help those who have received an endometrial cancer diagnosis.
A doctor may also recommend local support groups or a cancer nurse navigator, a nurse specially trained in connecting patients with needed resources and support for cancer care.
Just as there are people who could benefit from endometrial biopsy, there are patient populations who should not undergo endometrial biopsy.
- have acute pelvic inflammatory disease
- have an acute infection, such as cervical or vaginal infection
- have cervical cancer as the procedure could cause significant bleeding
If a person has a bleeding disorder, such as hemophilia or von Willebrand disease, they should discuss with a doctor about whether an endometrial biopsy is safe.
An endometrial biopsy is an important diagnostic procedure that helps a doctor diagnose potential causes of abnormal uterine bleeding.
This outpatient procedure requires minimal preparation, and the most common side effect is cramping. After the procedure, a person may want to wear a sanitary pad as bleeding may occur.